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Suggest Treatment For Dizziness Upon Standing, Metallic Taste In Mouth And Tiredness
Question: I am a 34 yr old female who has had a million and one health problems throughout the years. I have always had low blood pressure (average 100 over 60), and even though I get out of breath and feel faint from time to time, doctors always tell me this is a good thing. I have been tracking my heart rate for quite some time, and it seems as though, last year when I was a smoker, my resting heart rate was normal. Now, my resting heart rate averages around 50. I wouldn't be concerned, but I get out of breath super easily - like from walking 10 steps and talking. I get dizzy upon standing, I have palpitations (which isn't new, ive had them for about 8 years), I'm constantly cold, and its been getting worse ( I keep my house around 78 degree and still wear a sweatshirt), occassionally i will experience a weird metallic taste in my mouth, im always tired, i feel super dehydrated even though i drink 100 oz of water a day, pee constantly and clear. Sometimes I notice the edges of my lips are blue. I also have had acne for years, despite every effort and medication and topical known to man, including accutane. I recently brought all of these concerns to my doctor, and he of course laughed - as they usually do - because he thinks im just healthy and in shape. Regardless, to quiet me, he sent me for blood work - potassium came back slightly elevated (1 over normal range) (I do not take any potassium supplements), and BUN also came back slightly elevated (1 over normal range). He didn't seem to think this mattered at all and said that 1 over normal range is a fluke. He also sent me for an EKG where it came back as sinus bradycardia, and still no worry. He is sending me to a cardiologist for an echocardiogram, as well as a holter monitor, but my question is should I be asking for any other tests? Any thoughts on what could be wrong with me? What questions should I be asking my physician and cardiologist? I've been seeing doctors for 18 years on and off (starting when I was 16 for extreme tiredess - tested for anemia and came back normal) and still no one is stepping up to REALLY help me.
Brief Answer:
Some key points to consider.
Detailed Answer:
Hello!
Thank you for asking on HCM!
I understand your concern, and would like to explain that, your clinical scenario raises strong suspicions for a metabolic derangement. An endocrine disorder should be sought and ruled out by a comprehensive diagnostic work up.
I passed carefully through your medical history prescription, and would like to give you some opinions about additional key lab tests to be performed.
(1) Several clinical signs and complains raise suspicions about a low thyroid function (hypothyroidism). Bradycardia, hypotension, your permanent tiredness, your slightly elevated blood potassium, your cold sensation, and even acne presence, etc. are frequently seen in hypothyroidism.
So, I would recommend to discuss with your doctor about thyroid hormones blood level testing (FT3, FT4, TSH).
(2) Profound weakness, dehydration feeling, dizziness when standing, hyperkalemia, etc. may also be related to a low adrenal cortical output. You should check your blood corticosteroids levels.
So, I would suggest to add to your differential diagnosis lab test list, even: aldosterone, and cortisol dosing (blood and urine, or saliva), in different time points of the day and body positions. Some special tests are used for this purpose.
You should talk to your doctor about these modalities.
(3) A careful check up of your sexual hormones levels (including prolactine), should be performed too.
You need to talk to an endocrinologist about these topics.
Hope to have been helpful. Greetings! Dr. Iliri
Some key points to consider.
Detailed Answer:
Hello!
Thank you for asking on HCM!
I understand your concern, and would like to explain that, your clinical scenario raises strong suspicions for a metabolic derangement. An endocrine disorder should be sought and ruled out by a comprehensive diagnostic work up.
I passed carefully through your medical history prescription, and would like to give you some opinions about additional key lab tests to be performed.
(1) Several clinical signs and complains raise suspicions about a low thyroid function (hypothyroidism). Bradycardia, hypotension, your permanent tiredness, your slightly elevated blood potassium, your cold sensation, and even acne presence, etc. are frequently seen in hypothyroidism.
So, I would recommend to discuss with your doctor about thyroid hormones blood level testing (FT3, FT4, TSH).
(2) Profound weakness, dehydration feeling, dizziness when standing, hyperkalemia, etc. may also be related to a low adrenal cortical output. You should check your blood corticosteroids levels.
So, I would suggest to add to your differential diagnosis lab test list, even: aldosterone, and cortisol dosing (blood and urine, or saliva), in different time points of the day and body positions. Some special tests are used for this purpose.
You should talk to your doctor about these modalities.
(3) A careful check up of your sexual hormones levels (including prolactine), should be performed too.
You need to talk to an endocrinologist about these topics.
Hope to have been helpful. Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
Thank you for that answer. I will bring these questions to my doctor. As far as all three steps you posted, are these all something I should see an endocrinologist about, or start off by having my general doc do the tests? Also, what would be the reasoning behind testing sexual hormones? Would it be possible for you to send me a list of the tests you would recommend, for easy reference when I see my doc? Lastly, is seeing an endocrinologist and having these tests done something I could do while in early pregnancy? These symptoms have all been present before I was pregnant, but they seem to be getting worse every day, and I am 9 weeks pregnant.
Thank you.
Thank you.
Brief Answer:
An endocrinologist should guide through the right diagnosis work up.
Detailed Answer:
Hello again!
Regarding the above mentioned tests, you could discuss first with your GP (at least for thyroid function tests), and of course to talk about your complains with an endocrinologist.
The endocrinologist has to perform an overall evaluation of your signs and symptoms, and guide your through the right diagnosis work up, as the physiology of different endocrine axes has an interacting nature.
It remains on the endocrinologist opinion, the decision to perform a certain test modality.
Regarding sexual hormones evaluation, besides the endocrinologist, you have to consult with your attending gynecologist (facing you are a pregnant woman), for the most appropriate tests modalities.
Wish you a good health! Dr. Iliri
An endocrinologist should guide through the right diagnosis work up.
Detailed Answer:
Hello again!
Regarding the above mentioned tests, you could discuss first with your GP (at least for thyroid function tests), and of course to talk about your complains with an endocrinologist.
The endocrinologist has to perform an overall evaluation of your signs and symptoms, and guide your through the right diagnosis work up, as the physiology of different endocrine axes has an interacting nature.
It remains on the endocrinologist opinion, the decision to perform a certain test modality.
Regarding sexual hormones evaluation, besides the endocrinologist, you have to consult with your attending gynecologist (facing you are a pregnant woman), for the most appropriate tests modalities.
Wish you a good health! Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
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