Elderly mother in law hallucinating: is it dementia, or adverse drug reaction to antihistamines, alendronic acid??

[JudiBlueHen]

That is a LOT of levothyroxine. My sister had a thyroidectomy, so had no thyroid. She took between 87-100mcg max of Synthroid (doc insisted on brand name) and was monitored regularly. At that dose her TSH was quite low, under 1.0.

 

[messylttlfoodie]

UPDATE: massive improvement today after supplementing with vitamin D3 and calcium since yesterday. So, let me set the scene:
Friday night was the worst night ever. She was having terrors / scary hallucinations seeing people in her room, including a man coming at her and throwing a drink in her face causing her to shout at "him" and call out for her husband (who sleeps in a separate room), then still thinking we're in a hotel, not knowing where the bathroom is etc, thinking the front garden is being dug up moaning about whether they have permission to do that, it was rough!). Yesterday she was an absolute Zombie due to the lack of sleep, and hallucinating thinking once of our nieces had been here, having had roast (even though they hadn't eaten yet as I was cooking a fry up for dinner) and just being totally out of it all day, seeing the cat walking around when she wasn't in the house etc.

We decided to add some vitamin D3 and calcium to her drink yesterday, because of what my research showed about alendronic acid (biphosphonates) potentially causing chronic hypocalcaemia especially if there's a vitamin D deficiency which can cause symptos
of reversible psychosis.

So then, last night, she slept much better, it wasn't without hiccups but there was no getting up packing clothes or seeing people in her room or shouting out, just seemed to be sleeping quite heavily, except that twice she somehow got up, wound up on all fours on the floor - not falling, just sort of slipping out of bed and sliding down, half asleep, then getting back up and a bit disoriented trying to get to the bathroom. I think she was just too sleep deprived from the psychotic episodes but it wasn't anything like the nights prior.

So then, today she was almost back to normal, energetic, awake, coherent, no hallucinations, no confusion, a bit tired still but a night and day difference compared to the last few days. This can't be a coincidence that we give her D3 and calcium and boom the next day she's basically back to normal. I've been secretly crying tears of joy throughout the day. We did another round of vitamin D3 and calcium today, and she seems to just be super chirpy and full of beans, alert and coherent, just overall significantly improved.

Fingers crossed that tonight she'll get even better kip, and we may have to keep supplementing her with D3 (will look into K2 etc but they do eat a lot of dairy products so I'm not too worried) because she just doesn't go outside enough to get it from the sun and we just can't make her do it.

I will keep updating in case this might be useful to someone else. Hopefully next week we can get her to see her GP about changing her meds, maybe get her on some T3 although I highly doubt it as NHS docs generally refuse.

Thanks again to everyone who's given good advice on here and for kind words of support.

 

[messylttlfoodie]

That is a LOT of levothyroxine. My sister had a thyroidectomy, so had no thyroid. She took between 87-100mcg max of Synthroid (doc insisted on brand name) and was monitored regularly. At that dose her TSH was quite low, under 1.0.

Wow, thanks for sharing! I had no idea. I just realised I typed mg in my original post though it's probably meant to be mcg, not sure if 150mcg is still considered a lot?

 

[JudiBlueHen]

Wow, thanks for sharing! I had no idea. I just realised I typed mg in my original post though it's probably meant to be mcg, not sure if 150mcg is still considered a lot?

Yes 150 mcg is a lot, but if she does not have a thyroid and is monitored with blood measurements quarterly, then it might be OK. However, excess T4 can lead to tachycardia or AFIB. I had to reduce my supplemental T4 (I still have my thyroid) from 50 mcg to 25 mcg and my tachycardia is nearly gone. That means I don't have to take a beta blocker.

 

[messylttlfoodie]

Yes 150 mcg is a lot, but if she does not have a thyroid and is monitored with blood measurements quarterly, then it might be OK. However, excess T4 can lead to tachycardia or AFIB. I had to reduce my supplemental T4 (I still have my thyroid) from 50 mcg to 25 mcg and my tachycardia is nearly gone. That means I don't have to take a beta blocker.

To my knowledge she's never had a thyroidectomy. Just hypothyroidism, but I don't know her TSH levels. We might try measuring her heart rate tomorrow just to be sure but I don't recall her ever complaining of tachycardia or heart problems in general. Do you take any T3 meds or supplements?