My mother, 77 years old with erratic blood pressure

[akimbohr]

My mother who is 77 years old has problems with her blood pressure. It can be as low as 90/65/45 in the morning or rocketing high as 175/85/70 in the late afternoon.

She visited a cardiologist a couple of times in the past who put her on strong medications which helped more or less. He thought her heart was ok but suspected some psychological stress and alse gave her something to calm down.

She also had had some problems with her thyroid in the past but she had not been on any thyroid medications since then (20 years ago or so).

Last year I took her to the endo and the results were:

TSH 0.750 0,27 - 4,20 Miu/L

FT4 13.7 12,0 - 22,0 pmol/L

FT3 4.41 3,1 - 6,8 pmol/L

Anti - TG 27.5 0,0 - 115,0 IU/ml

Anti - TPO 46. 0,0 - 34,0 IU/ml

Cortisol 375 170-536

He also found two nodules. Slightly eleveted cholesterol at 5.8, all other blood results were normal.

He put her firstly on 25 then on 50 mcg Euthyrox.

After 2 months the results were:

TSH 0.342 0,27 - 4,20 Miu/L

FT4 16.8 12,0 - 22,0 pmol/L

FT3 4.18 3,1 - 6,8 pmol/L

She continued with the dose of 50 mcg and she felt good with no problems with the blood pressure for the next year. She also slept much better.

After one year, two months ago, she made another blood test:

TSH 0.50 (0.4-4)

FT4 14.3 (7.7 – 14.5)

FT3 4.1 (3.8-6)

Vit B12 264 (133 – 675)

Her GP , on the basis of low TSH and higher ft4, made her cut down the dose to only 25 mcg. Her problems with the blood pressure started approximately at that time so I thought maybe they are linked. She is slightly overweight, sometimes getting tired in the afternoon. She has been having some back pain and the rheumatologist put her on vit D. Apart the erratic blood pressure, no other symptoms or illness. Her basal body temperature is normal at 36.3 c. Her sisters also had problems with the thyroid in the past and I was diagnosed with low T3 syndrom last year and have been on the combo t4/t3 since then. I am planning to take her again to a private endo next week. I am wondering how apropriate is adding T3 to a 77 year old woman with the blood pressure going up and down.

Thanks for your opinions and suggestions.

[Rebec]

Does your mother eat salty foods? Does she do any sort of physical exercise as that will be good also in keeping strong bones?

[dgleds]

My Mom didn't have a thyroid problem, but she did have a heart problem...cholesterol, blood pressure etc...I remember the cardiologist told me as Mom was getting older, that Id be tweeking this med, and that med for her...They had her on so much water pills...she was so thirsty. I had to monitor her liquids...and she would sneak stuff...

I know this doesn't help you, but you reminded me when I was keeping an eye on my Mom...She did make it to 90...

All the best with your Mum...

ps/ when moms blood pressure was low..id give her coffee to help bring it up...

I also gave her many bananas for the potassium (cause of the water pills she needed the potassium) She sure hated coffee and bananas after a while..lol

[silverfox7]

From what you have said it looks as though your mum needs the medication higher but whether they would prefer to tweak it then with T3 I don't know. Age is so often used as an excuse but whether it is always justified I don't know but suspect not in all cases. Quality of life is also important but I feel the first step would be to get all her minerals and vitamins checked as I suspect many will be low. I raised my levels by supplementing and felt better for it though not perfect. I was converting the T4 to T3 better but for me still not quite enough.

[greygoose]

Well, her doctor's not very bright, is he? She should have had an increase, not a reduction. The TSH is irrelevant, and that low FT3 with high FT4 is telling us that she's not converting. She is hypo. That would explain the blood pressure problems.

Doses should never be changed according to the TSH. It's the FT3 that is important. They very rarely test it, but as he tested it, why didn't he take any notice of it??? He obviously knows nothing about thyroid.

Doesn't know andthing about B12, either. Her B12 is dangerously low. It should be at least 500, preferably higher. That is going to cause a whole heap of problems in itself. She should be tested for Pernicious Anemia - I'm afraid I can't tell you what the test is called, but I'm sure someone else will step in and say.

She also has low positive antibodies, so she has Hashi's which will cause other variables. I bet the doctor didn't mention those, did he!

Both her weight and her back pain could be linked to low T3. My personal opinion is that being 77 is no reason not to try a little T3. I'm 70 and am on T3 only, and have absolutely no intention of changing that!

