Critical Thyroid Medication Non-Compliance

[aliwitsend]

Dear Dr. Lupo,

I have searched high and wide for an answer, and it is not easily found. Please help me with this.  My mom is 80+ y.o.
female w/ total thyroidectomy (no function left).  As often happens with seniors they can miss doses for days, weeks,
and even months and months.  I have seen a deterioration in her condition for over six weeks now, dozing, sleeping, memory, some confusiion, etc.    Obviously, she needs to be on her Armour 180mg/daily.  However, that is not happening, and I am extremely concerned, and doing all of the prudent things one should do, and it is not happening fast enough.  I am concerned she could go myxedemic, or any of those not so nice other complications.   QUESTION:    So would you have any idea how many months or  (a month range)  that someone that age can safely do without any thyroid meds. or  with perhaps hit and miss Zero to 25% dosing following a very, very low thyroid level six weeks ago (ie:  TSH is high).   I am so worried, I am not sleeping well.  I would really be so entirely grateful for an
Endocrinology take on this hypothetically, by email, or otherwise.  I am desperately concerned for her.  Thank you so very, very, much.  

[Mark Lupo, M.D.]

She needs stable, consistent thyroid meds.  At this age, there is not a lot of tolerance for significant hypo or hyper.  Also, 180mg of armour all at once is a lot for anyone -- esp at this age.  Would consider changing to a long-acting T4 product like levothyroxine (ie, levoxyl, synthroid etc) and making sure she takes it every day -- if not, it is nearly impossible to predict the appropriate dose.

Without her own thyroid function, she would likely go to myxedematous coma in 3 months, but be progressively sicker along the way.

[aliwitsend]

Dear Dr. Lupo,
Thank you so very much for commenting on this.  Your answer means that I was most likely right that she should be hospitalized @ a teaching hospital to safely re-institute
the medication.  She's the patient type where many years ago, Synthroid alone resulted in the puffy face, etc. (my fault for omitting that.)  Hence the Armour.  Your answer also clarifies my thought that zero to 180mgs is not such a great idea (we all are just following orders, until new orders are written).   Thank you for being brave and compassionate enough to actually talk to me.  Tommorrow I am off to Social Services, or something, so that we can get my mom the help she just is not getting at home or elsewhere.  I just read your CV and I do love Duke, and have done many a road trip to Scripps La Jolla, very nice credentials.   If by some chance you don't mind being quoted, it might help my case.  But, I will start just with the content, and try to keep the nomenclature out of it.  Though the content is exceedingly helpful.  I can not thank you enough in my lifetime and there may still be time to help my mom.  Beyond Grateful and hopefully Successful & Life-Affirming, and I am definitely on a time-table.   Blessings