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Are There Any Risks Of Thromboembolism Associated With Thyroid Hormone Replacement?
Question: I've just been diagnosed with Hashimoto's thyroiditis. Doctors considering standard thyroid hormone replacement, but I have an extraordinarily high risk of thromboembolism (23% on genetic testing), so are concerned about risks. Also mentioned LDN as an alternative/complementary approach. I am a 50 year old normal weight woman with low blood sugar, slightly elevated cholesterol, low Vitamin D, reasonably active and fit. The specific genetic anomaly is Factor V Leiden, with a CT (C to V) variant.
Brief Answer:
Thyroid
Detailed Answer:
I understand your concerns.
Thyroid hormone replacement is not known to be associated with an elevated risk of thromboembolism directly in and of itself.
I see you are a healthy active adult. I am assuming you are on treatment for the low vitamin D levels. Lowering cholesterol can be accomplished with dietary and lifestyle changes. Whether or not medication is required for this purpose, is to be determined using a host of factors which you can discuss with your doctor in person.
I am familiar with the implications of Factor V Leiden. However, rest assured that taking thyroid hormone replacement with levo thyroxine in correct doses will not worsen your risk of thromboembolic events.
Also first be certain that your TSH is high enough to warrant treatment in the first place. If it is only mildly elevated then I recommend getting thyroid autoantibodies checked. I am referring to anti TPO (thyroid peroxidase) and anti thyroglobulin levels. It is likely you have already had these done and it must have been on the basis of this that you have been told to have Hashimoto's thyroiditis, although the diagnosis can be made with reasonable certainty without these tests too.
Taking levo thyroxine in appropriate doses is the correct way to treat this condition. The ATA (American Thyroid Association) guidelines have time and again reinforced the fact that levo thyroxine is the best way to treat an underactive thyroid.
I am not aware of any role of LDN in managing this condition. To the best of my knowledge there is no published scientific evidence that supports LDN for treating hypothyroidism
Thyroid
Detailed Answer:
I understand your concerns.
Thyroid hormone replacement is not known to be associated with an elevated risk of thromboembolism directly in and of itself.
I see you are a healthy active adult. I am assuming you are on treatment for the low vitamin D levels. Lowering cholesterol can be accomplished with dietary and lifestyle changes. Whether or not medication is required for this purpose, is to be determined using a host of factors which you can discuss with your doctor in person.
I am familiar with the implications of Factor V Leiden. However, rest assured that taking thyroid hormone replacement with levo thyroxine in correct doses will not worsen your risk of thromboembolic events.
Also first be certain that your TSH is high enough to warrant treatment in the first place. If it is only mildly elevated then I recommend getting thyroid autoantibodies checked. I am referring to anti TPO (thyroid peroxidase) and anti thyroglobulin levels. It is likely you have already had these done and it must have been on the basis of this that you have been told to have Hashimoto's thyroiditis, although the diagnosis can be made with reasonable certainty without these tests too.
Taking levo thyroxine in appropriate doses is the correct way to treat this condition. The ATA (American Thyroid Association) guidelines have time and again reinforced the fact that levo thyroxine is the best way to treat an underactive thyroid.
I am not aware of any role of LDN in managing this condition. To the best of my knowledge there is no published scientific evidence that supports LDN for treating hypothyroidism
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much for your detailed replay. I will confess that I had low expectations of this model of online health care delivery (am a medical psychologist, myself) and as a result did not put as much information into the original query as would have been fair to you, or in my best interests. Only my apprehension about the LDN as a primary mode of treatment had me looking for credible resources on a Saturday night.
Here’s all the other information I think might be helpful.
