When you say shiver, do you mean you are cold or that you have tremor? For cold feeling, you should have a
TSH and FreeT4 checked. For tremor:
Tremor
⢠Resting tremor (tremor at rest) â Tx: Dopamine agonist, Neurology referral for Parkinson workup.
⢠Intention tremor (tremor when reaching for object) â Tx cause (alcohol, drugs, multiple sclerosis, stroke).
⢠Essential tremor (tremor worse against gravity) â Tx: propranolol.
SX â Tremor. Hx of alcohol use, caffeine use. Fatigue. PE â Extremities, Neuro exam.
Next Steps
DX â Check med list.
TSH/FT4, EKG. Consider CBC, CMP, serum ceruloplasmin, EMG.
Health Tips
TX â Essential Tremor: trial of Propranolol 40mg BID OR Primidone 12.5-25mg QHS. Refer to Neurologist. PET scan.