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Family Medicine (Expert Forum)
Shaking and chills after falling asleep
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
Shaking and chills after falling asleep
by dlshinab, Apr 27, 2004 12:00AM
My wife is 39 years old, 130 lbs, excercises regularly, and is in good overall health. She has been a diagnosed hypoglycemic for 15 years, but she does a great job following a high protein, low sugar diet. She monitors her blood sugar regularly and has been in control of the hypoglycemia. For the last six months, she has had the following symptoms which initially occurred once every two weeks or so, but now occur 3-4 nights per week: Within 1-2 hrs of falling asleep (only at night), she is awakened by a "visceral" feeling that is quickly followed by a rapid increase in heartbeat (100-120 bpm up from a norm of 70 bpm) and blood pressure (140/70, up from her norm of 90/60). This is followed within 5-10 minutes by uncontrolled shaking and sweating. In addition, she often feels very cold during this event - but not always. Often the shaking and sweating subside for 30 min., but then occur again up to 3 more times. After the shaking and sweating events subside, she has a bowel movement and then is able to fall asleep within an hour or so. She has monitored blood sugar at the onset, during, and after this event - but it is never abnormally high or low (blood sugar of 90 is normal for her). She has been to our family physician, and he thinks that she is stressed, suggesting Xanax or a beta blocker to slow the heart down during the event. She has been seeing an endocrinologist, and he thinks that she has abnormal thyroid activity. She did have base level thryoid hormones measured for the last two months, and then again the morning after an event. The results showed very high levels of TSH and T3/T4, suggesting to the endocrinologist that her thyroid is hypo when she goes to sleep, but is being overstimulated by the pituitary. In addition, her cortisol levels were very high the morning after the event (she did a 24 hr urine). We can't help but think that because this event ONLY occurs when she falls asleep at night, this is providing a huge clue as to the cause.
Thanks, DLS
Thanks, DLS
Doctor's Answer
by Kevin Pho, MD, Apr 27, 2004 12:00AM
, Apr 27, 2004 12:00AM
An elevated TSH and T3/T4 suggests TSH-mediated hyperthyroidism. They account for less than 1 percent of all functioning pituitary tumors, and much less than 1 percent of all cases of hyperthyroidism.
Computed tomography (CT) or magnetic resonance imaging (MRI) of the pituitary should be performed in any hyperthyroid patient with a normal or high serum TSH concentration (see Differential diagnosis below). MRI is preferable since it is a more sensitive test for the detection of pituitary tumors.
If an adenoma is found, treatment including surgery as well as medications such as bromocriptine and octreotide can be considered.
You may want to discuss this further workup with your endocrinologist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
Weiss et al. Thyrotropin (TSH)-secreting pituitary adenomas. UptoDate, 2004.
Computed tomography (CT) or magnetic resonance imaging (MRI) of the pituitary should be performed in any hyperthyroid patient with a normal or high serum TSH concentration (see Differential diagnosis below). MRI is preferable since it is a more sensitive test for the detection of pituitary tumors.
If an adenoma is found, treatment including surgery as well as medications such as bromocriptine and octreotide can be considered.
You may want to discuss this further workup with your endocrinologist.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
Weiss et al. Thyrotropin (TSH)-secreting pituitary adenomas. UptoDate, 2004.
Member Comments
by kwag, Apr 29, 2004 12:00AM
What exactly is a visceral feeling? Does she do this every night?
