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Suggest treatment for fatigue and mild muscle pain

Answered by
Dr.
Dr. Shehzad Topiwala

Endocrinologist

Practicing since :2001

Answered : 1663 Questions

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Posted on Thu, 18 Dec 2014 in Thyroid Problem and Hormonal Problems
Question: Hello, I have suffered with fatigue, brain fog and some mild muscle pain for numerous years. I have never been diagnosed with anything. The doctors are perplexed. I have done so much blood work. When this first came on, I was age 27 and just endured a lot of stress about 4 weeks prior to the onset of symptoms. But, when the symptoms surfaced, the problems had been solved and I was VERY HAPPY. I was fit, very happy building my career with my partner and was making an enormous amount of money. I really had it all... So now I am still with the same symptoms and had to stop working years ago due to the symptoms. Recently I saw a new doctor. He said my ADH was below 1 and that this could be the cause of my symptoms. He said the normal range was 1-13. ADH is a hormone, right? Can this hormone cause these symptoms? I am NOT thirsty all of the time and I go the bathroom as a normal person.

SO MY QUESTIONS ARE:
1. What is the normal ADH level for women?
2. Can a low level cause my symptoms: fatigue, brain fog, muscle pain?
3. What else could cause my symptoms?

I already researched what this is:

What happens if I have too little anti-diuretic hormone?

Low levels of anti-diuretic hormone will cause the kidneys to excrete too much water. Urine volume will increase leading to dehydration and a fall in blood pressure. Low levels of anti-diuretic hormone may indicate damage to the hypothalamus or pituitary gland, or primary polydipsia (compulsive or excessive water drinking). In primary polydipsia, the low level of anti-diuretic hormone represents an effort by the body to get rid of excess water. Diabetes insipidus is a condition where you either make too little anti-diuretic hormone (usually due to a tumour, trauma or inflammation of the pituitary or hypothalamus), or where the kidneys are insensitive to it. Diabetes insipidus is associated with increased thirst and urine production.
doctor
Answered by Dr. Shehzad Topiwala 2 hours later
Brief Answer:
ADH

Detailed Answer:
What you have researched on ADH deficiency is correct.

1 Normal ADH level for women is whatever the range your laboratory mentions. Testing methods may vary from lab to lab

2 A low ADH value alone cannot explain your symptoms. It should be used anyway to interpret your symptoms. Because as you have learnt, diabetes insipidus has specific symptoms. It can be tricky to diagnose. And that is why the expertise of an endocrinologist is required who will examine you in person to arrive at or eliminate the possibility of this diagnosis

3 There could be other causes of your complaints.

For one, I see you are taking quite a large amount of vitamin D daily. Such intake can result in dangerously high blood levels of vitamin D. When I see someone like you in my practice I immediately stop the vitamin D and order a blood test for 25 hydroxy vitamin D.


Next, there is no need for iodine in your diet as salt is already fortified with iodine. So unless you absolutely avoid any salt, it is virtually impossible for you to have iodine deficiency.

I also understand you have undergone a whole lot of tests so it is likely your

CBC
CMP
TSH

must have been checked and come back normal.

Please do not worry about a single ADH blood test result abnormality. Have an endocrinologist assess you thoroughly and see if an ADH test is required at all in the first place
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shehzad Topiwala 49 minutes later
The reason for the Vitamin D, 10,000iu daily was because I was severely deficient in Vit D initially, now it is normal. I was also deficient in Vit B's. The Iodine was to have extra immune support. So Iodine is not necessary? What is the best vitamin for building better immune support? Honestly, I am absolutely burnt out on going to doctors. Last year in California, I went to a GP, then he sent me to a Rheumatologist, then he sent me to a Endocrinologist, then he sent me to a Neurologist, who she said would do a muscle biopsy and never did...saying that if it were a muscle disease, that is was incurable, so "what's the point"?. Unreal... Now living back in XXXXXXX and the Internist I went to put me on the 3 vitamins and ordered a muscle biopsy but the general surgeon backed out the day of surgery saying he had never done a muscle biopsy on the upper back. My next attempt at better health is trying Hippocrates and do a detox head to toe. I have had these symptoms since the age of 27. Imagine vacationing in Monaco, Portofino, London, Venice and the list goes on....and still having these symptoms so I don't think it is in my head. I also tried an anti-depressant and that was a horrible experience. I feel I have no where left to turn so this website popped up somehow and I may ask a few doctors to see if someone has come across a patient with my symptoms and figured out exactly what it was or can offer something for me to try that i have not yet done. Thank you
doctor
Answered by Dr. Shehzad Topiwala 8 hours later
Brief Answer:
Follow up

Detailed Answer:
1 Please get your blood levels for 25 hydroxy vitamin d and vitamin B12 checked.

2 Iodine supplementation is not necessary unless you completely abstain from salt

3 There is no specific vitamin recommended to build immune support

4 I am sorry to note your inexplicable symptoms. But I feel it would be worth trying to stop unnecessary supplements, based on the results of the blood tests mentioned above, and on the basis of what I just advised you regarding iodine/vitamins.
If you consume a balanced diet, you are generally expected to get adequate amounts of vitamins/minerals, except perhaps vitamin D for which sunlight is a good source.
However severely low vitamin D levels are best treated with supplements.

I generally recommend one multivitamin tablet to my patients

I hope you get to the bottom of your medical problems soon
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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