Too tired to live

[hashisucks]

I have had tsh of 55 a couple weeks ago. Awaiting repeat test results. I am so out of it that I wake up at work not even having realized I was ever dozing off. I also have been having chest pressure, joint pain, muscle cramps, right arm and hand tingling, too tired to live. At what tsh lab value does myxedema coma occur? Wondering if I am about to travel down that road.

[Hennerton]

What medication are you on and what dose? You probably should not even be trying to work with a TSH that high. Did your GP not sign you off for a few weeks? Depending upon your dose, you should start to improve soon. Make sure they do not leave you on the same dose, if it is just a starter level. It should be gradually increased. Also you should have blood tests for Iron, ferritin, Vit D, B12 and folate. These are all likely to be low, which will exacerbate your symptoms. If so, your GP should offer supplements. Do not accept levels around the low end of the reference range . All need to be towards the top end. Do hope you start to feel better soon. Make it your mission to keep on top of things and keep copies of all blood tests from now on. They will be invaluable records.

[hashisucks in reply to Hennerton]

I am on L evothyroxine .200 and my doctor is treating this like it is no big deal. Only test repeated was TSH and free T 3. She never tests for anything else.

[rosetrees in reply to hashisucks]

You need to go back and ask for Vit B12, Vit D, iron, folate and ferritin to be tested as a minimum. What was your FT3? She also needs to test FT4, because you need to know if you have a conversion problem - for example if your FT4 is high in range and your FT3 is low.

Maybe ask for a referral to an endo and ask if you can trial adding in some T3.

Have you considered seeing someone privately? I can PM you some names.

[frogandprincess in reply to rosetrees]

Rosetrees: can you PM me some names too please? I have almost enough test results now to have a much clearer idea of what to do, but my GP is a scaredycat and unlikely to let me pursue a path that is outside t he 'one size fits all' paradigm. Paying for things is not the main issue, but I do need a helpful GP or endo.

[eeng]

I don't think you are in danger of falling into a coma - people sometimes have TSH readings over 100, although without a lab range I can't be sure. I see you are in the USA, so your results might be in different units.

It takes 6-8 weeks for Levothyroxine to build up in your system, but I would have thought you would have noticed some difference by now. If you are very low on iron you would be feeling exhausted, so maybe there's something else going on, unless as someone has said above, your body can't convert the T4 you are taking into T3.

I hope you start to feel better soon.

[helvella Administrator Thyroid UK in reply to eeng]

A myxoedema coma does NOT necessarily mean that someone is comatose. Indeed they mostly are NOT comatose.

hashisucks is clearly in danger of this.

9.9 MYXEDEMA COMA

Definition and pathogenesis.

Myxedema coma is a rare, life-threatening clinical condition in patients with long-standing severe untreated hypothyroidism in whom adaptive mechanisms fail to maintain homeostasis. Most patients, however, are not comatose, and the entity rather represents a form of decompensated hypothyroidism 1,-5. Usually a precipitating event disrupts homeostasis which is maintained in hypothyroid patients by a number of neurovascular adaptations. These adaptations include chronic peripheral vasoconstriction, diastolic hypertension and diminished blood volume; in this way a normal body core temperature is preserved. The hypothyroid heart also compensates by performing more work at a given amount of oxygen by better coupling of ATP to contractile events. In severely hypothyroid patients homeostasis might no longer be maintained if blood volume is reduced any further (e.g. by gastrointestinal bleeding or the use of diuretics), if respiration already compromised by a reduced ventilatory drive is further hampered by intercurrent pulmonary infection, or if CNS regulatory mechanisms are impaired by stroke, the use of sedatives or hyponatremia 2.

Diagnosis.

The three key features of myxedema coma are 1: 1. Altered mental status. The patient may be entirely obtruded or may be roused by stimuli. Usually lethargy and sleepiness have been present for many months. Sleep may have occupied 20 hours or more of the day and may have interfered even with eating. There may actually have been transient episodes of coma at home before a more complete variety developed.

2. Defective thermoregulation: hypothermia, or the absence of fever despite infectious disease. Usually coma comes on during the winter months. The severely myxedematous patient becomes essentially poikilothermic. With cold weather the body temperature may drop sharply. The temperature is subnormal, often much depressed: a temperature of 74 F (23º3 C) has been recorded. A thermometer reading lower than the usual 97 F must be used, or hypothermia may be missed.

3. Precipitating event: cold exposure, infection, drugs (diuretics, tranquillizers, sedatives, analgetics), trauma, stroke, heart failure, gastrointestinal bleeding.

Diagnosis on clinical grounds is relatively easy once the possibility is considered. Previous hypothyroidism had been diagnosed in 39% to 61% of all cases (6,7).The pulse is slow, and the absence of mild diastolic hypertension is a warning sign of impending myxedema coma 1. Any patient with hypothermia and obtundation should be considered as having potential myxedema coma, especially if chronic renal insufficiency and hypoglycemia can be ruled out. The diagnosis can be confirmed by finding a reduced FT4 and marked elevation of serum TSH. However, TSH will not be elevated in myxedema coma due to central hypothyroidism (4% to 18% of cases (6,7,8). Sometimes serum TSH is just slightly elevated, possibly related to co-existent nonthyroidal illness 19 . Creatine phosphokinase is often elevated. Both hypoxia (80%)and hypercapnia (54%) may be present (7) . Hypothermia with a temperature less than 94ºF (34º4C) is seen in 88%.

Treatment. Myxedema coma is a medical emergency. Early diagnosis, rapid administration of thyroid hormones and adequate supportive measures (Table 9-14) are essential for the prognosis.

thyroidmanager.org/chapter/...

I urge hashisucks to follow that link and read up - if still capable or get someone else to take it on board and look after her.

Rod

[Shortstootight]

Your in the US. Find a new doctor! Make sure it's an Endo.

[faith63]

If you are on 200 t4 and have a TSH that high, then your meds are not being absorbed or are turning in to reverse t3 and not t3 or you have a Pituitary issue. Can you post labs? I would try and find an alternative med doctor or integrative doc..Endo's are horrible, in general. Very common for you to have vitamin/mineral/iron/b12 deficiencys with Hashi's..but for now, i would focus on Thyroid.. a TSH like this is a clear indicator of an issue there. See if they will check Cortisol as well.