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
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Patient's Query
Hi doctor,
I am a 34 year old white female. My height is 5.4 feet and weight is 165 lbs. I am a healthy athlete (CrossFit athlete and a former state champion). I had a very high stress as entrepreneur for more than 5 years. My initial complaints were low energy, depression, fatigue, irregular, heavy periods, unusual weight gain in two years and general malaise. My laboratory result includes elevated testosterone, high cholesterol, high fasting blood sugar. I was given Paxil for depressive symptoms and began taking Vitamedica course of vitamins to raise vitamin D levels. I have a previous history of depressive symptoms and menstrual irregularities before 10 years. Based on my current symptoms and preliminary research, my general health care practitioner assuming it as PCOS. I would like to know the type of treatment plan I can expect, tests I should order, etc. Please help.
Hi,
Welcome to icliniq.com.
This is probably PCOS (polycystic ovarian syndrome) as you mentioned. Your history is consistent with it. I need the actual report of testosterone to know the method used for analysis and whether it was total or bioavailable testosterone. I noticed the liver function tests were off, but then improved. What was going on? Do you have any acne or unwanted hair growth on the face? The endocrinologist will do a physical examination and depending on the findings, they may want to exclude other causes of your symptoms. Usually, LH and FSH ratio is also done (luteinizing hormone and follicle stimulating hormone). The first step in the treatment would be birth control if not planning pregnancy to normalize testosterone levels and regulating periods. If sugar is elevated, then Metformin will also be started.
Patient's Query
Hello doctor,
Thank you for responding. The testosterone result is in pg/mL of free testosterone. I am sorry that was not very clear. The liver issue is strange. The high results of ALT and AST were noted in a general blood panel check up for depression, weight gain, etc. I did not expect that anything was wrong, although I had noticed some strange clay colored stools in the previous weeks. I was thinking that the clay colored stools may have been caused by some previous medications I had taken after experiencing an autoimmune hives reaction. I was given Prednisone along with something for the itching. This is the one I think caused the clay stools and it started with alphabet "C", but I cannot remember the exact name. Also, I had another medication for bowel irregularities. It was a very small course and was an isolated allergic incident. My physician did a follow up ultrasound after the liver levels came back elevated. I have attached the results here. I do not drink often or take any Tylenol, so the liver levels were a bit of a mystery. I did not change any habits. I began taking the Paxil and vitamins and I am not sure how it is normal now. I do not have any acne or facial hair, but I have noticed that some of the hairs on my legs are darker than before, especially the inner upper legs near the bikini area. I have not ordered the luteinizing and follicle stimulating hormone tests yet. I can do that soon to see what comes up.
Hi,
Welcome back to icliniq.com.
One possible explanation of your elevated liver enzymes, clay colored stools and itching could be gallstones or inflammation of the liver ducts. If the gallstone passed the liver enzymes will recover. Another test I often order for my PCOS patients after doing an examination, is called overnight Dexamethasone suppression test. It requires a prescription of 1 mg Dexamethasone, taken at midnight and 8 AM cortisol or ACTH (adrenocorticotropic hormone). This is done to rule out excess cortisol production. I would also advise you to get a prolactin done for irregular periods alone.
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Same symptoms don't mean you have the same problem. Consult a doctor now!
Dr. Bindiya Thakkar
Endocrinology
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