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Fatigue, sleepy and feeling very cold - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Excellent Posted in: Diabetes
Answered by

General & Family Physician
Practicing since : 2009
Answered : 544 Questions
User :   Hi
User :   Hi doctor
User :   I have some medical reports I need your opinion
User :   I am 32 years old, a mother of 2 kids
User :   I gave birth 6 months ago
User :   sure , please tell me
User :   I am breastfeeding, every thing was fine except one issue
User :   ok
User :   4 hours after breakfast my blood sugar drops so much, when I feel dizzy, shaking, cold, can't focus, very hungry
User :   and very very weak and so on
User :   I was thinking that it is normal for every body to feel that if they are hungry
User :   ok
User :   3 weeks ago, I started to feel extremely fatigue, sleepy and feel very cold
User :   may i know if you have diabetes?
User :   no, but my sister has
User :   but once I had it in my first pregnancy
User :   it was mild and very unstable
User :   even in hospital they monitor my bllod sugar for 24 hours and they told my it is irregular
User :   have you done any blood tests , as in for thyroid , blood sugar, etc , if so when were they done?
User :   yes I have the recent tests and ultrasound report now
User :   may I write it here?
User :   ok , can you please type it to me here
User :   yes, you could
User :   TSH 6.09
User :   ok
User :   ft3 3.24
User :   ok
User :   ft4 13.78
User :   insulin 1.55 (fasting)
User :   the ultrasound report: User :   ok
User :   normal size of the thyroid lobes and isthmus
User :   the right 14*12 mm the left 12*11mm
User :   ok
User :   what is the final scan impression?
User :   2mm small hypoechoic nodule is seen in the right thyroid lobe
User :   he didn't right an impression
User :   ok
User :   i see that the TSH is little high
User :   but the last point is :no pathologically enlarged cervical lymph nodes
User :   do you have symptoms of weight gain , hair fall, also?
User :   hair fall yes
User :   and suuden dry skin
User :   ok , weight gain , feeling cold, lack of interest
User :   dry skin , onstipation , etc?
User :   constipation*
User :   my weight is still the same, but I feel very cold and tired, sleepy, have a bad dry skin
User :   mild constipation
User :   ok , these symptoms are more in favour of hypothyroidism
User :   you may have to take thyroid supplements
User :   the problem that I am already on depression medication for more than 1 year
User :   along with it i would recommended you to check your blood sugar again and blood pressure also
User :   my blood pressure is slightly low
User :   100/70
User :   ok , depression medicines need to be reviewed often and the dose also need to be adjusyed
User :   adjusted*
User :   your blood pressure is fine
User :   a bit on the lower side
User :   yes which is good I guess
User :   have you done tests for blood sugar recently?
User :   yes, may I right it here?
User :   yes , drink lot of water and fluids for maintaining the blood pressure in normal value
User :   yes, please write it
User :   it was GTT test
User :   fasting 83
User :   after 30 minutes 114
User :   ok
User :   after 1 hour 101
User :   after 90 minutes 80
User :   after 2 hours 70
User :   ok
User :   fasting insulin 1.55
User :   I felt so bad after I went home after the test, around 3 hours
User :   I was almost going to faint, I guess my blood sugar went to less than 50
User :   ok , your readings suggest a low blood sugar
User :   did you see an endocrinologist?
User :   no. not you think I should do?
User :   I really feel so tired
User :   but it does not indicate an impaired diabetic status, it may be normal too
User :   yes, i suggest you see an endocrinologist with the thyroid and diabetes levels as well
User :   impaired diabetic supposed to be high, right?
User :   meanwhile have you done any other blood tests for anemia
User :   yes, my Hb is 12.4
User :   yes , it is not impaired in your case, that is i meant it doesnot indicate diabetes
User :   great
User :   so we need to know what is the cause for your tiredness
User :   other hormone tests may be needed
User :   apart from the symptoms you mentioned. are there any other symptoms?
User :   that you have developed now?
User :   muscles pain
User :   any swelling of feet, joint pain, etc?
User :   my wrest
User :   I already have an injury on my right knee
User :   any fever, shortness of breath.

User :   so I am on physio therapy
User :   mild shortness of breath sometimes
User :   ok , apart from the localised injury related swelling , do you notice swelling of feet ?

