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These Are My Primary Symptoms - 1. Heart Palpitations 2.
Question: These are my primary symptoms -
1. Heart palpitations
2. Dull left sided chest pain that comes and goes - no correlation with food, activity or movement
3. Extreme fatigue
4. Muscle pain and fatigue during activity like exercise, climbing up stairs etc.
5. After intense exercise like running - sometimes experience chest tightness and feel like not able to take deep breath
6. Moody behavior - depressive at time and have anxiety
Research done -
1. Cardiac examination - TMT, 2D Echo, Holter, ECG all normal
2. Gastroenterology - Upper GI endoscopy - normal with mild pan gastritis, Celiac test -ve
3. Endocrinology - Subclinical Hypothyroidism (TSH between 5- 8 constant, TPO -ve)
Question - what do you think can cause this fatigue and chest pain?
I have attached blood report for past 6 months and my current doctor think this may be due to macrocytosis. But only my most recent blood report shows increased MCV and folate deficiency. In July-2018 the only odd number on the CBP is the increased RDW-SD.
I must mention that during July-2018 I was in experimental therapy for hypothyroidism with 25mcg thyronorm. I have since STOPPED this. No medication now.
Do you think this really is vitamin deficiency? Please advise if there is any alternate suggestion from your end.
Thank you.
1. Heart palpitations
2. Dull left sided chest pain that comes and goes - no correlation with food, activity or movement
3. Extreme fatigue
4. Muscle pain and fatigue during activity like exercise, climbing up stairs etc.
5. After intense exercise like running - sometimes experience chest tightness and feel like not able to take deep breath
6. Moody behavior - depressive at time and have anxiety
Research done -
1. Cardiac examination - TMT, 2D Echo, Holter, ECG all normal
2. Gastroenterology - Upper GI endoscopy - normal with mild pan gastritis, Celiac test -ve
3. Endocrinology - Subclinical Hypothyroidism (TSH between 5- 8 constant, TPO -ve)
Question - what do you think can cause this fatigue and chest pain?
I have attached blood report for past 6 months and my current doctor think this may be due to macrocytosis. But only my most recent blood report shows increased MCV and folate deficiency. In July-2018 the only odd number on the CBP is the increased RDW-SD.
I must mention that during July-2018 I was in experimental therapy for hypothyroidism with 25mcg thyronorm. I have since STOPPED this. No medication now.
Do you think this really is vitamin deficiency? Please advise if there is any alternate suggestion from your end.
Thank you.
Brief Answer:
About hypothyroidism and Vit B12 deficiency:
Detailed Answer:
Hello and thank you for asking!
I have gone carefully through your concern.
From the attached blood results there is a high TSH with normal Ft4 and Ft3 suggesting for subclinical hypothyroidism caused most probably from Hashimoto thyroiditis that needs to be confirmed (check antiTPo, antiTg antibodies). At your age, we suggest to start levothyroxine and keep monitoring TSH after 2 months.
There is also a Vit D and Vit B12 deficiency that needs to be corrected, probably VitB12 deficiency is of autoimmune origin like Hashimoto thyroiditis, your treating physician may investigate further to confirm it.
Rather your symptoms can be due to hypothyroidism or VItB12 deficiency is hard to say, but I would recommend checking adrenal function in order to rule out other pathologies that may be manifested with fatigue, mood changes etc.
Discuss with your physician about the above-mentioned problems.
Best wishes,
Dr. Mirjeta
About hypothyroidism and Vit B12 deficiency:
Detailed Answer:
Hello and thank you for asking!
I have gone carefully through your concern.
From the attached blood results there is a high TSH with normal Ft4 and Ft3 suggesting for subclinical hypothyroidism caused most probably from Hashimoto thyroiditis that needs to be confirmed (check antiTPo, antiTg antibodies). At your age, we suggest to start levothyroxine and keep monitoring TSH after 2 months.
There is also a Vit D and Vit B12 deficiency that needs to be corrected, probably VitB12 deficiency is of autoimmune origin like Hashimoto thyroiditis, your treating physician may investigate further to confirm it.
