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Suggest Treatment For Excessive Weight Gain After Child Birth

Posted on Wed, 22 Jul 2015

Question: Gained lot weight in few months after birth of my first child 11years ago. After birth of my second child 7 years ago (strugglling for almost 6 years) I was diagnosed for hypothyroid 5 years back. Since then have never been well. Fatigued, brainfog, muscle cramps, numbness, tingling, never ending headache( have migraine since childhood), joint aches and almost all other symptoms. I was diagnosed with fibromyalgia 3 yrs ago. Last month Tsh was around 7. Am on thyobuild 200 - 300 mcg. 2 years ago also had a knee dislocation without any injury or accident. I exercise as much as possible with aches and pains, am on strict and healthy diet of eggs and salad only for last 3 years but still unable to lose weight. It feels I am just dragging and not living. Was 58 kgs went up to 96. Now am at 85 kgs for last 2 years.Please help.

Have also developed modrate hernia, so always bloated and heavy, my period are irregular now, initially bled for 3 years continously, then no periods for 2 years and now irregular for 2 years.Difficulty swallowing/ feel choking all the time, can't lie down straight have to sleep upright. High pulse rate always. Have severe back ache, numbness in back and hip area, almost bent takes time to straighten up. Also have sciatica symptoms. vitamin D is around 4. Feel weakness in left side of body. Have severe skin allergy. Please help.

Medicines--
Thyobuild 200- 300mcg, naprosyn 500,betacap tr 40 twice a day, rarely spasmo proxyvon. Prescribed inj depomedrol 40. Lyrica, sebelium stopped these 2 after gaining further 10 kgs, by neurologist. Want to try thyro3.

Answered by Dr. Minal Mohit (24 hours later)

Brief Answer:
seems to be a case of exogenous obesity.

Detailed Answer:
dear ma'm, hi! welcome to HCM.
Let me try and help you to the best of my ability. I went through your reports, and primarily nothing seems grossly wrong though there are issues.
1. TSH is high
2. LPa is high
3. Vitamin D is low.
Now can i ask you for -
1. LH
2. FSH
3. Estradiol
4. Cortisol
5. prolactin
6. Fasting and post meal sugars
7. HbA1c
kindly send me the reports from a fasting 8 am blood sample . I might require your MRI brain with contrast for pituitary as well.
regards!
regards!

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Minal Mohit (7 hours later)

Hello Dr XXXXXXX
Thanks for the reply.
For the above tests, will send reports once I receive them. Also is there any prerequisite for these tests. As my periods are not regular when can I get LH, FSH, Prolactin done? Also is serum cortisol is required and for what time of the day? For MRI can only be done on Monday and will get back.
Any special instruction are welcome.
Regards
XXXX

Answered by Dr. Minal Mohit (38 hours later)

Brief Answer:
Fasting 8 AM sample is required for blood tests

Detailed Answer:
Dear Ma'm, As your periods are not regular, you can do the tests any day, but fasting 8 AM, sample is required. Same for Cortisol , fasting 8 AM sample to be given.
MRI with contrast for pituitary is the requirement.
regards!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Minal Mohit (16 days later)

Hello Dr XXXXXXX

Sorry for the delay, As per your recommendations I have undergone all the tests and the results are as follows.

FSH; FOLLICLE STIMULATING HORMONE, SERUM @ (CLIA) 26.94     mIU/mL

LH; LUTEINISING HORMONE, SERUM @ (CLIA) 9.49     mIU/mL

CORTISOL, MORNING, SERUM @ (CLIA) 12.00     µg/dL
(Cortisol History year 2012 morn sample Value 22.40, eve sample val 14.01)

PROLACTIN, SERUM @ (CLIA) Interpretation 28.83     ng/mL
(Prolactin History Yr 2010 val 2.49, Yr aug/2011 val 4.9, Yr dec/2011 val 9.5)

HbA1c (GLYCOSYLATED HEMOGLOBIN), BLOOD 5.60     %
@(HPLC, NGSP certified)