Results:
Date Result Name Ind Value Ref Range
11/07/2014 10:03 Testost Total <20 ng/dL (14 - 76)
11/07/2014 10:03 Estradiol Level 23 pg/mL
11/07/2014 10:03 Sex Hormone Binding Glob 66 nMol/L(18 - 144)
11/07/2014 10:03 Anti-TPO (H) >1000 unit(s) ( - <=100)
11/07/2014 10:03 Progesterone Level 0.3 ng/mL (*** - )
11/07/2014 10:03 Vit D25 OH, Total 46 ng/mL (30-100 - )
11/07/2014 10:03 Vit D 25 OH, D3 46 ng/mL
11/07/2014 10:03 Vit D 25 OH, D2 <4 ng/mL
Date Result Name Ind Value Ref Range
11/07/2014 10:03 Sodium 139 mMol/L (133 - 145)
11/07/2014 10:03 Potassium 3.9 mMol/L (3.1 - 5.1)
11/07/2014 10:03 Chloride 103 mMol/L (97 - 108)
11/07/2014 10:03 Bicarbonate 32 mMol/L (22 - 32)
11/07/2014 10:03 AGAP 4.0 mMol/L (4.0 - 16.0)
11/07/2014 10:03 Glucose Level (L) 57 mg/dL (70 - 100)
11/07/2014 10:03 BUN 18 mg/dL (5 - 22)
11/07/2014 10:03 Creatinine 0.6 mg/dL (0.4 - 1.2)
11/07/2014 10:03 GFR Calc >60 mL/min/1.73 m2
11/07/2014 10:03 Calcium 9.4 mg/dL (8.4 - 10.2)
11/07/2014 10:03 Protein 6.9 gm/dL (6.0 - 8.3)
11/07/2014 10:03 Albumin 4.5 gm/dL (3.7 - 5.5)
11/07/2014 10:03 Bili Total 0.4 mg/dL (0.3 - 1.4)
11/07/2014 10:03 Chol (H) 206 mg/dL (100 - 200)
11/07/2014 10:03 Tg 108 mg/dL (40 - 150)
11/07/2014 10:03 HDL 62 mg/dL
11/07/2014 10:03 LDL 128 mg/dL
11/07/2014 10:03 Alk Phos 50 Units/L (37 - 117)
11/07/2014 10:03 ALT 16 Units/L (7 - 52)
11/07/2014 10:03 AST 21 Units/L (12 - 39)
11/07/2014 10:03 FT3 3.0 pg/mL (2.3 - 4.2)
11/07/2014 10:03 FT4 1.14 ng/dL (0.62 - 1.57)
11/07/2014 10:03 TSH 1.372 mcIntUnits/mL (0.350 - 5.500)
11/07/2014 10:03 WBC 6.30 10^3/cmm (4.00 - 11.00)
11/07/2014 10:03 RBC 4.50 10^6/cmm (3.80 - 5.20)
11/07/2014 10:03 Hgb 13.9 gm/dL (11.3 - 15.2)
11/07/2014 10:03 Hct 41 % (33 - 45)
11/07/2014 10:03 MCV 90 fL (80 - 96)
11/07/2014 10:03 MCH 31 pg (27 - 33)
11/07/2014 10:03 MCHC 34 gm/dL (32 - 36)
11/07/2014 10:03 Platelet 199.0 10^3/cmm (150.0 - 400.0)
11/07/2014 10:03 RDW 12.3 % (11.0 - 16.0)
11/07/2014 10:03 MPV 9 fL
Upon looking at the medical genetic profile run a year ago, I see another entry for a genetic alteration pertaining to VT, in addition to Factor V Leiden:
Prothrombin 20210A G to A GG Genotype
Looking at the genetic report, I see that I was mistaken. It did not predict a 23% risk of VT, but 26.9% risk.
Last note on labs: I did a cortisol sampling study a week ago (fasting/a.m., noon, afternoon, bedtime). Those results are still pending.
Brief history:
Yes, you are correct, I am supplementing with Vitamin D, which keeps me in the low normal range if I am quite diligent – as in this most recent study.
My family history is notable. No woman in my mother’s line has seen her 60th birthday, and relatively few of the men. All of them died of cardiovascular problems (heart attack/stroke), often with a chaser of diabetes and alcoholism.
My mother died of a heart attack at 36, though her circumstances were exceptional. She contracted rheumatic fever as a child and sustained kidney and heart damage requiring the use of dialysis in the 1970s, when the process was more difficult to tolerate. She died of perhaps her 5th or 6th heart attack. Because they all died when I was a child, I have no autopsy records to go on.
My father is still alive, but in his 70s has exhausted his potential to have future bypasses after four surgeries each involving multiple bypasses. He has also had several strokes. The history on my father’s line is less dramatic than on my mother’s, but is still quite strong.