Rather your symptoms can be due to hypothyroidism or VItB12 deficiency is hard to say, but I would recommend checking adrenal function in order to rule out other pathologies that may be manifested with fatigue, mood changes etc.
Discuss with your physician about the above-mentioned problems.
Best wishes,
Dr. Mirjeta
Above answer was peer-reviewed by :
Dr. Kampana
Hi Doctor - Thank you for your response. Couple of follow up questions -
1. I have done antiTPO and antiTG in the past and both were negative.
2. For adrenal function - what do you suspect. I have suspected that this could be an issue in the past although my current doctor has brushed this away. I have already done a 24 hr urine catecholamine test that came back negative. I have not yet tested for cortisol level - what test would you recommend for that? Do you think this needs to be evaluated?
3. For elevated TSH - does this need to be treated? My current doctors says that the guidelines for treating subclinical hypothyroidism is that TSH must be above 10. My TSH as far as I can remember stays constant between 5-8. I have never seen it exceed 8. If treatment needs to be considered what would the recommended dosage be - 25mcg?
Please advise on this matter.
Also - I am currently taking B12 and Vit D supplements but dont see any cessation in the symptoms.
1. I have done antiTPO and antiTG in the past and both were negative.
2. For adrenal function - what do you suspect. I have suspected that this could be an issue in the past although my current doctor has brushed this away. I have already done a 24 hr urine catecholamine test that came back negative. I have not yet tested for cortisol level - what test would you recommend for that? Do you think this needs to be evaluated?
3. For elevated TSH - does this need to be treated? My current doctors says that the guidelines for treating subclinical hypothyroidism is that TSH must be above 10. My TSH as far as I can remember stays constant between 5-8. I have never seen it exceed 8. If treatment needs to be considered what would the recommended dosage be - 25mcg?
Please advise on this matter.
Also - I am currently taking B12 and Vit D supplements but dont see any cessation in the symptoms.
Brief Answer:
About hypothyroidism treatment:
Detailed Answer:
Hi again,
Guidelines recommend not to start treatment when TSH is from 4.2-10 when there are no symptoms of hypothyroidism, fatigue, mood behavior are suggesting for hypothyroidism so i suggest starting levothyroxine.
Excluding an adrenal insufficiency would be recommended before starting levothyroxine: Cortisol and ACTH level at 8.00 a.m and at 16.00 p.m are recommended.
I would also suggest checking testosterone level if you did not check it until now.
Regards,
Dr.Mirjeta
About hypothyroidism treatment:
Detailed Answer:
Hi again,
Guidelines recommend not to start treatment when TSH is from 4.2-10 when there are no symptoms of hypothyroidism, fatigue, mood behavior are suggesting for hypothyroidism so i suggest starting levothyroxine.
Excluding an adrenal insufficiency would be recommended before starting levothyroxine: Cortisol and ACTH level at 8.00 a.m and at 16.00 p.m are recommended.
I would also suggest checking testosterone level if you did not check it until now.
Regards,
Dr.Mirjeta
Above answer was peer-reviewed by :
Dr. Kampana
Thank you doctor. The testosterone levels are normal based on recent test - i have uploaded the same (Sep thyrocare report).
Regarding Cortisol/ACTH - are these blood/urine/saliva tests? Please clarify.
I will try to get these done and revert back with the results. Thank you.
Regarding Cortisol/ACTH - are these blood/urine/saliva tests? Please clarify.
I will try to get these done and revert back with the results. Thank you.
Brief Answer:
About cortisol/ACTH;
Detailed Answer:
Hi again,
Good news that cortisol level is within the normal ranges.
Cortisol and ACTH are blood tests. The first at 8 a.m should be fasting.
Looking forward to hear from you.
Regards,
Dr.Mirjeta
About cortisol/ACTH;
Detailed Answer:
Hi again,
Good news that cortisol level is within the normal ranges.
Cortisol and ACTH are blood tests. The first at 8 a.m should be fasting.
Looking forward to hear from you.
Regards,
Dr.Mirjeta
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Above answer was peer-reviewed by :
Dr. Yogesh D
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