GLUCOSE, FASTING (F) AND POST MEAL, PLASMA (Hexokinase)
Glucose Fasting 126.00 mg/dL

Glucose (PP) 83.00 mg/dL

ANTI THYROID ANTIBODIES PANEL, SERUM (CLIA)
(Always has been high never came down to normal, )

Thyroglobulin Antibody; Anti Tg @ 131.80 IU/mL
Peroxidase Antibody; Anti- TPO @ >1300.0 U/mL

EXAMINATION PERFORMED-MRI BRAIN WITH SELLA DYNAMIC CONTRAST STUDY

Multiplanar high resolution MR scanning of the brain and sella turcica was done on a 1.5 Tesla Intera MR scanner to obtain the following sequences:
T1SE, T2 TSE & T2 FLAIR sections in the axial plane. Thin section high-resolution SE T1W, TSE T2 & T1 dynamic post contrast sections though sella turcica in sagittal and coronal planes.

Findings:

The study reveals partially empty sella turcica with CSF filled cistern projecting in the pituitary fossa , the Pituitary gland appears normal in size, and signal intensity with no hypointense nodular lesion seen , the pituitary gland measures 9.6(tr.) x4.9(cc)x 10.6(Ap) mm in size with concave upper margins . Post contrast dynamic study shows homogenous enhancement of the gland . Posterior pituitary appears as a normal T1 hyperintense speck. Infundibulum is central and appears normal in thickness. Optic chiasma appears unremarkable. The para/suprasellar regions appear unremarkable.

Bilateral cerebral parenchyma is normal in morphology & signal intensity with preserved Grey-white matter differentiation. No evidence of restricted diffusion seen on DWI and no abnormal blooming on GRE.
Basal ganglia and thalami are normal in morphology & signal intensity.

Both lateral and third ventricles are normal. Septum is in midline. Cortical sulci, Basal cisterns & sylvian fissures are normal. Corpus callosum is normal in thickness & signal intensity.

Brainstem is in midline and reveals normal signal intensity. Fourth ventricle is normal.
Cerebellum reveals normal in morphology & signal intensity. Cerebral & cerebellar peduncles are normal.

Intracranial vascular flow voids are preserved. Hippocampus & parahippocampal region are normal. cavernous sinuses are normal. Marrow of the cranial vault appears normal.

IMPRESSION: Partially empty sella turcica, rest no significant abnormality detected .The pituitary gland appears normal.

Reports are also uploaded on this site. Hope these will help in diagnosing my condition.

Regards
XXXX

Answered by Dr. Minal Mohit (12 hours later)

Brief Answer:
partial empty sella.

Detailed Answer:
Dear XXXXXXX hi, Your reports are suggestive of two things.
1. high FSH & low e2
2. Partial empty sella.
so now, high FSh and low e2 explains your irregular periods, and your gain in weight.
partial empty sella explains your lethargy and your remaining symptoms.
now what concerns you is your treatment.
best option would be to see a doctor /endocrinologist personally. you need to discuss the plan.
regards!

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Minal Mohit (38 minutes later)

Hello Dr XXXXXXX

Thanks for the reply.
Is my headache and vision problems accredited to partially empty sella ?
Can you suggest me some medicine for weight loss.

Well I have been to many endocrinologist/ gynaecologist/ neurologists buy was unable to get appropriate treatment. So I turned towards online consultation in hope of getting resolutions.
Can you please suggest some treatment for my problems.

Regards
XXXX

Answered by Dr. Minal Mohit (1 hour later)

Brief Answer:
Needs counselling & discussion.

Detailed Answer:
Dear XXXXXXX headache and vision is not due to empty sella but due to low hormones.
weight loss medicines are many but work with diet and exercise. metformin, orlistat and liraglutide are few to name.
treatment is actually simple but needs personal discussion.
I would recommend do some net surfing and some home work on empty sella and premature ovarian failure. After that arrange a teleconsultation with me through HCM. May be I can help.
regards!

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. Prasad