In addition to all the cardiovascular risk, Type II diabetes runs on both sides of my family. I say this only because I have over decades clocked randomly low blood sugars (as in these Nov 7 labs), fasting, not fasting and with glucose challenge. (On one glucose challenge test 15 years ago, dropped into the 30s before they stopped that test.) Nothing has been done about this because my PCP/office partner does not believe in hypoglycemia, except that resulting from imperfect management of diabetes. The genetic testing shows me to be at elevated risk of Type II diabetes.
I have been largely vegetarian most of my life and exercised regularly in the face of all of this, and historically my BP, HR and cholesterol numbers have been enviably healthy. This began to change in the last few years as I approached menopause. The thinking has been that the numbers degraded as protective hormonal influences were lost with menopause - there were no corresponding changes in my lifestyle or diet to explain the declining numbers.
Noting these changes and the upcoming 50th birthday, I had genetic testing done as well as a cardiac stress test in February. No structural or functional cardiac anomalies were noted. That said, the test was aborted as my blood pressure increased rather dramatically on the treadmill. I was put on a low dose of propanolol BID, my only regular medication at this time.
I am aware that the overall thyroid hormone values are still in the normal range. That said, I have a wide array of symptoms I now realize are attributable to the combination of menopause/Hashimoto’s –
Low energy
Sleep disturbance
Low libido
Thinning hair
Hot flashes AND insensitivity to cold
Extremely dry skin
Weight gain (8 lbs in last 18 months)
Depression/anxiety
Constipation
Joint and muscle pain
Puffiness of the face
Tender and slightly swollen neck
Intermittently hoarse voice
I actually was beginning to be concerned I was developing obstructive sleep apnea, because of the visceral sense of an obstruction in the airway. The enlarged thyroid makes more sense, as my husband indicates no increase in snoring. My patients are the ones who picked up on the hoarse voice, frequently asking me if I had a cold when I did not. That did not register until the Hashimoto’s diagnosis.
Because the combination of all of this is intruding substantially into my quality of life, I would like to begin thyroid hormone replacement therapy, if it does not appreciably increase my risk of stroke.
With the additional information included, would you still recommend that course?
Are there any other medical treatment or lifestyle changes you would recommend?
Do you see any merit to the LDN that that has been recommended for me to start next week?
Finally, since all of this has been done through two exceptional PCPs who may have less than personal objectivity because they are also friends of mine, would you recommend an endocrinologist over a PCP to complete the workup and begin intervention? (And if so, can you recommend someone convenient to XXXXXXX AL?)
Thank you so much. I hope that all your other consults are less detail oriented than I am. Your response did impress me, which is why you "won" the full play version.
XXXXXXX
Here’s all the other information I think might be helpful.
Results:
Date Result Name Ind Value Ref Range
11/07/2014 10:03 Testost Total <20 ng/dL (14 - 76)
11/07/2014 10:03 Estradiol Level 23 pg/mL
11/07/2014 10:03 Sex Hormone Binding Glob 66 nMol/L(18 - 144)
11/07/2014 10:03 Anti-TPO (H) >1000 unit(s) ( - <=100)
11/07/2014 10:03 Progesterone Level 0.3 ng/mL (*** - )
11/07/2014 10:03 Vit D25 OH, Total 46 ng/mL (30-100 - )
11/07/2014 10:03 Vit D 25 OH, D3 46 ng/mL
11/07/2014 10:03 Vit D 25 OH, D2 <4 ng/mL
Date Result Name Ind Value Ref Range
11/07/2014 10:03 Sodium 139 mMol/L (133 - 145)
11/07/2014 10:03 Potassium 3.9 mMol/L (3.1 - 5.1)
11/07/2014 10:03 Chloride 103 mMol/L (97 - 108)
11/07/2014 10:03 Bicarbonate 32 mMol/L (22 - 32)
11/07/2014 10:03 AGAP 4.0 mMol/L (4.0 - 16.0)
11/07/2014 10:03 Glucose Level (L) 57 mg/dL (70 - 100)
