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Dr. Andrew Rynne

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What causes brain fog and derealization after reducing the dosage of a steroid

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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3601 Questions

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Posted on Fri, 16 Nov 2018 in Headache and Migraines
Question: ive been on steriods for 3 weeks 60mg ive droped down to 30mg now im having major brain fog and derealztion and tremors? what can i do till i see.my dr i feel awful. they put me on them for high antibodies due to hashimoto and nerogloic systoms



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i felt better at 60. yes they r treating me like HE im also on tyriod hormones



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Answered by Dr. Olsi Taka 2 hours later
Brief Answer:
Slower reduction may be considered if steroids were beneficial.

Detailed Answer:

Hello,

I am a little perplexed as steroids are not commonly used for Hashimoto thyroiditis. They are used only in case Hashimoto encephalopathy is suspected. I am assuming that is what the doctors thought, but I still think you should discuss that with your doctor.

I also wonder what was your initial response to steroids. If they led to an improvement to your symptoms and you are experiencing this worsening now that you've reduced the dosage then I would suggest that you augment the dosage till your next appointment, to 40 mg.
If these symptoms have been present before, not improved by the 60 mg steroid initiation then I think the steroid dose reduction is not related and the cause should be sought rather in thyroid function, a new TSH measurement would be recommended in order to adjust your hormone replacement dosage if needed (I am assuming you are under hormone replacement therapy).

Hope I have answered your query. I remain at your disposal for other questions.

Regards,
Dr. Olsi Taka,
Neurologist


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Brief Answer:
In that case slower reduction remains recommended.

Detailed Answer:

Hello,

Then in that case the worsening may be due to the encephalopathy. Till the next appointment, I would consider re-augmenting the dosage to 40 mg as I said. Of course, taking steroids for a long term is not desirable and if long term immune suppression will be needed, then treatment with immune suppressants like Azathioprine may be considered in the future.

I would still re-check TSH levels in the next appointment though, as thyroid function fluctuations may produce similar symptoms as well.

Hope I have answered your query.

Regards,
Dr. Olsi Taka,
Neurologist


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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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