I have a friend whose run into serious problems in the past six months,
both
physical and psychiatric, he just got out of the psych ward. To my
great annoyance
he was never tested for hyperthyroid during his stay despite my
request, however
his personal physician should be doing this test soon. What I'm looking
for are
other ideas, what if the thyroid tests come back normal, what else
could cause this?

History:
Was on opiates (percocet 10mg) for pain for several months, followed
by surgery.
The recovery from the surgery went smoothly, and opiate withdrawal
seemed to go
relatively smoothly, going off methadone in about a week. Immediately
following
surgery he seemed pretty cheerful and regained his strength quickly.

Gradually the following have taken hold.

 Insomnia, gradually become quite severe, he now only sleeps 1-2 hours
a night,
 this severe sleep loss has been going on for atleast 3 months.
Sleeping medication
 at most has helped for a night or two, eventually having virtually no
effect, or tending
 to lead to confusion.

 Reports burning eyes (from insomnia?).

 Depression and anxiety, both in an extreme and almost psychotic form.
For example
 a social worker will tell him one thing, and he will tell me
something almost completely
 different, and much more hopeless. A general distortion of reality in
this form. Depression
 always warps your world view some, but this is on a whole different
scale than anything I've
 seen before.  He has always had some emotional problems, but
generally of the short
  acute variety, nothing like this.

 This eventually lead to a very serious suicide attempt. An entire
bottle of sleeping pills,
 he didn't even pass out by his account, then followed that with
percocet (60 pills, 600mg
 oxycodone). He was making phone calls only hours after the OD,
luckily I happened to
 talk to him on the phone and noticed something was wrong, got him an
ambulance barely in
 time to save his liver from the tylenol poisoning.

 He has gradually grown physically weaker over the past few months,
recently much more so
 but some of this may be due to the liver damage. However the slide
into weakness began
 well before the suicide attempt, losing the ability to do physical
activities he had done easily
 not long after the surgery. He now gets dizzy from even leaving bed.

 He had originally tended to eat like a horse, could polish off truly
amazing amounts of food
 for a man in his early 50s, and yet remained reasonably thin. Along
with this he always got
 hot very easily. He always seemed very healthy, recovering from
surgery at an amazing
 rate.

 More recently eventhough he has largely stopped eating and is rapidly
losing weight, he is
 still hot to the touch, running a low grade fever. Yet rather than
chilled feels very hot under
 the covers. Some of this may be due to the poisoning, but again I'm
told that even before
 that that eventhough he wasn't eating much at all that he was always
hot, not using sheets
 or blankets when his lover (a large man) was cold enough to be under
blankets.

 He reports that his heart rate is over 120bpm.

 I asked him about any random symptoms he could think of. He reported
a bruised knee
 bruised without having had injury happen. He reports having one
nipple become very
 painful and tender.

 These symptoms seem unchanged even when the psychiatric issues are
reduced. He
 can be calm and rational, yet the physical symptoms are still there.
I don't believe they
 are simply psychosomatic.

The thyroid is going to be checked ASAP, even if I have to sit there
and yell at his doctor
until it happens.  However I need to know what to look at next, does
anyone have any other
ideas? Is there anything else I should be asking him? Are there any
doctors in the bay area who
take medi-cal and are good at resolving mysteries?

My other thought is some sort of long term opiate withdrawal effect?
Its been about 6 months
off of opiates, but things seem to be getting worse instead of better.