11/07/2014 10:03 BUN 18 mg/dL (5 - 22)
11/07/2014 10:03 Creatinine 0.6 mg/dL (0.4 - 1.2)
11/07/2014 10:03 GFR Calc >60 mL/min/1.73 m2
11/07/2014 10:03 Calcium 9.4 mg/dL (8.4 - 10.2)
11/07/2014 10:03 Protein 6.9 gm/dL (6.0 - 8.3)
11/07/2014 10:03 Albumin 4.5 gm/dL (3.7 - 5.5)
11/07/2014 10:03 Bili Total 0.4 mg/dL (0.3 - 1.4)
11/07/2014 10:03 Chol (H) 206 mg/dL (100 - 200)
11/07/2014 10:03 Tg 108 mg/dL (40 - 150)
11/07/2014 10:03 HDL 62 mg/dL
11/07/2014 10:03 LDL 128 mg/dL
11/07/2014 10:03 Alk Phos 50 Units/L (37 - 117)
11/07/2014 10:03 ALT 16 Units/L (7 - 52)
11/07/2014 10:03 AST 21 Units/L (12 - 39)
11/07/2014 10:03 FT3 3.0 pg/mL (2.3 - 4.2)
11/07/2014 10:03 FT4 1.14 ng/dL (0.62 - 1.57)
11/07/2014 10:03 TSH 1.372 mcIntUnits/mL (0.350 - 5.500)
11/07/2014 10:03 WBC 6.30 10^3/cmm (4.00 - 11.00)
11/07/2014 10:03 RBC 4.50 10^6/cmm (3.80 - 5.20)
11/07/2014 10:03 Hgb 13.9 gm/dL (11.3 - 15.2)
11/07/2014 10:03 Hct 41 % (33 - 45)
11/07/2014 10:03 MCV 90 fL (80 - 96)
11/07/2014 10:03 MCH 31 pg (27 - 33)
11/07/2014 10:03 MCHC 34 gm/dL (32 - 36)
11/07/2014 10:03 Platelet 199.0 10^3/cmm (150.0 - 400.0)
11/07/2014 10:03 RDW 12.3 % (11.0 - 16.0)
11/07/2014 10:03 MPV 9 fL
Upon looking at the medical genetic profile run a year ago, I see another entry for a genetic alteration pertaining to VT, in addition to Factor V Leiden:
Prothrombin 20210A G to A GG Genotype
Looking at the genetic report, I see that I was mistaken. It did not predict a 23% risk of VT, but 26.9% risk.
Last note on labs: I did a cortisol sampling study a week ago (fasting/a.m., noon, afternoon, bedtime). Those results are still pending.
Brief history:
Yes, you are correct, I am supplementing with Vitamin D, which keeps me in the low normal range if I am quite diligent – as in this most recent study.
My family history is notable. No woman in my mother’s line has seen her 60th birthday, and relatively few of the men. All of them died of cardiovascular problems (heart attack/stroke), often with a chaser of diabetes and alcoholism.
My mother died of a heart attack at 36, though her circumstances were exceptional. She contracted rheumatic fever as a child and sustained kidney and heart damage requiring the use of dialysis in the 1970s, when the process was more difficult to tolerate. She died of perhaps her 5th or 6th heart attack. Because they all died when I was a child, I have no autopsy records to go on.
My father is still alive, but in his 70s has exhausted his potential to have future bypasses after four surgeries each involving multiple bypasses. He has also had several strokes. The history on my father’s line is less dramatic than on my mother’s, but is still quite strong.
In addition to all the cardiovascular risk, Type II diabetes runs on both sides of my family. I say this only because I have over decades clocked randomly low blood sugars (as in these Nov 7 labs), fasting, not fasting and with glucose challenge. (On one glucose challenge test 15 years ago, dropped into the 30s before they stopped that test.) Nothing has been done about this because my PCP/office partner does not believe in hypoglycemia, except that resulting from imperfect management of diabetes. The genetic testing shows me to be at elevated risk of Type II diabetes.
I have been largely vegetarian most of my life and exercised regularly in the face of all of this, and historically my BP, HR and cholesterol numbers have been enviably healthy. This began to change in the last few years as I approached menopause. The thinking has been that the numbers degraded as protective hormonal influences were lost with menopause - there were no corresponding changes in my lifestyle or diet to explain the declining numbers.
Noting these changes and the upcoming 50th birthday, I had genetic testing done as well as a cardiac stress test in February. No structural or functional cardiac anomalies were noted. That said, the test was aborted as my blood pressure increased rather dramatically on the treadmill. I was put on a low dose of propanolol BID, my only regular medication at this time.