Hugs, Grey

[Hidden in reply to greygoose]

A majority of GPS do not understand the Endocrine System as it seems that the Thyroid is a grey area for them which really should be addressed as more and more people are having hypo and hyper symptoms. These GP's should be the first to spot abnormalities and treat patients accordingly, its a crying shame that many people have to go through so much illness with their thyroid before they get a proper diagnosis which is what GP's should be qualified in before they refer, they need to to do every test thoroughly and instead of passing the buck they also need to revisit their their training because these thyroid problems would have been covered.

[greygoose in reply to Hidden]

Unfortunately not, I'm afraid.

They do about one afternoon on the endocrine system out of the whole of 7+ years of med school.

They are not taught about symptoms, or how to diagnose from them.

They are taught that the TSH is the 'gold standard' test and no other is necessary, and that the only treatment is synthetic T4.

What is really a shame is that they do not have the wit to realise that their approach is not working, nor the curiosity to Wonder why.

[Hidden in reply to greygoose]

That really needs to be changed then as thyroid is becoming more prominent they need to know about the symptoms before they they refer as it could be a time saver for the Endocrinologist.when the see patients and have to decide what medication is the right one.

I was diagnosed as underactive at six weeks old so I have lived with it all my life , however I do know the effects if medication is altered or not medicated properly.these doctors need proper training on this subject before they are qualified.

[greygoose in reply to Hidden]

Yes, we know it needs to be changed, but it's not going to. Big Pharma is in control of what doctors learn in med school, and it's not in their interests that doctors become thyroid literate.

They are making a fortune out of treating our symptoms - statins, diet pills, blood pressure pills, antiDs, etc. They do not want us to be optimally treated and have all our symptoms disappear, because all their profits would disappear with them.

We are their Cash Cows, as they have openly admitted!

[Polaris]

I agree that your mother's thyroid medication should not have been reduced. Like others here, I had to battle to keep the dose that kept me well and my blood pressure and cholestrol down. GPs do not seem to realise that lack of thyroxine affects every cell and organ - they'd rather treat you with drugs that will eventually deplete B12 and cause worse problems.

Your mother's B12 is too low. Many other European countries as well as Japan, treat results under 500. Here is an extract from the book, "Could it be B12? - An Epidemic of Misdiagnoses" :

"we believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

Thyroid and B12 deficiency is often interlinked and symptoms can overlap. One of the problems is stomach acid, which reduces as we get older, and this can cause malabsorption of many vital nutrients, including B12.

My sister has severe B12 deficiency and we both have Hashimoto's. She is receiving frequent B12 injections for neurological symptoms, but we've both found supplementing with Jarrows B12 5000 mcg very effective for memory, numbness, tingling, glossitis, and energy (good reviews on Amazon).

[akimbohr]

Thank you all for your answers and suggestions. I am well aware of the fact that she is a poor converter. I am the same so it probably runs in the family. I was only reluctant about adding some T3 because she is 77. I think I'll take her next week to my private endo who is very open minded about it.

[Heloise]

What a disaster when she was doing so well, to cut back and produce symptoms again. I would say it was definitely linked to the reduction. Her numbers were very good with the increase. She should never have been reduced.

I think the heart is quite sensitive to T3 and they worry about too much but it's just as bad to have too little (possibly worse). If she did well on T4, it's unfortunate that they refuse to either go back to 50 mcg. or offer her a natural desiccated like Armour or Erfa which includes a small amount of T3 which might be perfect for her at 1/2 grain. What is the matter with these people?

I'm in the U.S. so I tend to rant a bit.

I guess if worse comes to worse, you could add T3 but I think it tends to complicate how to read test results.

[Clutter]

Akimbhor, Sounds like your mother's BP rose when her GP needlessly reduced her Levothyroxine to 25mcg. There was no need to do so, TSH was still within range. If she was comfortable on 50mcg T4 I'd be inclined to stick with Levothyroxine rather than introduce T3, but 10mcg T3 + 25mcg T4 would be appropriate.

Your mother's B12 is very low and this is common in elderly and hypothyroid patients. I would get her on 5,000mcg methylcobalamin sublingual lozenges, spray or patches for 6-8 weeks and then reduce to 1,000mcg daily. Top or over range B12 is desirable, particularly in the elderly, as it can delay the onset of dementia.

[akimbohr]

Thanks Clutter. From today she is already on the higher dose of 50 mcg. Hopefully her BP will go down. If not I'll take her to my private endo to discuss the possibility of adding some T3.