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What Causes Loss Of Balance, Fatigue And Dizziness?
Question: My daughter, 34 years old, has had almost one year of symptoms of off balance, fatigue, mentally dull, dizzy. She is hypothyroid takes levothyroxine, tsh wnl. Had a urine sodium low result, prescribed 3 gms sodium- helpful. Prior to sodium was hypovolemic and + orthostatics. EKG WNL, Stress test WNL. ECHO OK. All serum labs WNL, many times checked over he last year. EYE dr. exam revealed nothing out of ordinary. Can't drive at night withglare of headlights. Especially bad and disoriented in rain at night. Flashes of sunlight through trees makes her pull over - it exacerbates symptoms. She is vegetarian. B12 OK, Iron OK, Blood pressures run 90s to 100 systolic. Prior to sodum she would become tachy with the orthostatic hypotension. Any suggestions? She eats a very healthy diet.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome to HCM!
I carefully reviewed the uploaded medical tests and would like to explain that as they seem quite normal, your daughter's clinical symptomatology (off balance, fatigue, mentally dull, dizzy) seems most probably related to some kind of orthostatic intolerance.
Whether this is primary related to a nervous vegetative system disorder or is triggered by secondary factors like hypothyroidism, it remains to be clarified by additional tests.
Hypothyroidism may lead to decreased catecholamines effectiveness, decreased blood vessels reactivity, hypovolemia and hypotension.
It is necessary to properly review thyroid function status (including also FT3, FT4) and to adequately adjust levothyroxine daily dose.
Regarding orthostatic intolerance a Head up Tilt test is necessary for confirming the diagnosis.
In such case some precautions should be considered: taking plenty of fluids; avoiding prolonged upright positions, overcrowded places, high humidity and heated environment, etc.
Certain drugs may be helpful as well.
Hope to have been helpful!
In case of any further uncertainties, feel free to ask me again!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome to HCM!
I carefully reviewed the uploaded medical tests and would like to explain that as they seem quite normal, your daughter's clinical symptomatology (off balance, fatigue, mentally dull, dizzy) seems most probably related to some kind of orthostatic intolerance.
Whether this is primary related to a nervous vegetative system disorder or is triggered by secondary factors like hypothyroidism, it remains to be clarified by additional tests.
Hypothyroidism may lead to decreased catecholamines effectiveness, decreased blood vessels reactivity, hypovolemia and hypotension.
It is necessary to properly review thyroid function status (including also FT3, FT4) and to adequately adjust levothyroxine daily dose.
Regarding orthostatic intolerance a Head up Tilt test is necessary for confirming the diagnosis.
In such case some precautions should be considered: taking plenty of fluids; avoiding prolonged upright positions, overcrowded places, high humidity and heated environment, etc.
Certain drugs may be helpful as well.
Hope to have been helpful!
In case of any further uncertainties, feel free to ask me again!
Kind regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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