Diagnosed With Graves Disease. Done With CT Of Neck And Goiter. Having Hypothyroidism And Weight Gain. Advise?

Posted on Tue, 10 Sep 2013

Question: I was diagnosed with graves disease 7 years ago after going into svt from tsh .01 It is in remission now. It comes and goes. Last recurrence was a year and a half ago. I had a ct of my neck and had a small goiter. I have been having sx of hypothyroidism. Severe letheragy, weight gain, constipation. I went to the endocrinologist. My labs wnl. I am having dysphagia thyroid u/s showed 6 nodules. 5 about 2 cm and 1 midline 5cm. My b12 level was high at 1197. Current md is checking a mma. My biggest concern is my fatigue. I wake up tired. And some days don't think I can get out of bed. I'm not depressed or wasn't. This is depressing me.

Error on age

Gender : Female

Age : 37

Medical History
Svt, alcohol abuse approx 5 yrs. 3 yrs recovery.

Current Medications
Propranolol 40mg bid

Known Allergies
Benadryl phenergan
When I said labs my tsh- t4- t3 and tpo was 10 vit d was 40 and b12 stated above. Tsh was 1.22 t3 and t4 were well WNL

Answered by Dr. Minal Mohit (2 hours later)

Brief Answer:
Euthyroid status

Detailed Answer:
Dear, as per your reports your thyroid status is functionally normal. However, all the symptoms described by you, lethargy, weight gain and constipation are pointing towards hypothyroid state. But then your TSH is normal. Can you please let me know your Free T4 levels?

Your dysphagia can be attributed to a 5 cm midline thyroid nodule, for which you might need a surgery.

Your Vitamin D, & B12 levels are also normal, still you have significant fatigue. In that case, I might as well need to know your Serum Calcium, Serum Albumin, Serum electrolytes levels. What is your blood pressure like and what about your menstrual cycle? What all medicines are you taking presently?
Sorry “Current md is checking a mma" this line I did not understand.
I have put up more questions to you rather than answering your query, sorry for that too, but if you can give me the answers to my questions may be I am in a position to help you in a better manner, Regards!

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Minal Mohit (27 minutes later)

The endocrinologist sent a letter saying my b-12 norm was suppose to be (213-815) I wasn't on supplements except MVI. And she sent that my level being 1197 could indicate an inflammatory illness. But the abbreviated mma test checks to see if the b12 is entering at a cellular level. Because my primary md. Thinks my. Vit b12 isn't. I only take the propanalol. I used to run daily until about 3 months ago and was a nurse on a active cardiac floor. So my b/p is about 100/60 p-100. The drs. Have not ran any of the other tests. I can't remember my t4. But it was beautiful. Right in the middle of the values. I saw a endocrinologist 6 yrs ago. I followed him for a year. I tested for some antibodies then. And on a thyroid nuclear scan. He told me I did not have hashimotos and I did not have graves. When I tell other drs. This they look at me baffled. I can't remember the name. But he said the only cure was to remove my thyroid. Ath that time I was young. Didn't have a lot of symptoms too frequent. And just never went back. Big mistake. Oh. I do not have a menstrual cycle. I have an implanted device 4 yrs now. And it prevents one

Answered by Dr. Minal Mohit (42 minutes later)

Brief Answer:
Hormonal disturbances can be attributed to implant

Detailed Answer:
Thanks for reverting back. As you told your T4 was in the middle of the range, I think you did not notice I had asked for "free T4”.

As you have not done other tests what I had asked for, please get them done as well and then you can see your endocrinologist or post a follow-up query to me again on XXXXXXX
Regards!

Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Shanthi.E