User :   ok
User :   no
User :   ok
User :   let me summarize it to you
User :   ok
User :   on reading the reports, I WOULD ADVICE YOU ON THESE LINES
User :   1. you must drink a lot of fluids ina day , if low blood pressure is a problem here, it will be sorted
User :   2. eat healthy and lots of green leafy vegetables,will improve the health
User :   3. have frequent meals, small meals, whenever you feel tired or hungry.
User :   this will prevent the sugars from dropping down and relieve tiredness
User :   4. meanwhile you must get an opinion from the endocrinologist , for the thyroid leevls
User :   since i feel hypothyroidism may be the cause as well
User :   so you may need thyroid supplements till you feel fine
User :   do you think doctor that the small hypoechoic is ok?
User :   hypoechoic nodule
User :   i may not be able to comment on it as it needs a physician and radiologist to co relate it with the examinations
User :   an endocrinologist will interpret it the best
User :   so , we need to proceed step by step
User :   but in your opinion, it is something for concern?
User :   the thyroid function is slightly on hypothyroid side, for which the hypoechoic mass may be contributing
User :   since i did not examine you , i may not be able to say , it may be a functional one as well ,
User :   so do not wory about the readings
User :   why my G.P seems doesn't care about it, he was so busy in making phone call with friends
User :   may i know if anyone in your family had lupus, arthritis, etc?
User :   I am sorry, excuse me for my terrible language, what are those illness?
User :   your reports are on the borderline , hence the doctor would have not felt the need to intervene and he has also examine you
User :   i meant any auto immune disorders in the family like rheumatic arthritis, SLE , any joint pains , kidney related problems , arthritis, etc?
User :   he didn't examine me, and I was shocked when i discovered that he does not remeber the case
User :   my mother have some problems with joints for more than 20 years, she never done any tests for that
User :   ok
User :   do not worry for now, everything is border line
User :   TSH upto 6 also is ok, bt since you have symptoms of the same , i suggest you get a review
User :   apart from it, follow the general measures which i mentioned
User :   may I tell you something?
User :   sure, please tell me
User :   around 18 month or a little more
User :   ok
User :   I had the opposite of the symptoms which I have now
User :   I lost alot of weight, I had insomnia, I was very active but nervous, my menstruation was very very slight only dropping
User :   I had a sudden worsning in my vision
User :   ok
User :   that was only for 3 months
User :   ok
User :   then suddenly, I had the opposite
User :   ok
User :   so, I went to a doctor after a while, and I find that TSH was 9, but the other reading was fine
User :   ok
User :   after a month or so, every thing was fine. is there here any thing contrubute to the case?
User :   yes , i would want to explain it to you
User :   we have something called thyroiditis
User :   yes please
User :   yes
User :   I forgot to mention the diarhea
User :   in the first 3 months
User :   this is a condition common in women which follow after a viral fever, stress , like pregnancy , other hormonal changes , autoimmune disorders, etc, or just start without a cause
User :   aha after a stress I may say, at that time I lost my favourite job
User :   if it is thyroiditis, being autoimmune, called Hashimotos thyroiditis, we expect the start to be with symptoms of hyperthyroid, where a person has weight loss, palpitations , diarrhea, feeling very hot, menstrual irregularities, eye problems, like eyes get enlarged and pop out , lack of sleep etc
User :   they then slowly progress towards hypothyroid levels on their own as the gland functions get interupted
User :   in that time, one goes in for a hypothyroid state
User :   which presents with hair los, depression , weight gain , eye changes, lack of interest, feeling cold , voice changes ,etc
User :   it is not necessary that these symptoms should co relate with values, they may vary as the symptoms may over lap
User :   are you there
User :   yes
User :   yes doctor I am following
User :   so , it is too early to come to any conclusion
User :   i will not say that you have thyroiditis
User :   yes I understand
User :   but i just shared with you that this could be a possibility
User :   women and thyroid problems are very common
User :   they occur more in females
User :   we need to find the right cause for your symptms and try to help you best
User :   since i understand how tough it is to manage with a kid as well
User :   what makes me feel bad that I have kids need me to be more active
User :   apart from this , i suggest you to review on the psychiatry medicines as well
User :   yes doctor, and I am working online too
User :   if the dose is not proper, the side efects may also cause these symptoms
User :   I ahve an appointment with him after 3 days
User :   so those medicines also must be checked on frequently
User :   yes , that is good , please carry all your reports, thhyroid, sugar reports, scan reports everything and share your symptoms with him
User :   so, do you recommend me to consult an endocronologist or I may postpond it?
User :   first finish with the psychiatry consultation , after the review on medicines , you may see the endocrinologist next
User :   aha ok, this sounds good
User :   so that you will have 2 doctors who would have given their opinion on examining you
User :   did you follow my suggestions?
User :   yes of course
User :   i hope i answered your questions.
User :   yes doctor thank you very much
User :   Thank you for you time
User :   pleasure here
User :   thanks for consulting me
User :   do not worry much , everything may be normal as well
User :   I hope so, thanks alot
User :   see u doctor
User :   thanks , take care , bye for now
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