Dr. Basuki Nath Bhagat
Family Physician
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am suffering from hypothyroidism, high blood pressure, and brain fog. I am trying to figure out the root cause of my brain fog, cold hands and feet, headaches, fatigue, and anxiety. I had my thyroid removed due to thyroid cancer 30 years ago and have been on Levothyroxine since then. I did have radioactive iodine some ten years after the surgery as I developed Ewing’s sarcoma, which they thought might be metastatic thyroid cancer at that time. There was no recurrence of sarcoma. I have been on tablet Levothyroxine 200 mcg for the past year. My TSH level was suppressed, so my doctor reduced the Levothyroxine dose to 125 mcg. But recently, I had symptoms of hypothyroidism, so the dosage of Levothyroxine was again increased. I increased my Levothyroxine to 200 mcg for a couple of days to see if it worked. But most of my symptoms disappeared, so I stopped it and went back to the 137 mcg.
Based on recent reports, my doctor increased my Levothyroxine dose from 125 to 150 mcg. I have never felt like this in all the years since the surgery, but I am over 60 years old now. I have never tested positive for Covid, but I had bronchitis several months ago, after which I started getting these symptoms. I have had them now for the better part of four months. I have been on a Levothyroxine 150 mcg tablet for the past week, and I still feel terrible.
Before my thyroid medication dose was increased this summer, I was told I had high blood pressure (170/95 mmHg). I was prescribed the tablet Lisinopril, which had several side effects like cough and anxiety, so I switched to the tablet Losartan, which also had similar side effects, so I stopped it. Later, I started taking the tablet Propranolol for several weeks but stopped it, thinking I could lower my blood pressure with diet and exercise. I will say that all were effective in reducing my blood pressure to normal range, and I think it helped somewhat with the brain fog, but I was experiencing terrible anxiety, which I felt might be attributed to it, so I stopped.
My doctor advised me to take tablet Sertraline 50 mg daily for anxiety, and increased it to tablet Sertraline 100 mg. So I am not sure about the cause of my anxiety. Is it the blood pressure medications, the Liothyronine, or taking the Sertraline to help it. The anxiety has subsided, but the brain fog is still there.
I am currently taking tablet Levothyroxine 150 mg, tablet Sertraline 100 mg, tablet Atorvastatin 20 mg and tablet Ativan 5 mg as needed. I feel like I might be on the right course with the thyroid and Levothyroxine, but not so sure what to do with the blood pressure medicines. For the past several days, my blood pressure has been 155/95 mmHg, and I have felt very lightheaded with headaches and brain fog. I am unsure if it is related to the blood pressure or the thyroid. I want to feel normal again.
Kindly help.
Hello,
Welcome to icliniq.com.
Thank you for your query.
I read your query and can understand your concern. You suffer from hypothyroidism, anxiety, high blood pressure, and high cholesterol.
You have enquired about the root cause of high blood pressure, hypothyroidism, and brain fog. Brain fog is not a medical or scientific term; it is an individual's description of how they feel when their thinking is sluggish, fuzzy, and not sharp. It is not clear when your brain fog symptoms started. Brain fog can be caused by stress, inadequate sleep, hypothyroidism, depression, diabetes, COVID-19, and autoimmune diseases.
High blood pressure could be the cause of headaches and light-headedness or dizziness. It would help if you started taking your prescribed blood pressure medication. Since you have side effects with ACE Inhibitors (angiotensin-converting enzyme inhibitors) or angiotensin 2 receptor blockers (ARB) medications, I suggest you can take a tablet of Amlodipine (calcium channel blocker) 5 mg once daily and also try meditation and mental relaxation techniques.
Consult your specialist doctor, or an online doctor prescription may be a good option to consider to effectively continue treating the condition without having to visit a local doctor in-person. However, take medicine with their consent. Your laboratory values of TSH (thyroid stimulating hormone) show a lot of variations for one day (attachment removed to protect the patient's identity). Currently, I think your brain fog symptoms could be due to thyroid, anxiety, and increased blood pressure. First, try to identify the problems or triggers causing your anxiety. Once you know the trigger, we can try to reduce your anxiety.
High blood pressure at this age is primary hypertension. The risk factors include diet, stress, physical inactivity, obesity, and others. I suggest you do not increase the dosage of Levothyroxine on your own, as it might cause hyperthyroidism symptoms. Instead, strictly adhere to the recommended dosage of thyroid medication. In addition, start blood pressure medication and lifestyle changes, including aerobics, exercise, meditation, and mental relaxation techniques to bring positive changes in mental clarity.
I hope this has helped you. Thank you.
Patient's Query
Hello doctor,
Thank you for your reply.
I have started taking the blood pressure medication tablet Amlodipine 5 mg daily for one week, and my blood pressure is in the range of 152/80 mmHg throughout the week. I feel better overall. However, I am experiencing lightheadedness and have mild headaches as a side effect of Amlodipine intake. When will my blood pressure become normal? Can you please suggest another blood pressure medication that does not have lightheadedness as a side effect?
Kindly help.
Hello,
Welcome back to icliniq.com.
Your diastolic blood pressure (lower value) is well controlled, but the systolic blood pressure (upper value) is high. Amlodipine (calcium channel blocker) 5 mg controls blood pressure well. I had suggested a calcium channel blocker medication, as you had side effects after intake of the other blood pressure medications such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). Peripheral edema, dizziness, and headaches are the common side effects of the medicine. Headaches are common when a person starts with the medication. However, they will become less noticeable with time.
Your blood pressure would get controlled by continuing the medicine. However, you must watch out for serious side effects such as cardiac side effects. I suggest you not to switch the medication based on one week's observation. Continue taking Amlodipine (calcium channel blocker) 5 mg for a few more days before deciding on switching medications. Also, do not stop the medication suddenly.
Please elaborate on the nature of your light-headedness. Do you experience mild dizziness on changing posture?
I suggest you to follow a few instructions mentioned below:
1. Try relaxation techniques. These will help with lightheadedness, anxiety, and headaches.
2. Do regular aerobic exercise.
I hope this has helped you. Thank you.
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Family Physician
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