Suggest Treatment For Difficulty Hearing In A Patient With Thyroid Disorder

Posted on Wed, 21 Jan 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Wed, 21 Jan 2015 Answered on

Wed, 18 Feb 2015 Last reviewed on

Question : Hi!

This is regarding my uncle, aged 57, currently undergoing treatment in ICU for Thyroid. His both Kidneys are damaged for which he was getting treatment for the last 2 years.
Around 10 days back, he was feeling very cold, his entire body got swollen and he had a problem with speaking, hearing. That's when he got admitted to a hospital.

He has been given Dialysis as well as Levothyoxine Sodium injections 100 mcg/vial for thyroid since he was not responding to other medicines. Even then, his condition remains to be critical.

Please suggest how should we proceed and what best can be done?
Also wanted to notify that blood platelets (AB+) have also being given on regular basis - last count was 23000

Thanks a lot for your help in advance and looking forward to hearing from you.

Answered by Dr. Ajish TP (30 minutes later)

Brief Answer:
Probably Myxedema coma

Detailed Answer:
Hi XXXXXXX

Welcome to HCM. I had gone through your question and understand your concerns.

Your Uncle is probably having a condition called Myxedema coma. This is a condition with severe hypothyroidism (thyroid is not producing any thyroid hormones) and patient goes to a comatose stage, usually precipitated by some infections.

All our vital organs like heart, kidney, liver, brain and lungs need thyroid hormone for its functions. When heart pumping decreases the blood flow to kidney decrease and will result in renal failure requiring dialysis. The precipitating infection or multi organ failure result in low platelets.

The treatment is:

1. For thyroid

Intravenous thyroxine, till he can take orally. This will take some time to act and normal thyroid hormone function will take up to 10-14 days.

2. Supportive treatment

Treatment of infection that may be responsible for low platelet count. All other treatment is supportive - cardiac pumping drugs, dialysis, mechanical ventilation through ventilator etc., may be needed.

Survival chance depends on the response of the patient in first 2-3 days. Once the patient is showing signs of improvements the chance of complete recovery is good.

Hope I have answered your question. If you have any further questions I will be happy to help.

Wishing him speedy recovery.

Regards
Dr Ajish TP
Consultant Endocrinologist

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Ajish TP (26 minutes later)

Hi Dr Ajish,

Thank you for your prompt response.

Since the condition of the patient is not improving for the last 10 days and Levothyoxine Sodium injections are very hardly availbale in XXXXXXX can you recommend some alternative medicines?

Regards,
XXXXXXX

Answered by Dr. Ajish TP (59 minutes later)

Brief Answer:
No alternatives available

Detailed Answer:
Hi,
XXXXXXX XXXXXX,

The treatment option for this condition is only injectable levothyroxine or T3 (Tab cytomel). T3 is an option only when the patient starts taking orally. Cytomel is unfortunately not available in XXXXXXX

Injectable thyroxine is expensive and not freely available. It is currently available in Narayanappa Pharmacy in XXXXXXX who deals with all rare medicines. You can contact them if in need.

Regards
Dr Ajish TP

Above answer was peer-reviewed by : Dr. Ashwin Bhandari