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Dementia and hypothyroidism
Good morning.  My 77 y/o mother in law has very recently been admitted with signs of possible stroke:  acute mental confusion, loss of memory and orientation, slight weakness.  After a very complete workup, including labs, CT, MRI, CXR and neuro exam, no stroke has been indicated.  MRI showed only normal, expected, age-related changes.  Labs were normal except for mild anemia.  Dementia appears to be the diagnosis by exclusion.  I this is in fact her condition, we'll do whatever is necessary, but we want to be sure that is in fact her final dx, and that there is no underlying metabolic condition causing this that could be reversed.
She allegedly (this has come from her over the years, but she's never been the best medical historian) has been diagnosed by someone as hypothyroid, despite normal labs, and put on Synthroid.  However, as she has been very independent, we haven't felt it necessary to monitor her med intake and we now have discovered that she apparently stopped her synthroid 2-3 years ago.
Some symptoms:  likely brittle nail, itchy scalp and dry skin, intermittent complaints of serious head pain (same area), thinning hair, minimally forgetful and agitated (thought that was just her being difficult).
Our point of confusion is that this came on so acutely that it doesn't seem like a metabolic issue would do that.  She had been fine, if not with some age appropriate issues, until 3 days ago, when we found her extremely altered, hence the ER visit and subsequent admission.  Her S/S prompting the ER were: didn't know if it was day or night, no memory of doing things during the day, didn't remember her birthday, the year, the president (she watches CNN obsessively), where she lived (she lives in a separate apartment in our home), and more.  She still admits to being confused and feeling off.  She also is apparently sundowning, which could account for the acute S/S.

Can such acute S/S occur in hypothyroidism?  Is there any way to identify a possible metabolic cause for these S/S?  Other labs to run despite normal TSH and T4?  I've also read that adrenal disease can mimic/produce dementia.

We're at the point of discharge within a day, likely to a rehab facility, and we do not want her to get lost in the system with the dementia tag, if it can be reversed through proper diagnosis.

Thanks to anyone.  No idea if my email can post, but if you'd like, my direct email is ***@****.  I understand and acknowledge that any information provided by medical professionals in response to this forum in no way represents treatment or a medical opinion, and is only provided for informational purposes.  We're all alone caring for her, with no support system, so if there's a chance that this can be corrected, we'll consider anything.

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393685 tn?1425816122
If your MIL was hypothyroid and stopped taking her medication - it could definately be liked to dementia and even her stoke.

The words "brain fog" are commonly associated with a person experiencing hypothyroid symptoms and I - as someone who had that when undermedicated - I can tell you in a sense - a person can feel off or even retarded as defination to the symptom.

Many experience brain fog as a sense of not being in tune with the moment. Like a cloud or gray fog is over there thinking ability and they can't focus on anything. I remember going to a grocery store and walking through the door - not having a clue why I was there. - What I should buy - or even how I got there to begin with.

Among having that - the anxiety I had also was unbearable and usually those 2 symptoms can go hand and hand.

Dementia is not - in my opinion - an actual illness. - Its a signal of something underlining the issue.

Thyroid or adrenal issues could be reason and if - pursay she was not taking care of her thyroid with her regular medication - then the adrenals can develop issues so now there would be 2 issues and not only one that is bringing her down.

Most definately I would demand testing on both adrenal and thyroid - I can't stress to you enough how important specific labs would be needed - due to her condition and heart issues.

Don't accept any tests besides

TSH - Free T3 and Free T4 - for thyroid - You may have to learn about these tests quickly to educate yourself on where all these levels should be at.

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231441 tn?1333896366
I'm assuming they have also tested Vit B12 and Vit D.  Low levels of these, particularly B12, can also contribute.

They should also have screened for infection. UTI (urinary tract infection) is classic cause for dementia in the elderly.

Hope they can find a cause.  The acute onset would make me suspect there is some underlying cause to this, in which case, there should be an appropriate treatment.
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