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HI Doctor - These are my primary symptoms - 1.

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Posted on Fri, 12 Oct 2018
Question: HI Doctor -

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.

Do you think this really is vitamin deficiency? Please advise if there is any alternate suggestion from your end.

Thank you.


doctor
Answered by Dr. Harshita (2 hours later)
Brief Answer:
All these symptoms point towards a thyroid dysfunction.

Detailed Answer:
Hi, this is Dr. Harshita. Thank you for your question. After very carefully going through your symptoms I would like to suggest that these all point towards a thyroid hormone deficiency. The blood tests which you have attached show a complete T3 and T4 and I would like you to repeat it for free T3 and T4 because that is what matters: the free molecule. TSH is high and the newer criteria for it is 0.3-3 so we have TSH definitely on the higher side. Also, have an anti-TPO antibody test so we can rule out thyroid autoimmune disease. The thyroid is the master gland and will cause fatigue, depression, constipation, weakness, hair loss, cold intolerance, weight gain, slow heart rate and not feeling hungry. You should work with an endocrinologist regarding thyroid dysfunction and he or she can titrate the dose of thyroxine needed for optimum function as it is tricky and it can take a while. We start with 25 mcg and then accordingly increase or decrease based on the blood reports and patients symptoms.

Hope it helps. I would be happy to answer if you have any further queries.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Harshita (17 hours later)
Thank you doctor.

I have attached details TSH reports for July-2017, Aug-2017 and Feb-2018. They contain details on Free T3, Free T4 and TSH.

Please review and advise.

Also - if subclinically hypothyroid - I should be gaining weight correct? I find that I am thin and skinny and unable to put on weight even if i try. Current weight for the past 1 year is averaging between 66- 68kgs.
doctor
Answered by Dr. Harshita (23 minutes later)
Brief Answer:
Tsh is even higher

Detailed Answer:
hey, thanks for the follow-up reports. TSH is even higher and this isn’t a good sign. we need to titrate the dose with your TSH levels. I also noticed homocysteine is high and vitamin B12 is less pointing towards a vitamin b complex deficiency which I advise you to take a supplement. homocysteine is an important molecule and is related to stroke like phenomenon in the body. this vitamin deficiency couple with a subclinical hypothyroidism Maybe causing you to not gain weight as in a subclinical disease all manifestations may not come. hope it helps
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Harshita (25 minutes later)
Thank you doctor. I will follow up with an endocrinologist based on your advice. I have seen them in the past but they are very reluctant to prescribe medication for subclinical condition. They will agree to treat if TSH beyond 10. For anything between 5-10 - they are refusing to treat and I do not want to self medicate as I am not sure what consequences that will have.
doctor
Answered by Dr. Harshita (1 hour later)
Brief Answer:
But the new criteria is 0.3-3

Detailed Answer:
hey dear, you should consult an endocrinologist. they will start treatment. your TSH is increasing and your symptoms very well match with it. hypothyroidism untreated can be a very debilitating disease and depression is its first sign many times. please consult an endocrinologist for the same
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Harshita (1 hour later)
Thank you doctor. I will follow up with an endocrinologist.
doctor
Answered by Dr. Harshita (2 hours later)
Brief Answer:
You are welcome

Detailed Answer:
you are welcome
Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Harshita

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Practicing since :2011

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HI Doctor - These are my primary symptoms - 1.

Brief Answer: All these symptoms point towards a thyroid dysfunction. Detailed Answer: Hi, this is Dr. Harshita. Thank you for your question. After very carefully going through your symptoms I would like to suggest that these all point towards a thyroid hormone deficiency. The blood tests which you have attached show a complete T3 and T4 and I would like you to repeat it for free T3 and T4 because that is what matters: the free molecule. TSH is high and the newer criteria for it is 0.3-3 so we have TSH definitely on the higher side. Also, have an anti-TPO antibody test so we can rule out thyroid autoimmune disease. The thyroid is the master gland and will cause fatigue, depression, constipation, weakness, hair loss, cold intolerance, weight gain, slow heart rate and not feeling hungry. You should work with an endocrinologist regarding thyroid dysfunction and he or she can titrate the dose of thyroxine needed for optimum function as it is tricky and it can take a while. We start with 25 mcg and then accordingly increase or decrease based on the blood reports and patients symptoms. Hope it helps. I would be happy to answer if you have any further queries.