How to manage worsening shaky hands and numb toes?

Question

Hi doctor,

I had my first appointment with a neurologist this week. I am a 21-year-old student. For the past several years, I have been dealing with shaky hands, worse on my left side, that have continuously gotten worse. I also have hypothyroidism and had hoped that as my thyroid balanced out, the shaking would decrease, but it has only gotten worse, and now the shaking often moves up my arms and makes it very difficult to write or work.

Within the past year, I have noticed that some of my toes go numb while walking and can stay numb for several days. Recently, I have noticed numbness in my right arm at times. My neurologist first thought it could be from stress, but then proceeded to run through a series of tests, where he mentioned that the reflexes in my feet were very uncommon and that my pupils also were not working the way they should.

He asked about any back pain; I told him I struggle with that as well. He then did a test where I would touch my nose and then his finger. I could do it on my right side, but missed every time on the left. He ended up taking quite a bit of blood and was asked to get a magnetic resonance imaging (MRI) of the head and cervical spine this week. He did mention that this could be serious and heavy, but not much else. Currently, I am on Levothyroxine.

I am starting to get nervous and wanted to see if anyone had any input or ideas about possibilities or conditions that could be wrong with me.

Kindly help.

Thank you so much.

Answer 1

Hello,

Welcome to icliniq.com.

Your history is suggestive of neurological issues with very little possibility of anxiety.

The following are the possibilities that I can think of:

Amyotrophic lateral sclerosis (ALS).
Multiple sclerosis.
Young-onset Parkinson's disease.
Parkinson's plus syndrome.
Drug-induced Parkinson's.

Now, to help you better, I need the following answers from you. Please think in detail and answer:

Have you ever been admitted to the hospital for vomiting? Or ever received any injections for vomiting for long?
Do you notice any visual issues? Is there any tingling or numbness in your legs?
Do you have any difficulty in holding objects?
Do you experience any cervical pain?
Are you suffering from weight loss or memory loss?
Have you noticed any other neurological issues in life?

Please check with your family for answers that you are not sure about. I mean any previous significant history of such episodes in childhood.

Reach out to me as early as possible to help you further.

Answer 2

Hello,

Welcome back to icliniq.com.

Based on your symptoms, I would like to evaluate you for multiple sclerosis.

Now, you need the following investigations:

Magnetic resonance imaging (MRI) of the brain with spine screening.
Optic nerve examination.
Nerve conduction velocity (NCV) testing.

NCV testing to rule out carpal tunnel syndrome, and this is a common reason for nerve compression in hypothyroidism. If these investigations turn out to be normal, then your symptoms would probably be due to anxiety and hypothyroidism only.

I hope this helps.

Thank you.