Brief Answer:
Her symptoms are worsening due to psychiatric issues and not due to thyroid

Detailed Answer:
Hello thanks for asking from HCM for your health related queries

I can understand your concern. She is 50 and have thyroid abnormalities and anxiety precipitated by hypothyroidism. More than 50% of individuals suffering from thyroid hormone abnormalities have anxiety and panic attacks as co-morbid symptoms. It is very common finding. She could not tolerate the Sertraline about a year back and also she failed to respond to Effexor and Quetiapine in current psychotic episode.

Her current results are also showing hypothyroidism but in my opinion there is no need to check other hormones because thyroid is not related to these glands. Her hormones levels are not in very deranged range but her anxiety and psychosis symptoms are persisting and these should be treated.

She is not tolerating the anti depressants and is probably having panic like symptoms because of peripheral effects of external thyroid hormone that is synthyroids.

For severe panic and anxiety symptoms she should be given some anti anxiety drug for control of symptoms. Low dose benzodiazepines would help. Clonazepam or Lorazepam on SOS basis can help to control severe panic and she would feel better. She couldn't tolerate Effexor and Sertraline in such situations she should be given some other SSRI in low doses and then doses should be escalated gradually. Fluoxetine or Escitalopram starting with low doses would help and she will tolerate these drugs. For her psychotic symptoms Olanzapine can help. Olanzapine in low doses like in 2.5-5 mg per night would help in sleeping and will improve psychotic symptoms. Even combination of Fluoxetine and Olanzapine are available which is relatively better tolerated and will not cause side effects like worsening headache, first dose anxiety. If some worsening of symptoms occurs then benzodiazepines would do the work.

So her symptoms are getting worsened due to psychiatric issues and not due to endocrine problems. She should be shown to a psychiatrist again. Don't fear from psychiatric medicines, most of individuals show worsening of symptoms due to first dose but that can be minimised by starting with low doses and prescribing benzodiazepines in low doses along with medicines. Please try to follow my advise. Discuss with her psychiatrist for the prescription of these medicines and for re-evaluation.

Thanks, I hope this helps you. If you have more doubts please ask again. Take care

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Brief Answer:
Yes Valium and Xanax both should help.

Detailed Answer:
Hello again and thanks for asking a follow up question

Yes either of Valium or Xanax can help to relieve first dose restlessness and her other symptoms of severe anxiety. Xanax is relatively faster acting. Starting with low doses and the gradual escalation of dose and concomitant use of Benzodiazepines reduce the chances of aggravation. In normal situations Xanax is used in doses of 0.25-0.5 mg of doses preferably in SOS basis. Please consult her psychiatrist and take proper prescription of the drugs.

Thanks, Hope this helps you. Still have more doubts please ask again.

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