Cardiac patient low thyroid & anemia, Suggestions please

[loutomaio]

74 year old male

history of quadruple bypass, stents, arythmia, and a defibrillator in his chest...

He was put on Amioderone to control heart rythm a couple years ago. And even though this drug is known to cause thyroid issues and patients on it are supposed to be monitored, somehow his Thyroid was never monitored until he hit rock bottom (falling asleep mid sentence). (Malpractice???)

I sent him in to a congestive heart failure Dr because he has abnormal leg swelling, fatigue etc. this doctor finally decided to look at his TSH, which was over 200, and they thought it was a lab error, but it was not. I have attached a copy of the lab.

He is

Free T3 0.9

Free T4 <0.1

Total T3 35

He also has anemia:

REsults: Refrence Range

RBC 2.93 4.50-5.90 million/mcL

Hgb 9.0 13.5-17.0 gm/dL

Hct 27.4 % 39.8% - 52.0%

They want to do a cardiac cath but his Kidneys are very bad...

ANy thoughts or suggestions would be appreciated!!!

[loutomaio]

Thank you, I fixed it!

[Hillwoman]

Fistly, I recommend you remove the personal information that appears on the lab report in your post.

From my very brief look at a book that arrived only today, Thyroid and Heart Failure (Iervasi & Pingitore, eds., pub. Springer), sufficient T3 is the crucial factor in maintaining or improving heart health.

You don't say what your relationship is to the person whose details you have posted, but do you know whether they experienced any health problems in the years before the diagnosis of CVD and kidney disease? Low T3 may be both a cause and a consequence of this state, but I don't know enough about the role of iron deficiency anaemia here. All these problems appear very pressing from the lab results.

[loutomaio in reply to Hillwoman]

I believe I have removed the important personal information. This is my father. And no he didn’t have any thyroid issues until they put him on the amiodarone. No other health issues before the cardiac events.

[Hillwoman in reply to loutomaio]

I suppose if I were in your father's position, I would be pressing my doctors to treat my very low T3 and anaemia properly before they put me through any kind of traumatic medical procedure.

[Marz in reply to Hillwoman]

Enjoy the book ! - yes T3 is the star of the show. Also worth mentioning that the book came about when Endocrinoligists and Cardiologists came together in the name of research ...

[Hillwoman in reply to Marz]

It looks very interesting - and also very dense! I'm starting at chapter 14, because it looks at bit more general, and because I'm left-handed, so always start books at the back.

[Marz in reply to Hillwoman]

My youngest did the same and was left-handed ! I believe there is a link with thyroid there too 😊

I just read the Introductions then the Conclusions !

[Hillwoman in reply to Marz]

I tend to read conclusions, then the intro/foreword, then some of bits inbetween.

Didn't know about the left-handedness/thyroid connection...🤔

[Marz in reply to Hillwoman]

You may need to have a google 😊

[MissGrace]

This is appalling. Those results mean severe ill health in my opinion. You must complain, if this isn’t malpractice I don’t know what is. What is happening to treat the thyroid problem? I’m surprised this person is functioning at all. T3 is crucial to life. It is monitored closely if a patient is in an ICU. Someone needs to step in quickly here - an expert endo? Demand that this is dealt with immediately. Don’t get fobbed off, this needs immediate treatment in my opinion. And then complain to PALS. and a solicitor! I am shocked.

[loutomaio in reply to MissGrace]

After I started calling his cardiologist and making a fuss they finally sent them to an endocrinologist last month who put him on 112mcg of Synthroid

[loutomaio in reply to MissGrace]

I wouldn’t say he’s functioning. I finally called the ambulance yesterday and had him brought to the ER. Because he keeps falling off of his chair. Falling asleep while driving. Doesn’t have the strength to get himself into his bed at night…. I do not live near him. So this has been challenging. I have been trying to get him to move in with me for many months but he is a little bit resistant. He doesn’t quite understand how neglected he has been by the medical complex.

[MissGrace in reply to loutomaio]

In my experience with my mum and my dad unless an elderly and vulnerable person has someone to fight for them they are largely and often abandoned by the ‘caring’ professions. I think you are in the US as you refer to Synthroid and I am in the UK, but I doubt it’s any better under your system and quite likely worse. I really really hope this gets sorted - be his voice (even if he resists - my parents often resisted being dependent on me when they needed to be, but I fought their battles anyway.) You only get one dad and I miss mine every day, your dad must have abs deserves proper attention and treatment.

[MissGrace]

abs? Goodness! Should be ‘and’!

[MaisieGray]

loutomaio That dratted Amioderone! Someone posted a short while ago, who has suffered the thyroid-consequences of that drug. I can't remember who, so hopefully they will see your post and respond. Meanwhile, not least what it can cause, a major problem is that the thyroid does not respond immediately on cessation of the drug, so the hypothyroidism effects have to be monitored and managed beyond.

This abstract is useful, and then I'll post a link to another article in case you've not read them.

Amiodarone-induced thyroid disorders: a clinical review Keh-Chuan Loh

Abstract

Although amiodarone is regarded as a highly effective anti-arrhythmic agent, its use may lead to alterations in thyroid gland function and/or thyroid hormone metabolism, partly because of its rich iodine content. Patients treated with amiodarone may manifest altered thyroid hormone profile without thyroid dysfunction, or they may present with clinically significant amiodarone-induced hypothyroidism or amiodarone-induced thyrotoxicosis. The former results from the inability of the thyroid to escape from the Wolff-Chaikoff effect. It prevails in areas with high dietary iodine intake, and it is readily managed by discontinuation of amiodarone or thyroid hormone replacement. Amiodarone-induced thyrotoxicosis occurs more frequently in areas with low iodine intake; it may arise from iodine-induced excessive thyroid hormone synthesis (type I) or destructive thyroiditis with release of preformed hormones (type II). Type I should be treated with thionamides alone or in combination with potassium perchlorate, whereas type II benefits from treatment with glucocorticoids. Surgery may be a feasible option for patients who require long-term amiodarone treatment.

dx.doi.org/10.1136/pmj.76.8...

Also: ncbi.nlm.nih.gov/pmc/articl...

[loutomaio in reply to MaisieGray]

Thank you, I have actually read that one you posted above. I wish I had been on top of this sooner. But I wasn’t aware and I do not live near him.

[SlowDragon Administrator]

Some other posts that mention amiodarone

healthunlocked.com/search/p...

[SlowDragon Administrator]

This also by the expert Thyroid research website

deiodinase.org/2014/01/13/i...