Caroline's 'death is, in every sense, tragic'

When ‘Irish Times’ journalist, Caroline Walsh, died after a short illness, her family needed answers about her condition

Caroline enjoyed very good health up to a few months before her death on December 22nd, 2011.

She was a keen walker and cyclist, very active on both fronts. She went for health check-ups regularly, including two thyroid examinations in recent years, the last of which was in July 2011.

These were not prompted by any particular symptoms of malfunction but by concern, informally raised by several people, among them medical practitioners, about the prominence of her thyroid.

While these examinations showed her thyroid to be multinodular, there was no immediate health risk. However, it was signalled that such a threat might arise down the line, so she was advised to continue with periodic check-ups.

A middle ear infection, developed on holiday in August 2011 and treated with antibiotics from the outset, took some six weeks to clear. In mid-September she began to suffer from insomnia, waking frequently and very suddenly with what she described as “a racing” sensation. She then developed a hand tremor and spoke increasingly of her inability to think clearly, describing it as a “sort of murkiness”.

Following tests in October, thyroid malfunction, hyperthyroidism, was diagnosed and treatment, Carbimazole (Neomercazole, begun.

This treatment also included medication to alleviate associated symptoms, primarily anxiety and sleeplessness. When, after three weeks or so, there was no improvement, she was referred by our GP to the Beacon Clinic in November, but discharged that night on the basis that her thyroxin levels did not appear to warrant urgent medical attention.

In the course of the weekend to follow, her symptoms became more pronounced. I recall her using both hands to steady her teacup on the Sunday morning, eventually forced to leave it down because of the way the tea lapped over the sides.

Her level of agitation, exacerbated by breathing difficulties and chronic sleeplessness, was extremely worrying.

Diagnosis

On Monday morning, utterly exhausted, confused and very fearful, she was admitted to the Blackrock Clinic where, following an extensive series of thyroid tests, she was diagnosed with both hypothyroidism and psychosis. Thyroxin levels, initially above normal, were now below.

Physically restless, very agitated and deeply concerned about what was happening to her, it was recommended that treatment be continued in a specialist facility.

Accordingly, she was transferred to St John of God’s Hospital where a course of treatment for anxiety and psychosis was begun.

When her thyroid function began to settle, her medication, Carbimazole, was discontinued, but TFTs (thyroid function tests) continued, showing flux within the “normal” range. When, a fortnight or so later, tests revealed a hypothyroid profile requiring treatment, she was again prescribed Carbimazole.

By that stage Caroline was thought to have made sufficient progress, both in her own estimation and in that of her doctors, to begin planning to go home. This was organised on a piecemeal basis, first a day, then a weekend, with final discharge on December 8th.