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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes occasional dizziness in an elderly person while on Synthroid?

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Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

Answered : 3621 Questions

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Posted on Fri, 3 Aug 2018 in Elderly Problems
Question: Q: What tests should be given to my 85 yr. old mother for occasional dizziness with no other symptoms? She's on Synthroid for thyroid; stable for 20+ yrs/blood labs checked every 6 months. No other meds; noticeable cognitive decline; mild hypertension & refuses medication. Dizziness only upon waking/sitting up or turning in bed and bending down to pick something off floor intermittently. Lasts roughly 2-3 days w. frequency couple times per year; (Weight-115/Height 5-feet). Had a recent brain CT scan brain due to a mild fall/bump on head; no abnormalities seen other than "a few scattered deep subcortical white mater hypodensities most commonly seen in the setting of chronic ischemic changes." Previous brain MRI done re dizziness @ 5-7 yrs. old also noted mild chronic ischemic changes but no other abnormalities.
FURTHER INFO: She has no other symptoms during dizziness episodes; with stroke checklist of symptoms, she has none of them when I ask her. I also check her heart with my own portable AliveCore Heart EKG which reads "Normal" right after dizziness episodes. Pulse is roughly 70-75 during inactivity; roughly 80-85 right after dizziness episodes.Her family doctor who ordered the brain MRI mentioned that the report stated there were hardening of the arteries in brain... That brain MRI was done approximately 3-7 years ago.
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Answered by Dr. Panagiotis Zografakis 1 hour later
Brief Answer:
BPPV probably

Detailed Answer:
Hello,

Her case sounds like benign paroxysmal positional vertigo (BPPV) particularly since there are no other concomitant symptoms. The characteristic presentation of BPPV is as follows: the patient provokes the symptoms by moving his/her head (or the body and the head). The symptoms usually start after a few seconds and they don't last for long but they may reoccur with every movement. Sometimes the symptoms are severe enough to prevent the patient from getting out of the bed. Lying still usually eliminates the symptoms.

Your primary care physician or the ENT specialist can diagnose this disorder with the Dix-Hallpike test. This is a test that elicits vertigo by moving the patient's head and looking for nystagmus (rapid abnormal eye movements). Depending on the ear facing down and the direction of the eye movements the doctor can pick the right treatment which is another set of maneuvers on the bed (Epley's maneuver).

Regarding the findings you've mentioned on the radiological tests, they're quite common for patients of her age, so there's nothing in particular to worry about.

So in conclusion, the Dix-Hallpike test may be used to diagnose BPPV (if this is what causes her symptoms) and Epley's maneuver is the right treatment for it. Please note that the set of moves is different depending on the affected ear and type of nystagmus so there is nothing like "one treatment for all".

I hope you find my comments helpful!
Kind regards!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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