Hashimoto's Disease and Myxedema

[KristenMarie26]

Three years ago, my sister was diagnosed with a Myxedema Coma.  During this time period she exhibited many psychiatric symptoms including paranoia, confusion, and hallucinations.  She has Hashimoto's Disease and at the time of her admission her TSH level was a 26.  

Since then she has displayed no signs of any behavior or mental health issues.  She is social, responsible, and does very well in school.  She has functioned well without any antipsychotic drugs.  She has just been taking her regular doses of synthroid.  

Several days ago she started acting disoriented again and displaying all the signs that she had 3 years ago.  Her face was swollen beneath her ears and through her jaw line.  When we took her to the emergency room her TSH level was a 29.84.  The ER doctor stated that she has a behavioral issue and that her levels weren't high enough to cause Myxedema.  I can't seem to find the TSH criteria for a myxedema diagnosis anywhere.  Also, once her TSH level has been brought down into a normal range, how long would it be before her symptoms fade and she returns to normal?  

[dawnangela]

I also suffered this with myxedema, My TSH was 144 but the doctor went on my appearance more..I started treatment and look and feel better..Is it true as i was told that Myxedema never goes though?

[Mark Lupo, M.D.]

There is not a TSH that is diagnostic of myxedema.  Classically the TSH is very high (>30-50 or even in the 100's), but the clinical picture is more important, as some patients are more sensitive to relatively small changes in thyroid status.  Getting the levothyroxine dosing adjusted to keep TSH around 1 and then testing frequently to ensure stability is important.  It often takes 2-3 months to get back to "normal".