I am aware that the overall thyroid hormone values are still in the normal range. That said, I have a wide array of symptoms I now realize are attributable to the combination of menopause/Hashimoto’s –
Low energy
Sleep disturbance
Low libido
Thinning hair
Hot flashes AND insensitivity to cold
Extremely dry skin
Weight gain (8 lbs in last 18 months)
Depression/anxiety
Constipation
Joint and muscle pain
Puffiness of the face
Tender and slightly swollen neck
Intermittently hoarse voice
I actually was beginning to be concerned I was developing obstructive sleep apnea, because of the visceral sense of an obstruction in the airway. The enlarged thyroid makes more sense, as my husband indicates no increase in snoring. My patients are the ones who picked up on the hoarse voice, frequently asking me if I had a cold when I did not. That did not register until the Hashimoto’s diagnosis.
Because the combination of all of this is intruding substantially into my quality of life, I would like to begin thyroid hormone replacement therapy, if it does not appreciably increase my risk of stroke.
With the additional information included, would you still recommend that course?
Are there any other medical treatment or lifestyle changes you would recommend?
Do you see any merit to the LDN that that has been recommended for me to start next week?
Finally, since all of this has been done through two exceptional PCPs who may have less than personal objectivity because they are also friends of mine, would you recommend an endocrinologist over a PCP to complete the workup and begin intervention? (And if so, can you recommend someone convenient to XXXXXXX AL?)
Thank you so much. I hope that all your other consults are less detail oriented than I am. Your response did impress me, which is why you "won" the full play version.
XXXXXXX
Brief Answer:
Follow up
Detailed Answer:
1 I have reviewed all the new information and comments.
2 Your TSH, free T4 and free T3 are normal even though the thyroid antibodies are positive. In this situation, thyroid hormone replacement is not begun. Unless the TSH rises above the normal range, a legitimate case for treatment with levo thyroxine cannot be made. The only exception to this is pregnancy which we will not discuss as it does not apply to you.
3 The low glucoses merit thorough evaluation.
4 Kindly see an Endocrinologist for comprehensive and systematic assessment of your hormone-related complaints.
I am providing a list of ones near you. Please verify if they are Board Certified in Endocrinology before scheduling an appointment.
1 Arguello, XXXXXXX MD,FACE 2000 6th Avenue South 4th Floor XXXXXXX AL 35213 (205)996-4005
2 Bahl, XXXXXXX MD FOT 702
1530 3rd Avenue S XXXXXXX AL 35294 205 - 934-4171
3 DeAtkine, Jr., XXXXXXX MD,FACE 805 St. Vincent's Drive
Suite 500 XXXXXXX AL 35205 (205) 313-2650
4 Garvey, W. XXXXXXX MD,FACE U of Alabama at XXXXXXX
1675 University Blvd XXXXXXX AL 35294-3360 (205) 996-7433
5 Goncalves, Edison, MD,FACE 2022 Brookwood Medical Center Drive
ACC - Suite # 408 XXXXXXX AL 35209-6807 (205) 870-8112
6 Kreisberg, XXXXXXX MD Baptist Health System
840 Montclair Rd. Suite 317 XXXXXXX AL 35213 (205) 592-5135
7 Osburne, XXXXXXX MD Simon-Williamson Clinic
Apt 425 XXXXXXX AL 35211 (404) 355-4393
8 Ovalle, XXXXXXX MD,FACE 510 20th Street South
FOT Suite 702 XXXXXXX AL 35294 (205) 975-2422
9 Pino, XXXXXXX MD,FACE 2022 Brookwood Medical Center Drive
Suite 307 XXXXXXX AL 35209-6807 (205) 877-2960
10 Porterfield, Jr., XXXXXXX MD Endocrine Surgery, UAB Department of Surgery
1530 3rd Avenue South, KB 417 XXXXXXX AL 35294 (205) 934-9086
11 Rizo, Ivania, MD 510 20th Street South
FIT 702 XXXXXXX AL 35294-3407
12 Rosenthal, XXXXXXX MD,FACE 2000 6th Avenue South XXXXXXX AL 35233-2110 (205) 801-8495
13 Rowland, XXXXXXX MD Brookwood Medical Plaza
513 Brookwood Rd, Suite 200 XXXXXXX AL 35209 (205) 802-6722
14 Sohn, XXXXXXX MD POB III, Suite 300
833 St. Vincent's Drive XXXXXXX AL 35205 (205) 918-4075
15 Taunton, XXXXXXX MD,FACE 840 Montclair Road
Suite 310 XXXXXXX AL 35213 (205) 599-3000
16 Valderrama, XXXXXXX MD 800 montclair road,
POB 860, Suite 450 XXXXXXX AL 35007 (205) 599-2450
17 Vargas, XXXXXXX MD,FACE 2022 Brookwood Medical Center Drive
Suite 307 XXXXXXX AL 35209-6807 (205) 877-2960
18 XXXXXXX XXXXXXX MD FOT 702
510 20th St. S XXXXXXX AL 35294 (205) 934-4174
Follow up
Detailed Answer:
