Confusion/ Disorientation ???

[Kalvin]

Towards the end of last week, my elderly Mom was so fatigued, that she could barely lift her head off the pillow, in addition to being extremely confused and disoriented. Because she has a lot of health problems it was difficult for us at home to figure out exactly was causing these symptoms. I got her to the emergency room and they ran every test in the world and found out that her TSH was 26.10. Which from what I gather, is extremely low, E.R. Doctor said that was more than likely causing the symptoms.

I’m not sure how it got to be that low, because she has been taking medication for several years, anyway the focus right now is getting her better. Her Doctor made a medication adjustment and I’m making sure she’s taking her meds. She is getting stronger and is up more, but she’s still confused quite a bit.Is this something that I should be concerned about, from what I gather, confusion isn’t that uncommon in cases of extreme Hypothyrodism, particularly in the elderly? Their telling me that it could take up to six weeks for her level to get where they need to be.

Anyone know if Warfarin could have caused her level to change drastically, because she just started taking it recently. I checked for interactions between Levothyroxine and  warfarin, and there are some, but they didn’t seem to fit. Any input would be appreciated.

Thanks

[Red_Star]

I've suffered badly with severe bradypnea due to hypothyroidism. At my worst, breathing dropped down to 6 breaths a minute.  My symptoms included severe shortness of breath, extreme exhaustion doing anything, feeling really out of it, dizziness/almost fainted.  

Bradypnea - Causes, Symptoms, Treatment, Diagnosis...

"The onset of Bradypnea can affect the brain as a result of lack in oxygen supply. Multiple body system can also get affected with the insufficiency in oxygen supply. In the event of Bradypnea, the signs and symptoms should be carefully observed and these symptoms include the following:

Episode of chest pain
Syncope or episode of near-fainting or fainting
Extreme and easy tiredness from routine activities
Weakness and fatigue
Dizziness
Confusion or memory loss
Difficulty in breathing or shortness of breath"

[Barb135]

Sorry, I didn't mean to offend you with my explanation of TSH, but it did appear that you were confused with purpose.

TSH is affected by many variables and can fluctuate by as much as 75% over the course, of a day's time.  Since it's affected by so many things, we can't rule out the possibility that other meds can affect it.  

If she has not been taking her replacement thyroid hormones regularly lately, that most certainly would have the greatest effect of all.

It's very important to note, however, that TSH is, at best, a screening tool. Being hyperthyroid, yourself, I'm sure you know that far more important are Free T3 and Free T4, since those are the actual thyroid hormones.  Free T3 and Free T4 must be adjusted to alleviate symptoms, without worrying so much about TSH.

If she has not taken her medication regularly for a while, and begins taking it regularly, it will take a while (4-6 weeks) for it to reach full potential in her blood and for symptoms to begin to subside.  The thyroid controls so many bodily functions and the body will heal the most important ones (heart rate, body temperature, metabolism, etc) first, so the confusion and disorientation may last a while until the medication has taken full effect again.  It's also important that her dosage be high enough to alleviate the symptoms, not just lower the TSH to within the reference range.

[Kalvin]

No, I’m not confused, my mistake with the high/ low. I am well aware that her thyroid is underactive, and has been so for the past 10yrs. What I’m curious about is whether this  sudden change is an anomaly, due to her not taking her meds or possibly influenced by one of the numerous drugs she takes. I'm also concerned about the continued disorientation, although, it is lessening. From what I’ve read, it’s not unheard of, particularly in the elderly.

And yes being Hyperthyroid myself and being treated by an Endocrinologist for the past 15yrs, I’m perfectly aware of what TSH stands for.

Thank you, for your response.

[Barb135]

I think you're somewhat confused... TSH of 26.10 is not low; it's actually quite high for TSH.  That said, I hope TSH isn't the only thyroid related test they ordered.  

TSH is a pituitary hormone and is actually counter intuitive.  TSH stands for Thyroid Stimulating Hormone and is produces when thyroid hormones are low, in an effort to stimulate the thyroid to produce more thyroid hormones. The lower thyroid hormone levels go, the higher TSH goes. When thyroid hormones are adequate or high, TSH levels will go lower.  

What your mother needed was more thyroid hormones to lower her TSH level, not raise it.   However, the doctor should also have ordered Free T3 and Free T4, which are the actual thyroid hormones to see what their levels actually were.  If those weren't ordered, you need to make sure they are the next (and every) time thyroid levels are tested.

While TSH of 26.10 is high, it's not considered "extreme", but can cause brain fog and possibly confusion in the elderly.

Confusion is a specific side effect of Warfarin, by itself, add uncontrolled hypothyroidism, which can also cause confusion/brain fog, and you have what happened.