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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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Published At March 27, 2016
Reviewed AtMay 29, 2023

Patient's Query

Hi doctor,

I am a 25 year old female. In childhood, I had malaria and double typhoid. Everything was normal until few years back. Things started all over again since the last five to six years. I have been putting on weight continuously, suffering from weakness, horrible fatigue and body pain all the time. So, I was done with blood and thyroid tests. My TSH level was at 5.4 then. Doctor told it is at border level. Walking and good food would be enough to make it normal. Two years later of it, also nothing much changed instead symptoms worsened. Apart from the symptoms stated above, muscle cramps, low energy levels and irregular periods got started. This time, I was tested with whole body health checkup package. Results are stated below. T3 138, T4 7.53 and TSH 6.89. Through ultrasound scan peripherally placed small follicles got revealed in both ovaries, might be PCOD. Creatinine serum/plasma 1.0, HDL cholesterol serum/plasma 36, LDL cholesterol serum/plasma 103, ALT (SGPT) serum/plasma 20, calcium serum 9.4, urine routine and specific gravity 1.005. These tests were done two years back. I have mentioned only the values which were not in the normal range specified. So, it was confirmed as the hypothyroid condition and I went on with homeopathy treatment.

When I was done with thyroid profile test again in a year's time during the treatment, my results were T3 112, T4 8.26 and TSH 4.15. During the first month of the treatment, I felt slightly better. But, after that nothing changed. Doctors affirmed that there was an improvement, but I kept suffering from symptoms horribly. I had a test again a year back and the results were T3 140, T4 8.68 and TSH 4.92. Though I learned from reports, that I am fine, nothing was actually changed. My quality of life has been ruined completely. Doctor suggested using vitamin D supplement Must D3 60K for three months. After using it also I did not get required energy to bring life on track again. Since the start of the treatment, I have joined in the gym and later did things like walking, exercise at home, proper diet but nothing had still changed. Seeing the symptoms persist, I lost motive in doing any of them. My treatment period was completed one year ago and I have given up on homeopathy. Now I had done all tests once again, and would like to consult a physician. Please check the latest reports, which I have attached. Before taking treatment again, I would wish to know the answers and have some knowledge from my few questions. So, it would be really helpful if you suggest solutions to them.

My present and persistent symptoms and issues are as follows. I have hair dryness, hair fall and dandruff. I am getting dry cough while waking up from sleep sometimes in one-sided position sleep. It is like I wake up because of cough. I am unable to bear the weight of the head on the neck often. I was done with x-rays of neck for neck and shoulder pain. A numb ache persists all over neck and shoulders. Everything was normal there with x-rays. I have cold intolerance. I am getting joint pains too quickly. I am affected with cold easily. It always present each day around the year. I am unable to lose weight how much ever I exercise. With or without exercise it remains the same. I was 165.3 lbs when I did the tests. After three months of exercise, I came to 156.5 lbs, but again it went up to 163 lbs. Now too it is the same. My height is 5.4 feet. I have shoulder sockets, neck and upper back area ache almost constantly. I use a heat pad and ice bag for relief, but it aches numbly again. Massaging muscles there gives relief for some time. Ribs, lower back, hips, thighs, calves and wrists ache badly during nights and late afternoons. I am getting some electric spark like sensation, itch in fingers, palms and arms mostly on midnights, sometimes during the daytime as well.

The main symptom of all is fatigue. This is the worst problem I face. It ruins my day, energy and focus. I sleep seven to eight hours daily. Morning, I cannot wake up due to the coldness and body stiffness. After breakfast and lunch, fatigue takes over me at any cost. In the evenings, I am active and energetic compared to rest of the day. I usually stay up to 11 or 12 to cover up afternoon’s work. Even after some days of good deep sleep also I end up sleeping easily all the day. It is more of like an unreasonable, unknown nervousness, hesitation and fear that I may not memorize things and concentrate well on an issue than the actual point is. I lose focus on things easily due to internal disturbance. I am getting irritated easily these days. Even after sensing not to shout, I lash out at others and stay fuming for a long time. I am suffering from high mood swings and unpredictable moods. I feel happy and positive in one hour and suddenly nothing seems to change how much ever I try, getting sad in next hour. Again, I will end up boosting myself to keep going in next hour. The same goes on. I am naturally ambitious since childhood. As my state affected my studies and made me unemployed, I get depressed few times. But, I still feel I am an optimistic person and do hard work with what I have. I am taking a lot of time to digest and accept change and decisions in life. I just lost self-confidence completely to take any initiative in everything. Cravings over specifically on ice creams, chocolates, sweets and samosas. It gets high during midnights. I had irregular menstrual pain. They got corrected, but there is PMS pain, giddiness, irritability, etc. During periods, my back pain is very high. Now my periods has been delayed for 10 days. I tried hard to push myself to walk half an hour daily. Then I tried exercises at home for an hour. Failing to push further, joined in the gym and did aerobics, strength training for about five to six months. I did breathing exercises regularly. And tried my best to make myself mentally strong. I used B-complex and vitamin C supplements often for pains. Now, I stopped everything and looking for proper medication and advice. I would like to start everything again with confidence.What is my exact condition? How worse it is? Is it only hypothyroidism or any other condition? If it is only hypothyroidism, why it did not show any improvement on the physical symptoms level? I want to present all new present condition reports before the doctor. So which tests should I undergo? Which specialty doctor should I consult who can treat these above conditions well? Apart from doctors and treatment, what personal measures should I take? Which supplements can I take? Which foods can I take for energy boosting and to remain healthy? Which exercises can I do? I am desperate for a proper solution for this, as it is affecting my career and personal life.

Hi,

Welcome to icliniq.com.

You have what is called subclinical hypothyroidism. It is also a metabolic component of PCOD (polycystic ovarian disease). You are doing most things right. Remember there is no magic treatment. Exercise and diet are continuous events that need regular and consistent follow up. I would suggest you to start Eltroxin 25 mcg (Levothyroxine) once a day on an empty stomach for two months and repeat TSH (thyroid stimulating hormone), free T4 and anti-TPO (thyroperoxidase) after that and let us decide whether to continue that medicine or not further based on your future reports. You should continue the diet and exercise. Feed yourself with positive emotions and cut the negativity. Regarding PCOD, we need to evaluate and will discuss about that next time. Continue vitamin D once a week for 10 weeks.

Patient's Query

Hi doctor,

I have used the medicine prescribed by you and continued physical exercise. I have attached my recent reports after starting medication. I got periods for every two months. I still did not get relief from body aches especially upper back, shoulders and up to neck. Still, I have frequent mood swings and joint pains. My weight is still the same 162 lbs. Please let me know do I need to continue the medicine and follow any additional things. Thank you.

Hi,

Welcome back to icliniq.com.

From your reports (attachment removed to protect patient identity) it is evident that the TSH has improved from the previous. I suggest you to continue the Eltroxin medicine for the next two months. Your TSH is trending towards normal. Hence, I do not see thyroid being responsible for aches and pains. Are you having periods once every two months prior to treatment or they have started delaying now?

Same symptoms don't mean you have the same problem. Consult a doctor now!

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Dr. Swaraj Waddankeri

Endocrinology

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