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Blood sugar dropping post meals, sinus, headaches, tachycardia, lab tests showing PCOS, hypothyroid status. Treatment ?

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Endocrinologist
Practicing since : 2001
Answered : 297 Questions
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Hi doctor,
I am a married woman 32 years old, I gave birth 3 times normal deliveries.
Few months ago I started to consult a doctor regarding my blood sugar which it droops dramatically 4 hours after the meals, and the lab tests confirmed that.
I have polysystic ovaries.

At that time ( 5 months) I felt onset of fatigue and feeling sleepy, I had blood test showing subclinical hypothyroid, I was put on thyroxin and it was perfect, and I had only one hypoechoic nodule 2*2 mm.
Now, in my follow up some changes have come up, I started to have sinus tachycardia, headache, and heavy menstruation( I breastfeed my baby for 1 year now)
I attached the reports with my question, I hope you have a look through it. and I hope you give me a detailed honest diagnose, since I know folliculare lesion means so many things
Posted Sun, 6 May 2012 in Thyroid Problem and Hormonal Problems
 
 
Answered by Dr. V. Kumaravel 19 hours later
Hello.

Thanks for your query.

I do understand that you have been suffering from Polycystic Ovaries and Subclinical Hypothyroidism. your concern seems to related to the Follicular lesion of the Thyroid.

I had gone through your medical history, reports and medications. Your thyroid function reveals low FT3, normal FT4 and increased TSH (Thyroid Stimulating Hormone). Your ultrasound shows features of Thyroiditis and many small hypoechoic nodules. Tc (Technetium) scan reveals a cold area and the Biopsy of the area shows Adenomatoid Follicular Goitre.

All the above reports reveal features of Hypothyroidism with incidental Benign Thyroid Nodule, that is not a cancer and absolutley not to be worried about.

Your nodule size of 2mm is very small to derive any conclusion. Your FNAC (Fine Needle Aspiration Cytology) has clearly ruled out malignancy. It just shows Adenoma, which is nothing but a benign simple enlargement of the thyroid gland, that can be present in many individuals.

I would suggest you to continue taking Thyroxine and titrate the dose as per your TSH. Moniter your nodule size and be under regular follow-up.

Hope I had answered your query.

I will be available for follow up queries if any.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Blood sugar dropping post meals, sinus, headaches, tachycardia, lab tests showing PCOS, hypothyroid status. Treatment ? 41 minutes later
Hello doctor,
Thank you very much for your answer.
My concern regarding the FOLLICULAR LESION, because the nodule was( 2mm 5 months ago), but is is bigger now, and because what I read evey where about folliculare lesion and how it is difficult to diffentiate between adenoma, neoplasm and carcinoma in cytolgy and some time surgery is recommended in larger nodules to get examined histololgically.
therefore, exceuse me doctor to clarify what I need to know:
1- If you please give me explanation for the report in a simple language.
(Naked nuclei, tiny follicular clusters,few colloid)are all of these normal and 100% benign?

2- The report said (hypocellular/suboptimal follicular cells) does this mean the cells were not enough for diagnosing?

My doctor told me that we don't need to worry at the moment, but we still need to repeat FNA after 3-6 months.
3- Should I repeat the FNA biobsy or US is enough?

Thank you doctor very much, and I really appreciate if you answered me in details
 
 
Answered by Dr. V. Kumaravel 16 hours later
Hello

Thanks for your feedback.

Question-1: FNA(fine needle aspiration test) test is nothing but, you take a small bit of thyroid tissue through the needle and look it under the microscope. What we look is the type of nuclei (Every cell is made up of a nuclei and cytoplasm), The pattern in which cells are arranged and the amount of colloid inside. Depending on the characteristic features we try to find whether the tissue is adenoma or carcinoma. Whatever explanation provided for your FNA, shows by all probability, the tissue examined is benign. FNA can never be 100% but the positive prediction is atleast 90%.

Question -2: Hypocellular could mean that the cells are less. It does not essentially mean the cells are not enough. Cancer smears are usually hypercellular.

I totally agree with your doctor that you need not worry at this time. We can repeat FNA and ultrasound at 3-6 months interval and if 2 FNA are normal then repeat FNA may not be required, unless otherwise there is a rapid enlargement in size.

Just to reassure, any lesion less than 10mm is very unlikely to be a cancer and small thyroid nodules are normally seen in atleast 10% of individuals.

Hope this answers your query.

Wishing you good health.
Above answer was peer-reviewed by
 
Follow-up: Blood sugar dropping post meals, sinus, headaches, tachycardia, lab tests showing PCOS, hypothyroid status. Treatment ? 7 hours later
Thank you very much doctor, Your answer was very helpful and more than satisfying.
The last question I have is regarding my blood sugar, which drops after breakfast 4 hours. I feel confused, my hands shake, headache, dizzy, cold, nervous and sometimes nausea and stomach pain, after eating or drinking something sweet I feel better, but the rest of the day I feel out of energy and that my legs and hands are still very weak.
Most of the times I try to avoid that and eat every 3-4 hours, but not all of the time it is easy, specially if i were outside or busy.
Is this something I should take action to cure it or just try to ignore?
My sister and uncle are diabetic.
Thanks alot, and I promise you not to bother you again unless I will take another consultation.

 
 
Answered by Dr. V. Kumaravel 17 hours later
Hello again,

You are not at all bothering me and it’s my pleasure answering your query.

Regarding your blood sugar that drop after 4 hours of food, the most common possibility can be a reactive hypoglycemia (where there is an increase in sugar at 1 hr and gradually drop in sugar later and patient feels hypoglycemic by 3 to 4 hours).

The only way to confirm it is an extended Glucose Tolerance Test for 5 hours. This would also help to know your predilection for Diabetes, given a strong family history.

Whatever may be the reason you will do well with frequent meals and also with foods of low glycemic index and high fiber.

Regards and best wishes,
Above answer was peer-reviewed by
 
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