Dad is dying?

[deb__0__0]

  I hope this is the right forum to respond to.  Dad is 63 and in the past year he has become a completely different person.  Once a successful businessman with a solid memory and very active in his business, he has completely withdrawn from work, family and friends.  He has forgotten things he used to remember; he only goes to work for a few minutes a day, doesn't answer the phone, spends money like there's an endless supply, is very impulsive, sleeps way too much and drives like a maniac to the point we fear for the safety of others.  He was diagnosed with theyroid cancer (previously survived this 23 years ago), had surgery this past fall and one treatment of radioactive iodine.  He is taking thyroxine.  We had him committed last summer for some of his bizarre behavior (ie:  disappearing out of town, losing vehicles) but doctors here will not take a stand.  Psychiatrists find him "functional" saying he has a medical problem while the medical doctors say it is not a physical problem.  The system has him in the cracks.  We fear that he will die, possibly injure someone else or even just end up destitute.  He lives alone and his 2 grown children (one being myself) live a fair distance away.  I have researched many medical topics and cannot find one to pinpoint what is wrong and to get the appropriate treatment for him.  We believe there has to be some type of psychiatric illness involved and we want to get him help before it is too late.  Dad himself does not understand what his behavior has been like.  Where do we go from here?

[HFHS M.D.-JK]

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Dear Deb,
Your father is fortunate to have you looking out for his welfare.  You listed a number of concerns about your father’s behavior and medical condition.  First of all, you should make sure your father has had a full physical examination by his primary care physician.  Thyroid disease, both overactive and underactive can cause psychiatric disturbances.  It is not uncommon for patients with hypothyroidism to develop depression, and cognitive deficits.  Frank dementia can occur as can psychosis.  Patients with hyperthyroidism can develop anxiety like symptoms, agitation and manic behavior.  As the change in his behavior is temporally related to his thyroid cancer, this is the first area that must be investigated.  A thorough work-up will review other possible areas of concern, including other endocrine, cerebrovascular, and metabolic causes.
At your father’s age some of the causes for his memory and behavior problems can be medical conditions such as Alzheimer’s dementia or dementia due to other medical illnesses such as cerebrovascular disease or hypothyroidism.  Other forms of dementia such as Pick’s disease can present with cognitive loss and personality changes.  
After he has had a full physical examination, he can then be referred to a psychiatrist.  You stated that he has withdrawn from family and friends.  This can be a symptom of depression, which is common in the elderly. In the elderly, depression often presents with cognitive loss as a symptom.  His periods of impulsivity and spending money could indicate a Bipolar disorder, although it is unusual to have onset in one’s 60’s. While the diagnosis is being investigated, particularly for organic causes of his symptoms, he can be treated with medication that should help with his impulsivity and mood.
It sounds like you are frustrated with the current status of your father’s condition.  I urge you to set up an appointment with your father’s physician, as well as you father’s psychiatrist, to share your concerns about his symptoms.  Good luck.
To set up a psychiatric consultation at Henry Ford Behavioral Services call us at [phone].
This response is being provided for general informational purposes only & should not be considered medical advice or consultation.  Always check with your personal physician when you have a question pertaining to your health.