Suggest treatment for pituitary disorder and depression
Patient: Hello, I am trying to figure out if my husband could have a pituitary disorder. For the last two years he has had consistently low levels of testosterone with normal levels of LH and FSH. A year ago blood work showed he had low total t4 but normal TSH. This week his free t3 and free t4 were as low as they could get withing normal range. His t4 was .8 and that was the lowest in the range. However, his TSH was on the low end of normal. Despite undergoing testosterone replacement therapy for a year his levels never increased. He has developed severe mood problems and was diagnosed Bipolar type 2 a year ago after a hospitalization. He has very severe depression and absolutely no energy. He never has euphoric mania. He only experiences periods of terrible rage consistent with IED, racing thoughts, and the need for activity. Even in his high states he has no energy. Growing up he was overweight but lost 60 pounds. Later he rapidly gained a hundred pounds and lost a patch of hair out of his beard. He has always felt bad about his chest as well and felt that even at his thinnest he too much fat there. He has been rapid cycling and experiencing mixed states. Also, he has not had any break or normal period since suddenly developing his mood problems two years ago. I do not understand why his pituitary sending hormones do not increase when he has low levels of hormones such as thyroid and testosterone. Is it possible he has an endocrine problem worsening bipolar? Or could the bipolar be a misdiagnosis? Doctor: Hi! I'm Dr. Neel Kudchadkar and I will help you with this problem. I would like to politely request you to give me some information about your husband, such as 1) Did he have any thyroid problems BEFORE a bipolar II affective disorder (Hypomania with dysphoria and depression: BPAD Type 2.) Did the bipolar issues surface first and then, a diagnosis of thyroid/ pituatory / HPT was made? 3) Regardless of the hormone levels currently in his blood serum, I would state with confidence that Lithium is the culprit behind the thyroid problem. Lithium Carbonate is the most common drug prescribed for Bipolar II, and causes thyroid problems. I would ask you to stop Lithium if it is being taken and to try another medication called as Lamotrigine at a dose of 100mg at night after food. This drug (Lamotrigine) was designed exactly for the state of mind your husband is in. I would state with confidence that the Bipolar diagnosis is 80% probably right. I'd like to have a conversation with you as regards the details of this case, and being a neutral observer, you could provide me with these details. Kindly provide me with the details, including what current medications your husband is taking, because these are important, for his cure. You might wish to contact me 24x7 at this link http://www.bit.ly/askdrneel Please send an email to customercare@healthcaremagic.com with the subject "ATTENTION: Dr. Neel Kudchadkar" A mutually beneficial dialogue could begin. In confidence,Dr. Neel Kudchadkar (Psychological Medicine)HealthCareMagic