Dr. Thiyagarajan. T
Diabetology
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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Patient's Query
Hello doctor,
I am concerned about a possible hormonal, adrenal, or thyroid issue. My gynecologist and PCP dismissed my symptoms last year, and I cannot see an endocrinologist until two months, but I would like to get healthier sooner. I included my current symptoms, medications, and last week's blood work reports. I am a 30-year-old female of height 5.4 feet and weight 230 lbs. I am taking Spironolactone 100 mg per day (50 mg for three years, then raised to 100 mg three months ago). In transvaginal pelvic ultrasound taken last year, there were no abnormalities reported.
My symptoms are difficulty in losing weight when eating 1200 calories a day (weighing portions), whole-body inflammation with joint pain that worsens when eating carbohydrates, edema in the lower legs and feet, hormonal acne, cold hands and feet, anxiety and irritability, an adrenaline rush or fight or flight panic every afternoon like clockwork between 3:00 to 7:00 PM that comes from my lower chest with no triggers, rash or hives on arms and chest, long light periods for two weeks on and two weeks off, and lower left pelvic or ovary pain during ovulation.
Kindly help me.
Hi,
Welcome to icliniq.com.
I understand your main concerns are that you are not able to lose weight, you have joint pains, edema, acne, cold hands or feet, and mood symptoms like anxiety, mid-afternoon panic attack-like symptoms, and irregular periods with pain during ovulation. From the laboratory reports (attachments removed to protect the patient's identity) I gather, that you have slightly elevated TSH (thyroid-stimulating hormone), high total testosterone, and higher LH: FSH (luteinizing hormone: follicle-stimulating hormone) ratio, others in the normal range. I need a bit more information:
1) Do you have excessive hair on the face, arms, chest, or thighs?
2) Do you have a long history of irregular periods?
3) Are you taking OCPs (oral contraceptive pills)?
4) Do you get headaches, nausea, vomiting, or easy bruising?
You may likely have PCOS (polycystic ovarian syndrome). If you do not desire to get pregnant, I recommend you take OCPs along with Spironolactone, and it will likely help you with acne and irregular periods. Repeat TSH (ultra-sensitive) with FT4 and anti-TPO (thyroid peroxidase) antibodies. Nobody nowadays does T4, T3 uptake, and Free T4 index anymore. Based on physical exam, may consider doing the following tests:
1) 1 mg Dexamethasone suppression test.
2) Fasting glucose with fasting insulin.
3) 24-hour urine Metanephrines.
All the above three tests only after much more history and physical exam by an endocrinologist. Intensive behavioral, dietary and physical activity program for losing weight with medicines (there are newer medicines like Semaglutide), please discuss with your doctor.
I hope this was helpful.
Patient's Query
Hi doctor,
Thank you.
I will bring up the additional tests during my local endocrinologist visit. I get bruised easily but do not have a long history of irregular periods, excessive hair, headaches, or nausea. I was on Aurovela Fe 1-20 OCP from three years till the end of last year. When I began to have bad side effects (vaginal atrophy, hair loss, hot flashes), I stopped taking it. So if possible, I hope to manage my condition through lifestyle changes or non-OCP medication.
I forgot to mention I do have a lymph node on my neck that has been hard for 16 months now. I am not sure if it was caused by a previous HSV-1 outbreak (they make all my lymph nodes hurt) or a chronic neck muscle sprain (or if the lymph node is causing the neck pain now). I figured to bring this up since the thyroid is in the neck, but you can ignore this if it is not important. I plan to have the local endocrinologist check it out as well.
Kindly give your opinion.
Hi,
Welcome back to icliniq.com.
Although less likely, ruling out certain conditions like Cushing's syndrome and NCCAH (Non-classical congenital adrenal hyperplasia) with tests like 1 mg Dexamethasone suppression test and 17-OHP (hydroxyprogesterone) may be considered. Same with pheochromocytoma, 24-hours urine metanephrines. The lymph node in the neck may be related to the thyroid. When you see the endocrinologist, they will palpate your thyroid and can make a recommendation whether you need an ultrasound scan of the neck. I did not answer the rash or hives part since I do not think this falls under the scope of other things we discussed. I could be wrong. I again want to emphasize the importance of weight loss and intermittent fasting, ketogenic diet, LCD (low-calorie diet), or VLCD (very low-calorie diet) programs and medicines like Semaglutide may be helpful for you.
I hope this was helpful.
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Diabetology
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