Hello,
Welcome back to icliniq.com.
I have gone through all the reports (attachment removed to protect patient identity) of your daughter.
As I said previously, based on her symptoms, she is a person with the polycystic ovarian syndrome. Even the ultrasound finding is suggestive of the same and substantiates the diagnosis, although it is not always necessary that the ultrasound show polycystic changes every time. So there is no point repeating the scan, again and again, to check if she still has polycystic changes, as it is just one of the condition's findings. And as advised previously, she needs to focus on her lifestyle modifications by reducing weight and having a proper healthy diet and regular workouts or exercises. Exercises tend to prevent insulin resistance development, which is the main culprit of all the hormonal disturbances in PCOS. Based on her test results, she does not have insulin resistance (although borderline fasting insulin - recheck after a year).
Also, I approve the treatment suggested by your doctor, as your daughter has been found to severely deficient in Vitamin B12 levels; she needs injectables to replenish the levels as vitamin B12 is an essential constituent for the nerve function regulation. If injectables are not feasible at present, she can go for oral therapy for three months as suggested and recheck her levels after that to see if they have been corrected or not. She is also having insufficient Vitamin D levels, for which supplements have been suggested by your doctor already. Regarding her thyroid levels, her TSH levels point towards hyperthyroidism, which needs further evaluation. She needs to check her free T4 and free T3, and Anti TPO levels and consult an endocrinologist. Based on the free hormone levels, it will be evident if she has clinical hyperthyroidism or not and whether she needs any medications to correct the thyroid levels. Because total hormonal levels may be in the normal range many times, the active hormone, that is, the free hormonal levels determines their function. Also, most commonly, hyperthyroidism can have an autoimmune origin of causality, so that is anti-TPO antibodies levels are essential in such cases. As advised, please get these three blood tests and consult an endocrinologist to evaluate the thyroid gland and further management accordingly.
Her lipid profile is borderline, and nothing majorly abnormal. This could be corrected by maintaining a proper diet and doing regular exercises. If possible, consult a good dietician to get a diet plan for your daughter. Her prolactin levels, DHEAS (Dehydroepiandrosterone sulfate), free testosterone levels, blood sugars, HbA1c level, hemoglobin, liver, and renal functions are fine, and nothing to be worried about. Also, the LH: FSH ratio is around 2:1, which explains her menstrual irregularities. This should be ideally <2:1. But this is nothing to worry about and does not need to be followed up by rechecking it as they are expensive to test and do not help much in further management. A course of Dronis 20 for three months should be good enough for her, and in the meantime, if she reduces her weight and does regular exercises, once she stops Dronis, she will get her periods on time. Also, acne and unwanted facial hair growth will reduce on their own. To know more go through prescription medication for acne.
I hope I have explained everything to you in detail. Please feel free to revert anytime. All the best for your daughter's future.