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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
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Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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how long can someone without a thyroid last without taking

Resolved Question:

how long can someone without a thyroid last without taking any form of thyroid hormone supplement (thyroxine or tetroxine) before major complications can occur and what sort of complications would normally result long term.... leading towards death?
Submitted: 5 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 5 years ago.

Greetings.

 

This would cause what we term as Myxedema coma. Hypothyroidism lead to decreased mental status, hypothermia (decrease in body temperature), and other symptoms. The function of virtually every organ system and the activity of many metabolic pathways are slowed in severe hypothyroidism. The hallmarks of myxedema coma are decreased mental status and hypothermia, but hypotension (low BP), bradycardia (low pulse), hyponatremia (decreased sodium), hypoglycemia (decreased blood sugar), and hypoventilation (respiratory problems) are often present as well.

Myxedema coma can occur as the culmination of severe, long-standing hypothyroidism or be precipitated by an acute event such as infection, myocardial infarction, cold exposure, or the administration of sedative drugs, especially opiates. Please read this resource;

 

http://www.medicinenet.com/script/main/art.asp?articlekey=19712

 

Please feel free for your follow up questions.

 

Dr. Arun

Customer: replied 5 years ago.
Thanks Arun for your information - I was quite surprised by the level of severity described in the attached text you referred me to. I will give you some further information so as you understand the background to my question and then request that I get a little bit more specific information.

I have had no thyroid since i was 8 years of age (it was progressively removed from the ages of 6 1/2 to 8 years of age due to cancer in 1976). I have been undergoing preparation for yet another radioactive iodine scan (of which I have, naturally had several throughout my life... as well as radiation and chemotherapy).

Preparation, as you may already know, involved going off all thyroxine and onto tetroxine (short acting thyroid medication) for 4 weeks, then no medication whatsoever for the last two weeks prior to radioactive iodine dose, 24 hours isolation and the scan. Not sure if it is relevant to mention I also have only 2 of my 4 parathyroid glands.

Have also had a metastasis in the lungs at 21 and suspected lymph cancer at 25 (I did not allow treatment) and current mass on the carotid artery which needle biopsy showed cells the pathologist "had seen nothing like in 30 years of pathology". My endocrine surgeon, in 2006 said "I don't know how long you have to live, but in older patients, with similar cell mutations, they have not lived longer than 3 months"..... (I should also point out the doctors at Brisbane Radium Institute here in Australia told me in 1994/95 that i had about 40% or less chance of survival and they believed I would die unless I had my lymph glands out back then....

Blow me (and all of them away) I'm still here!

Anyway.... full biopsy not really an option on the mass on carotid artery as I have way too much scar tissue in my neck region and doctors are unwilling to perform it.... fair enough I say as complications could cause me to become really unwell and i am a single mother with no support.... have better things to do in life than lay around being sick with infection etc.... like bring up my daughter with sound morals and values etc.

Trying to keep this short but I do have a complex history.

Radioactive iodine failed quality control last week so scan scheduled for 2 weeks after I stopped all medication (23rd April) was postponed. Radioactive iodine failed qc again this week.... 4 weeks off medication... feeling (not to mention looking) really REALLY ordinary.

My doctor rang me this morning and I was barely able to talk. I had mixed emotions (disappointment that we couldn't proceed but also relief that I could go back onto my medication) when he told me it was too risky to continue and that we were aborting the scan as there was no guarantee the radio active iodine would pass qc next week.

I should point out that this same thing happened to me in 2002 and it's only happened with the plant that produces the radioactive iodine twice in 10 years... lucky me. Back then I was at the stage of hearing voices calling me.... whispering to me to come to them... as well as feeling people touching me which I also have experienced this time for the last week or so.

My question is... how much longer could I have gone before I went into a full coma and died? What would be the indicators of further decline?

At present I have taken 3 tetroxine today plus 150mcg of thyroxine... and feel 100% better than I did this morning (have had severe headaches for days now across my head and face accompanied by pain from chin down the full length of torso etc as well and biting my tongue several times everynight along with psychotic episodes ... and feeling as though the spirit world was trying to take me).

Although i feel a lot better... i also recognise i still need a lot of rest as I still look very ill... but am so relieved it's hard for me to sit still and not get up and get going.

Can you please tell me.... how far from being really critical would I (possibly) have been and could I have gone another one or two weeks waiting for the radioactive iodine to become available?

My doctor has now opted for a different type of scan (which we originally discused because of the complications last time) but he decided against because he is afraid of missing something...he still believes my future is very uncertain. I just want some answers and am hoping for a medical retirement from work so I can get my affairs in order and ensure things are adequately in place for my daughter if the worse case scenario happens... not to mention wanting to have some semblance of a peaceful life as I've had a long hard road with my thyroid issues being only the very tip of the iceberg and my psychologist stating she doesn't know how I've managed to stay sane.

Are you also able to shed any light on the other scan's effectiveness to pick up de-differentiated cancers as my last scans did not show activity with the iodine in the mass on my carotid artery? The other scan is (I think) called a thyrogen scan.. where they give two needles, no isolation period and then the scan.

Sorry for the long winded reply... but as you can see... it's a very complex case of which my brief here is only a brief.....

Many thanks
Nichole Kertesz
Expert:  Dr. Arun Phophalia replied 5 years ago.

Hello,

 

Thanks for the so thorough information. I am so privileged to assist you. I can just imagine, how strong you have been all these years.

 

It is difficult to say exactly how the coma ensues as there are wide spectrum of symptoms by which it ensues; but with your description you were very close to the getting it. This could have started with a deep sleep. In your case treatment would have been effective as they would know the cause. In many cases cause of coma is diagnosed very late. Still it was a close shave!

 

Withdrawal of thyroid hormone therapy has traditionally been required before radioiodine imaging in order to raise the serum TSH concentration and stimulate thyroid tissue for tracer uptake. However, this practice results in temporary hypothyroidism, and a significant decline in quality of life when compared to rhTSH use (recombinant human TSH, which you mentioned as thyrogen scan). This is effective and sensitive method and in your case would be prudent.

 

It is pleasure assisting you.

 

Good luck.

 

Dr. Arun

Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29791
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Dr. Arun Phophalia and 8 other Health Specialists are ready to help you
Customer: replied 5 years ago.
Many thanks again for your assistance and thorough reply Arun.... I am greatful for the incredible quick response and thorough answer you have provided.
Expert:  Dr. Arun Phophalia replied 5 years ago.

You are welcome.

 

Best wishes and kindest regards.

 

Dr. Arun

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