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Hypothyroid with psychotic symptoms along with pneumonia - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Thyroid Problem and Hormonal Problems
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2585 Questions
User :   My mother had her thyroid removed at age 17. She took synthroid for 28 years, then about five years ago (around menopause), decided she no longer believed in taking it. She has been off of any kind of thyroid hormone replacement at all for about 3.5 years now. She adamantly refuses medical help of any kind, but she suffers greatly both mentally and physically. I have done a lot of online research, and she has textbook symptoms of myxedema. Recently, she got what seems to be the flu, but she has had it for nearly three weeks and does not seem to be getting any better. She lives alone and refuses help. I understand there is such a thing as myxedema coma, which can be precipitated by an infection such as pnemonia or influenza. I am wondering how long she is likely to survive with such depleted thyroid hormone levels, and if she might actually not recover from her current illness? My sisters and I are at a loss...Thank you so much for your help!
Doctor :   Hi
Doctor :   let me read
User :   Sure
Doctor :   what type of thyroid surgery was done any idea ?
User :   95% removal, I don't know how it was done.
Doctor :   and what was the dose of thyroxine she was taking ?
User :   125 mg? Something like that? It was steady or 28 years...same amount. Then she quit completely.
Doctor :   ok
Doctor :   what symptoms does she have now ?
User :   Swollen face, puffy eyes with fluid-filled sacs around them, thickened tongue, coarse dry skin, slow speech, hallucinations & delusions (severe), moves very slowly, easily fatigued, sleeps a lot, lesions on arms and neck, sometimes face...
Doctor :   ok
User :   currently has something like the flu, with bad cough
Doctor :   people with the hypothyroidism do have or will develop psychotic symptoms
Doctor :   it is that which has made her to leave the medications
Doctor :   she is a neglected case of hypothyroidism with the active infection ?pneumonia
User :   that's what we believe.
Doctor :   pneumonia with the present hypothyroid status may be fatal
Doctor :   she needs hospitalization
User :   that's what we're afraid you know what kind of time-line we could possibly be looking at? She refuses hospitalization adamantly. We cannot convince her.
Doctor :   she is suffering from some sort of psychiatric abnormality. it is difficult to convince or it is just not possible to convince her
Doctor :   might require some force to get her medical help
User :   yes, definite psychiatric abnormality...just not possible to convince her. She refuses.
Doctor :   if it is to be pneumonia it will be fatal rapidly
User :   When previously forced against her will into hospitals (5 years ago), she was forced back onto thyroid medicine, but as soon as she was released, she went off it again.
Doctor :   i think you need to use force to take her to hospital this time given the condition she might have pneumonia
Doctor :   once her condition is stabilized she needs a psychiatric help so that she takes her medicines regularly
Doctor :   was psychiatric help offered at that time( 5 years ago)
User :   we were also told by a nurse that we cannot force her unless she is deemed mentally unfit to make her own medicl this so? Despite her severe delusions, she is capable of carrying on normal conversation and can tell people she is fine.
Doctor :   legal issues are there
Doctor :   but it can be worked out
User :   She was examined by psychiatrists, but they would not help us because they determined her psychiatric problems to be medical-based
Doctor :   yes it is because of the medical based that is hypothyroid status
User :   since she would regain her normal mental capacity when on proper thyroid meds
Doctor :   yes
User :   they say not a psychiatric problem
Doctor :   at least now she has a psychosis because of the deficient thyroid
User :   there seems to be no place for her. we have been through this for years. very difficult. we are afraid she may be dying.
User :   what symptoms of myxedema coma should we be looking for?
Doctor :   let the psychiatrist treat the present psychosis part
User :   I don't know what to expect in terms of how long se can live this way.
User :   psychiatrists won't touch it - we have tried. they say it is a medical issue only.
User :   if her illness is not pnemonia, just flu...can she recover?
Doctor :   she can recover but over a long period than usual
User :   her immune system must be long can she live with the depleted thyroid hormone levels?
User :   years?
Doctor :   she is not completely depleted of the hormone.
User :   the 5% puts out enough?
Doctor :   it is enough to keep her alive but not enough to maintain the normal function
User :   enough to keep her alive for many years?
Doctor :   usually they will contract an infection and or kidney failure which is the cause for the mortality
Doctor :   when it happens cant say
User :   why will the kidneys fail?
User :   what are symptoms of that we should watch for?
Doctor :   thyroid hormone is required for the normal functioning of the many organs
User :   if she recovers from this current illness, do you know how long it would take her impaired system to recover?
User :   what about fluid build-up around the heart/lungs?
Doctor :   you have already mentioned some of the symptoms she is having that is all indicating the multi organ involvement
Doctor :   yes the fluid retention occurs in the hypothyroid state
Doctor :   weight gain, fluid retention, fatigue, depression , slow heart rate are all the early symptoms
User :   she doesn't eat much at all, so she has not gained weight. she has a very hard time moving around at all.
User :   I know we are almost out of time, and I appreciate your help so much. So to sum up, you would say if she has pnemonia, she is likely to die quickly. Otherwise, she may recover slowly and maintain her status quo until infection/kidney failure?
Doctor :   yes
Doctor :   it is like that even heart failure can happen
User :   Thank you so much for your help
Doctor :   find a way so that she gets a medical help
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