So many symptoms

[brewcrewcath]

My husband is a CLL patient, recently recovered from pneumonia, and had a hypothyroid crisis, his TSH was 95. How aggressive can we be to get him established on  levothyroxine?

[Barb135]

It sounds like you have your hands full and I, truly, empathize with you.

No offense to you or your daughter, but I totally disagree with the idea that there's no difference in starting thyroid med slow or fast... We've seen way too  many people whose doctors panicked at high TSH levels and started them at, what they thought would be, "maintenance dose", but they went too fast and the body can't always tolerate that.  Once we've been without thyroid hormones for a while, our adrenals kick in to take up the slack.  If you bring on the thyroid med too quickly, it doesn't give the body a chance to readjust and let the adrenals go back "doing what they do". This wreaks havoc for a lot of people, because they end up with both thyroid and adrenal insufficiency.

That said, I wish you and your husband all the best... My sister has leukemia, so I have an idea what you're dealing with. I suspect that, she, too is hypothyroid, and have recommended testing, but I don't if she's done it or not.

[brewcrewcath]

Steve had every symptom of hypothyroidism except irregular periods, altho this is a rather irregular period in his life...Ha.  His tongue was twice it's normal size, thinking very slow and sluggish speech.  I thot he'd had a stroke.  And the reason no one caught it sooner is he hasn't had chemo for 15 months.  But his Chronic Lymphocytic Leukemia has only dealt him 2 symptoms thru out, 11 allergic reactions and anemia requiring 22 transfusions or 11 sets of 2 usually.  The docs believe this is either viral or autoimmune.  My daughter forwarded me an article the same day I posted here to explain the current research and apparently there is no diff in starting slow or fast.  We are just a little too impatient.  He is now on 150mcg and will need more.  His symptoms are slowly vanishing altho the hugest improvement was the absence of his falling asleep during a conversation.  He was somewhat comatose when admitted for "pneumonia". A savvy MD did an admit H & P and asked immed for a thyroid level and he started on IV thyroid the same day.  God bless him. I have a slower version of my husband back. The cancer nursing I seem to have a handle on, the thyroid I'm new to and trying to get a handle on...Thnx

[Barb135]

Does CLL stand for Chronic lymphocytic leukemia?  

What was the nature of the hypothyroid crisis? While 95 is much higher than normal for TSH, it really shouldn't create a crisis situation.  

Have any other tests been done, besides TSH?  What about Free T3 and Free T4?  Those are the actual thyroid hormones and give a much clearer picture of what's going on, than just TSH, which is a pituitary hormone and, at best, is only an indicator of a thyroid problem. If he hasn't had those tests, you should insist that the doctor order them.

As far as aggressive treatment, it's always best to start thyroid medications at a very low dosage, in order to eliminate the possibility of a reaction to the med.  Apparently, your husband has been without thyroid hormones for a while, so it will take time for his body to readjust to having them again.  Personally, I'd suggest that he be started somewhere around 50 mcg, tested after 5 weeks and med increased according to FT levels and symptoms.  If after a couple of weeks, there have been no adverse reactions, he could conceivably be increased to 75 mcg, I'd not suggest going higher until after further tests (including FT3 and FT4 ) are done.

Is your husband currently on any type of chemo therapy?