1 I have reviewed all the new information and comments.
2 Your TSH, free T4 and free T3 are normal even though the thyroid antibodies are positive. In this situation, thyroid hormone replacement is not begun. Unless the TSH rises above the normal range, a legitimate case for treatment with levo thyroxine cannot be made. The only exception to this is pregnancy which we will not discuss as it does not apply to you.
3 The low glucoses merit thorough evaluation.
4 Kindly see an Endocrinologist for comprehensive and systematic assessment of your hormone-related complaints.
I am providing a list of ones near you. Please verify if they are Board Certified in Endocrinology before scheduling an appointment.
1 Arguello, XXXXXXX MD,FACE 2000 6th Avenue South 4th Floor XXXXXXX AL 35213 (205)996-4005
2 Bahl, XXXXXXX MD FOT 702
1530 3rd Avenue S XXXXXXX AL 35294 205 - 934-4171
3 DeAtkine, Jr., XXXXXXX MD,FACE 805 St. Vincent's Drive
Suite 500 XXXXXXX AL 35205 (205) 313-2650
4 Garvey, W. XXXXXXX MD,FACE U of Alabama at XXXXXXX
1675 University Blvd XXXXXXX AL 35294-3360 (205) 996-7433
5 Goncalves, Edison, MD,FACE 2022 Brookwood Medical Center Drive
ACC - Suite # 408 XXXXXXX AL 35209-6807 (205) 870-8112
6 Kreisberg, XXXXXXX MD Baptist Health System
840 Montclair Rd. Suite 317 XXXXXXX AL 35213 (205) 592-5135
7 Osburne, XXXXXXX MD Simon-Williamson Clinic
Apt 425 XXXXXXX AL 35211 (404) 355-4393
8 Ovalle, XXXXXXX MD,FACE 510 20th Street South
FOT Suite 702 XXXXXXX AL 35294 (205) 975-2422
9 Pino, XXXXXXX MD,FACE 2022 Brookwood Medical Center Drive
Suite 307 XXXXXXX AL 35209-6807 (205) 877-2960
10 Porterfield, Jr., XXXXXXX MD Endocrine Surgery, UAB Department of Surgery
1530 3rd Avenue South, KB 417 XXXXXXX AL 35294 (205) 934-9086
11 Rizo, Ivania, MD 510 20th Street South
FIT 702 XXXXXXX AL 35294-3407
12 Rosenthal, XXXXXXX MD,FACE 2000 6th Avenue South XXXXXXX AL 35233-2110 (205) 801-8495
13 Rowland, XXXXXXX MD Brookwood Medical Plaza
513 Brookwood Rd, Suite 200 XXXXXXX AL 35209 (205) 802-6722
14 Sohn, XXXXXXX MD POB III, Suite 300
833 St. Vincent's Drive XXXXXXX AL 35205 (205) 918-4075
15 Taunton, XXXXXXX MD,FACE 840 Montclair Road
Suite 310 XXXXXXX AL 35213 (205) 599-3000
16 Valderrama, XXXXXXX MD 800 montclair road,
POB 860, Suite 450 XXXXXXX AL 35007 (205) 599-2450
17 Vargas, XXXXXXX MD,FACE 2022 Brookwood Medical Center Drive
Suite 307 XXXXXXX AL 35209-6807 (205) 877-2960
18 XXXXXXX XXXXXXX MD FOT 702
510 20th St. S XXXXXXX AL 35294 (205) 934-4174
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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