Brief Answer: Consider also other causes of fatigue Detailed Answer: Dear patient, Thanks for the query. Fatigue, feeling sluggish and having difficulty with daily activities culd come from multiple causes: hypothyroidism is one of them, but the most common of them all is deconditioning with metabolic syndrome, that is weakness from not doing much regular exercise and associated obesity; with obesity, there are other conditions that can increase the symptoms, including impaired concentration, such as obstructive sleep apnea. Psychologic causes of these symptoms include depression, which should also be entertained as you refer yourself as being "not happy or blue". Hypothyroidism itself can be associated with depression. So I would recommend: 1) Screening for sleep apnea 2) Intensive healthy diet and exercise plan, to lose at least 2-4 pounds per month 3) Continue regulating thyroid meds until TSH is normal 4) Have you provider do a PHQ-9 questionaire (screening for depression) and if a high score obtained, may consider an anti-depressant trial. 5) Recheck hemoglobin given your history of anemia, and a Hemoglobin A1c to rule out diabetes Hope this helps, wish you the very best, Dr Brenes-Salazar MD Mayo Clinic MN Cardiology

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Brief Answer: See below Detailed Answer: Dear XXXXXXX Thanks for the follow up. Metabolic syndrome: a generalized, inflammatory metabolic condition of innapropiate utilization of glucose and fatty acids, mainly as a consequence of obesity and insulin resistance, that can lead to diabetes, high blood pressure, and elevated cholesterol levels. Deconditioning: process in which the muscles of the body become weak, or atrophied because of lack of use, and become metabollically inefficient, instead of using fatty acids as fuel, they start using glucose, which is not the best fit for a muscle. Hope that is clearer, it is a simplified explanation on these processes, which are far more complex than that. Best regards, Dr Brenes-Salazar

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