Dr. Bindiya Thakkar
Endocrinology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Education:
DM Endocrine and Diabetes,USA, Harvard University and Boston University
Professional Bio:
Dr.Bindiya Thakkar is a highly skilled and established physician in the field of Diabetology, Endocrinology. She listens to all the patient queries deliberately and is an expert in devising a proper treatment plan.
This doctor is not available for online consultations on the platform anymore.
Dr. Bindiya Thakkar
Medically reviewed by
Patient's Query
Hello doctor,
A little over two years ago, I experienced some stress in my life that resulted in a high level of anxiety and depression. I was prescribed Paxil and took it for one year. At the time, I was also taking Diovan and Atenolol for hypertension, Pantoprazole for reflux, and Simvastatin for high cholesterol. One positive side effect of the stress was that I lost 25 lbs and went from 195 lbs to 170 lbs. I also started to eat more healthy foods and started to exercise regularly. One effect of my anxiety and depression is that I would awaken frequently during the night and morning between 3 AM and 5 AM and feel very agitated and get panic with upsetting thoughts. Over the past year or so, I have managed to improve my condition with counseling, meditation, etc. I am also no longer taking any medicine since my health dramatically improved. I am at the point where I am doing well, but still awaken very early about 4 or 5 AM, no matter when I go to bed I feel very anxious and my heart starts to pound. I used to have bad thoughts, but I have managed those and now just feel the physical feelings. The thoughts diminish gradually throughout the day and seem to end at about 5 PM. I am wondering whether I have a cortisol or adrenaline problem. What are your thoughts regarding the same? Please guide.
Hi,
Welcome to icliniq.com.
Do you currently have hypertension? When you wake up early morning, do you have hot flashes or night sweats? Do you have headaches with these episodes? Have you checked your thyroid level recently? Any palpitations felt? If yes, have you had an EKG (Electrocardiogram) to rule out any cardiac issue?
Investigations to be done
Patient's Query
Hi doctor,
Blood pressure is very good now after changing the lifestyle and weight loss. Thyroid was checked and there was no issue; free T4 1.05 ng/dL and TSH 2.61 mIU/mL. No sweats or headaches, but heart is pounding. I wake up (too early) very alert with the feeling of being very upset, anxious, and depressed at the same time. These used to be accompanied with thoughts and images that were upsetting. This has been going on daily for two to three years. I met with psychologist yesterday and discussed the fact that the images and thoughts are no longer accompanying the physical feelings of upset in the morning. Prior to this, I assumed that the feelings were being caused by the thoughts and images. We are now considering the possibility that the thoughts and images follow the physical feelings of upset. From my own research, it seems that cortisol or adrenaline may be involved. Maybe blood sugar too, but blood sugar tests are good. I am attaching all my test reports for your reference. Please guide.
Hello,
Welcome back to icliniq.com.
The laboratory reports are reassuring (attachment removed to protect patient identity).
The symptoms are not very typical for a pheochromocytoma, but you can easily do a test to rule it out (adrenaline). The test is called plasma metanephrines.It is important not to take interfering medications for at least two weeks prior to test, like painkillers (Non steroidal anti-inflammatory drugs such as Ibuprofen) or Ethanol. Cortisol issues give a lot of weight gain, hypertension and diabetes and this is not what you are describing. If the endocrine work up is fine, make sure your primary physician does an EKG and sometimes they need a Holter monitor where you were a device which can pick up the periods of heart racing.
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Dr. Bindiya Thakkar
Endocrinology
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