High TPO in new very symptomatic patient. Advice for treatment? List for PCP?

[williegates]

Hey there, I'm the husband.  

My wife was fine in July.  Then in August, everything went to hell.  She has a TON of symptoms - from weight to lack of energy to fluid retention.  

We initially thought it was psychological, so we've been treating it like this since Aug with almost no changes.  Horrible time it has been.  After feeling defeated, I just started reading for hours and I wised up at some point that it could be a symptom and not just depression/suicidality.  I thought maybe Estrogen Dominance.  

A test of her Estrogen/Progesterone levels show a ratio of 12.  The low end is 100 and the high end is 500.  Hers was 12.  Top top top end of scale for Estrogen and bottom low end of scale for Prog.

Before waiting two months to see a OBGYN, I researched the ED for hours and hours, frequently seeing ED caused by thyroid dysfunction.  I thought the same thing as with the depression --- what if the ED is ALSO a symptom and not a cause.....

So I chased that one down, nagged the hell out of the doc, and got her to call in a full Thyroid panel for the wife.  Bam.  Got it.  TPOA is supposed to be under 9UI/mL....it's 301.  

So the biggest concern is the insane fatigue and depression she has.  It's killing her.  I worry about her snapping one of these days.  I really do.  She says she will tell me if it gets there, but she's sobbing just getting up out of bed some days after 14 hours in bed, then going down and sitting on the couch and falling asleep sitting up.  It's scary and depressing for me too.  

The reason why I post is we have one of those PCP docs that if you tell him you want something, he will most the time just do it.  And while I would much rather get her in to see a specialist Endo, the three in network are booked solid until JULY !!  So I'm not okay with just letting the wife suffer for five months waiting to see a specialist.  

So MY QUESTION IS----What can we throw at this to start trying to narrow in on a treatment...at least at the level of the PCP so we can get her some relief (because we've tried every antidepressant in the book and none help)?  My research says start with 15-30mg Armour (slowly stepping up) with of course exercise and diet positive changes.  Most of her levels are fine except for TPOA is off the charts, but she is HIGHLY and DEBILITATINGLY symptomatic.

Happy to add info or labs if you need/ask.  Appreciate the help.  

My plan that I've created on my own up to this point lol was just to have PCP (A) give referral to Endo in July, (B) referral for ultrasound of thyroid, (C) start the Armour "exploratory" trial.  (D) Already starting her on Centrum once a day, (E) Just ordered Selenium 200mcg 1xday and (F) just ordered Methyl B12 5000mcg 1xday.  

Anything else?  Does that sound great or terrible lol?  Appreciate your help.

[gimel]

From the symptoms and the high level of TPO antibodies, your wife has Hashimoto's Thyroiditis.  With Hashi's the autoimmune system erroneously identifies the thyroid gland as foreign to the bod and produces antibodies to attack and eventually destroy the gland.     Since symptoms are the most important indicator,, before further discussion please review the following list with your wife and copy and paste the list in your reply, marked with an x on the ones she has.

fatigue                                                                                                
inability ot cope with stress                                                                          
cognitive dysfunction                              
hot flashes
hypotension, lightheadedness                                                                                                
depression
anxiety                                                                                                        
insomnia/frequent awakening
irritability
low blood pressure                                                                                      
body hair loss    
nausea, diarrhea or vomiting  
low blood pressure
unexplained weight loss
salt craving
mental fog/poor concentration  
cold extremities, always feels cold    
aches and pains
hair loss/dry coarse scalp hair
dry skin (use skin creme)
weight gain                                                  
constipation   (have to use laxatives/fiber)                                          
high cholesterol                                        
ankle swelling/facial puffiness                                                                          
hair dry/brittle/loss                                                                                
hoarseness                                            
                                                                          
                                                                                          

[williegates]

THYROGLOBULIN ANTIBODIES    <1     (< or = 1 IU/mL)

THYROID PEROXIDASE ANTIBODIES 301     (<9 IU/mL)

T3, TOTAL 118   (76-181 ng/dL)

T4, FREE 1.2   (0.8-1.8 ng/dL)

T4 (THYROXINE), TOTAL     8.8         (5.1-11.9 mcg/dL)

TSH 2.51

T3, FREE   3.0    (2.3-4.2 pg/mL)