Posted by katekite on August 14, 2002, at 13:35:28
In reply to Re: Symptoms » medlib, posted by Squiggles on August 14, 2002, at 7:52:25
Hi Squiggles,
This is long so is separated into part I and II.
Part I, increased urination.
You are right: if you have had a recent urinalysis that showed no protein or glucose and showed your urine was normally concentrated you most likely do not have either kidney problems or diabetes of any sort.
However, you still pee too much.
This can be caused by problems at the level of the kidney, whole body metabolic problems, or a hormonal problem.
The workup of your excessive urine would be a urinalysis, and a blood chemistry panel. The important values on the urinalysis are protein (not normally present but present in the dreaded nephropathy, and sometimes in infections), glucose (present in bad diabetes mellitus) and how concentrated it is (if well concentrated all forms of diabetes insipidus are unlikely). The important values on the blood chemistry are glucose (which would be elevated in diabetes mellitus), electrolytes like calcium and sodium (which would be off in a metabolic problem) and creatinine (increased value means poor kidney function.)
If a blood chemistry panel and urinalysis are normal then you are looking at one of two things: either a hormonal problem or a side effect of lithium (or that you were just drinking too much).
Most hormonal disorders (Cushing's, probably hyperthyroid though I hadn't heard of that before, DI, DM) can cause increased urination.
Lithium can cause increased urination by itself as a weird known side effect. In order to show it was the lithium causing the extra urination you would reduce it and see if the urine volume went down: I don't know how long it takes to get out of your system or even if that's a wise thing to just do on your own. I remember you tried reducing lithium in the past to see if the neuropathy was due to it: do you recall if you peed less?
So -- in summary for the increased urination -- a regular doctor could rule out many problems by doing a urinalysis and a blood chemistry panel. If they do not find the cause you should be referred to an endocrinologist. If you can, try to discover if it is the lithium or not. Do not ignore this problem as it could be an indication of something serious, though I hope it is nothing.
Part II. Bubbles, TSH, candida.
You mentioned your urine has bubbles in it. If it is foamy that can be an indication that there is protein in the urine, which should not be there. Bubbles occur too in some urinary tract infections but you would probably have other symptoms of a urinary tract infection like urgency or burning.
I saw a note somewhere on the net from someone taking lithium and tegretol who was asking about bubbles in urine, so maybe it is a drug side effect. If the bubbles are new and haven't been there the whole time you've been taking lithium I would ask a doctor. A urinalysis would be able to show if there was protein or a urinary infection.
Your TSH went up over the last year. Which means, I think (but do not know for sure) that your thyroid gland is becoming less sensitive or less active, that your thyroid problem worsened.
Not getting a call about results does not mean anything. Always call. I have had several personal experiences where no one called even though my results were abnormal.
I read a little thing on the web about research showing benzodiazepines (they were talking only about valium though) interact with the proteins that carry thyroid hormone around in the blood. To me this says that restarting klonopin could possibly affect your thyroid level and you might need to tweak your thyroid dose. It might affect the amount of free thyroid hormone. Sometimes it is not enough to test TSH: the actual T3 and T4 levels might be useful to test as well. How you feel is of course a good indication of your thyroid level as well and you are probably pretty good at knowing if it is too high.
Not everyone can stay on lithium very long term. It sounds like it has worked for you and of course it is not great to change what has worked. On the other hand it may continue to make your thyroid problem worse and can have other long term effects so it might be good to have a back up drug in mind.
I don't know much of anything about systemic candidiasis. I have had the more common oral candidiasis infection recently with having high cortisol (I have reduced immune function) and took the drug Nystatin, which cleared it up in a few days. With oral candidiasis, when you wipe off the white part there should be a red raw area underneath. I would guess if it isn't raw at all underneath it is not candidiasis.
My feeling is you should ask to be referred to an endocrinologist and go to them and tell them you are urinating too much and just let them work it up. The regular blood chemistry and urinalysis will probably be normal if you are not feeling on death's door. You seem worried about your health so I wouldn't just ignore the increased urination.
Hope this has been helpful. Please do not consider anything I say as substitute for asking a doctor. Even though I sound knowledgeable sometimes I might be just plain wrong.
Kate
poster:katekite
thread:116094
URL: http://www.dr-bob.org/babble/20020814/msgs/116412.html