Hi,

Thanks for the detailed query.

As per your description, you been suffering with generalised tiredness and easy fatiguability, pedal edema, confusion, hematuria and on and off bilateral headache. You had been investigated extensively.

1. I would be able to interpret your ECHO reports had you mentioned the final impression on the Echo cardiogram / thallium stress test. You mentioned fraction short is 32.7 %, do you mean ejection fraction is 32.7 % ?

2. The Thalium Stress test reading typed were confusing and misleading. One line EKG says normal and the other line it says as abnormal. No ST changes on exercise with normal LVEF is not suggestive of disease. I suggest you to upload the scan copy of the report.

2. Thyroid function test revealed hypothyroidism. These can explain your generalised weakness and easy fatiguability. It is good to know that your values were improved. And I agree with your doctor’s suggestion to continue you on synthyroid. Once a fixed dose is set you should continue to take for several years with follow up.

3. Presence of dysmorphic red blood cells in the urine is concerning. Though the Computed Topography (CT) scan of abdomen seems normal, you need to be reviewed to rule out renal disease. It can be a defective filter (kidney) or plumbing system ( urethra or bladder). If I were to be your treating doctor, I would consider repeating urine microscopy first. Further tests and renal biopsy are needed if necessary.

4. Elevated Erythrocyte Sedimentation Rate (ESR) and C Reactive Protein (CRP) is a non specific marker of inflammation. Their assessment can be confusing for you.

5. Headache with normal temporal arteries rules out temporal arteritis which is good. If the headache is recurring, you might need prophylactic medication like amitriptyline to manage them.

The bottom line is your symptoms are concerning. Based on the details provided, it is probably related to renal disease or hypothyroidism or both. My best suggest is to follow with a single primary physician ( XXXXXXX Medicinist) and take necessary referrals with Nephrologist, Cardiologist while he treats Hypothyroidism.

Hope this helps you to take an informed consent. Let me know if you have any queries.

Regards.

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Hello Mr. XXXXXXX
Thanks for enclosing the reports.

I have gone through them and would like to make the following comments:
a. As far as your Echocardiogram reports are concerned, there are largely normal. The ejection fraction of the left ventricle, which is a reflector of how well the heart is able to do its function, is normal and not something you need to worry about.
The dilation of aortic root is commonly seen in people with high blood pressure. I would like to know if you have high blood pressure and if yes, whether it is under control.

b. The thallium stress test is normal and you do not have any coronary artery disease at present. So you don't need to worry on that front.

Your fatigue and the swelling in your feet need evaluation by a nephrologist. With respect to the other reports, my comments remain the same.
Awaiting your reply.
Regards

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Hi XXXXXXX
Thanks for writing in.
I wanted to know if you have ever been told that you have high blood pressure. Also, when I was going through your reports, I noticed that you would need to lose some weight. The size of the aortic root increases with age and size of the body. Weight reduction would be possible through a mix of dietary interventions and exercise. Dietary interventions would include small, regular meals; having an early dinner; avoiding refined food; and avoiding sweets. This will also help you control your diabetes better.
Once you see the recommended specialists, we can take this ahead.

Hope this helps.
Regards

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