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What causes insomnia and weakness while on Thyroxin?

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Posted on Mon, 28 Jul 2014
Question: i am writing in regards to my mother born 1935, she was very fine and normal and strong and on May 27th she had a partial thryroidectomy because of Goiter and the Histologie report showed it was benign. Her Thyroid was functioning very well before the surgery. She put on 75 mg thyroxin but she got off it becuase she thought it was causing her symptoms. Now since 4 weeks she had been suffering with 24/7 insomnia she cannot sleep one second. She feels very weak! we really need help and feel very despartate.
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Answered by Dr. Binu Parameswaran Pillai (6 minutes later)
Brief Answer:
Hello

Detailed Answer:
Hello,
Good day.
You have mentioned that she had a normal thyroid function test before opartial thyroidectomy. What about the thyroid function test after surgery and after stopping Thyroxine ??

Being normal PTH, calcium elevation is not PTH mediated. At this age, we have to think of multiple causes of high calcium. How high is calcium?
Could you please attach full reports ?

Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Binu Parameswaran Pillai (8 minutes later)
Reports attached
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Answered by Dr. Binu Parameswaran Pillai (1 hour later)
Brief Answer:
Hello

Detailed Answer:
Got the report. Unfortunately, the PTH and Thyroid function test reports were not attached.
Looking at the report, she has mild rise in calcium. ( the corrected calcium level is 2.6 mmol). Her ESR and blood glucose also is high.,

The cause of weakness could be due to diabetes itself. If the TSH is elevated, she will need Thyroxin replacement. Hypothyroidism also can lead to weakness.

Lastly, the mildly elevated calcium and rise in ESR, may also point towards some kind of infection or inflammation. You have mentioned that PTH was normal. Hence we have to think about non PTH mediated hypercalcemia ( some infections, some cancers, some inflammatory conditions, dehydration etc can cause rise in ESR and calcium) . At her age, we have to consider all these.

My advice would be to control diabetes first. Add Thyroxine if she has high TSH. Recheck calcium, albumin, PTH and phosphorus in fasting after few days. If calcium and PTH is high, the diagnosis is obvious and we have to do an ultrasound of neck and do a SESTAMIBI Scan. If calcium is elevated and if PTH is normal or low, we may need to do a Chest Xray, serum protein electrophoresis and some bone xrays.
For now, give her fluids to drink. This will reduce calcium levels.

This surely need an endocrine help.

Regards XXXXXXX




Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Binu Parameswaran Pillai (23 minutes later)
I am reattaxhing teports. Chest x ray was normal and ct scan too. The spine x ray showed some osteo poroses .
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Answered by Dr. Binu Parameswaran Pillai (54 minutes later)
Brief Answer:
Hi

Detailed Answer:
Thyroid function looks normal now. She dosen't need Thyroxine now.
PTH report is not seen in the attachment. However you mentioned that to be normal.
Chest Xray and CT scan of chest is normal, which is reassuring. We need a serum protein electrophoresis as well.

If the repeat test shows normal PTH and elevated calcium, we can also do a PTHrp ( parathyroid hormone related protein).

Need control of blood sugar as well. Noted that Vitamin D is low, but it is best to avoid giving her Vitramin D now till the hypercalcemia is sorted.

Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Binu Parameswaran Pillai (19 minutes later)
Dr many thanks one last question the severe insomnia she has. What could it be ?
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Answered by Dr. Binu Parameswaran Pillai (3 minutes later)
Brief Answer:
Hi

Detailed Answer:
Well, high calcium can cause that, but her calcium levels ( corrected calcium) is not that high. Uncontrolled diabetes could be contributing. Does she have any other symptoms like fever or night sweats ?
Is she passing excessive urine? ( that also can contribute to lack of sleep).
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Binu Parameswaran Pillai (7 minutes later)
Yes excessive urine. Some night sweats. And some times feeling cold. But she used to have sone naps during the day and sleeo well at night. Now for the past one month she is unable to sleep for one second !!! That is after the surgery. No one is teing why this is happening. The lack of sleep is making her very weak. At night in order to sleep she take zeplidem which is highly addictive .
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Answered by Dr. Binu Parameswaran Pillai (5 minutes later)
Brief Answer:
Hi

Detailed Answer:
Hmm, I am very suspicious of a hidden infection somewhere ( urine/chest/abdomen) . Sorry to say, but my other suspicion is a multiple myeloma or lymphoma ( rare though) with the high calcium with normal PTH and elevated ESR.

The lack of sleep could be multifactorial. The underlying disease + excess urination.

I think she need to be admitted to a good hospital and need a thorough work up

Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Binu Parameswaran Pillai

Endocrinologist

Practicing since :2003

Answered : 1435 Questions

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What causes insomnia and weakness while on Thyroxin?

Brief Answer: Hello Detailed Answer: Hello, Good day. You have mentioned that she had a normal thyroid function test before opartial thyroidectomy. What about the thyroid function test after surgery and after stopping Thyroxine ?? Being normal PTH, calcium elevation is not PTH mediated. At this age, we have to think of multiple causes of high calcium. How high is calcium? Could you please attach full reports ? Regards Binu