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CHRONIC CONFUSION: HYPOTHYROIDISM
The thyroid gland in the neck produces the hormone thyroxin. It is the thermostat of the body and one of its regulators. It sets the level at which all the body processes run. The gland commonly fails in old age, but it tends to do so slowly so that the effects only come on gradually. As the thyroxin level falls the body slows down. The person becomes tired and slow, but as it all happens over a long period of time many people put it down to old age. Gradually the symptoms worsen. People tend to put on weight, especially around the face which gets very puffy. Everything slows up including the bowels so that constipation is a problem. Even the pulse slows down as the body adjusts to a lower level of functioning. The person commonly complains about the cold and can never get warm, and hair loss can occur from both the head and outer third of the eyebrows. If stressed (by cold weather) the sufferer can lapse into a coma. Because all of this happens over many months, if not years, it can be very difficult for carers to notice the changes. Even the family doctor, if he/she sees the person regularly, may miss it. It is the classic condition of the doctor\'s mother! I often see people on trains or at functions who I am certain are hypothyroid and I wonder if anyone else knows. As the disease progresses mental faculties slow down with the rest of the body so that confusion in the latter stages is common.
In its late stage the condition is readily diagnosable - the facial appearance, husky gruff voice, slow pulse and slowed reflexes - let alone the symptoms of constipation, feeling the cold, etc. A blood test confirms the diagnosis and treatment is carried out by replacing the thyroxin in a tablet form. This has to be done extremely slowly at the beginning because the body has got used to a much slower pace. Gradually the dose is increased and everything returns completely to normal.
Because many of the symptoms and signs of the condition are rather non-specific (constipation and chronic confusion occur commonly together), the blood test to check the level of thyroxin and more importantly TSH (thyroid stimulating hormone – a substance that goes up in the blood stream as the thyroxin level falls) should be given to everyone with a chronic confusional state.
The thyroid replacement medication usually has to be taken for life. Hypothyroidism is especially common after the thyroid gland has been removed for over-activity when the person was younger.
A thyroidectomy scar in a confused old person should always lead one to consider the diagnosis of hypothyroidism.
*16/128/5*
GENERAL HEALTH
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