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Suggest Treatment For Lethargy And Problems In Sleeping
Question: Two years ago I had my left thyroid lobe removed because of a benign growth as big, if not bigger than the lobe itself. I am on Levothyroxin at 150mcg and Furosemide at 20mg. I take potassium glutonate 99mg 1x/day, fish oil 1200mg 3 2x/day (I just had rotator cuff surgery & was told it would aid the healing process), D3 5000iu 1x/day, CoQ10 300mg 1x/day, iodine plus 12.5mg 1x/day, Zonisamide 100mg 2-1x/day (I have a tumor in the temporal and have temporal irritation), aspirin 81mg 1x/day. All this to give a better picture, sorry it's long. I have recently had trouble losing weight and actually gained 17 in 6 weeks even walking an average of 3 miles/day and intake of 1600 calories/day! I record every bite/drink in my phone! I have reduced my calorie intake to 1200-1400/day and am fluctuating between a total 11-13# gain, so I'm down about 4#, 7 on a good day. I went to an endocrinologist and was told to reduce my intake to 1000-1200 calories and that my symptoms were due to sleep apnea (I rarely snore according to my husband, and if I do, I wake myself up). This is without a sleep study. I just received my labs today. I will give the asterisked levels & this doctors comments. Cholesterol-244, LDL-173, Glucose-102, Calcium-10.7, Albumin-4.9, AST-52, ALT-105, Protein-7.7, TSH-.10, Hemoglobin A1C-6.4. Comments: Your lab tests again show your thyroid to be slightly off, but would just monitor this after stopping the kelp. It may improve. You do have some metabolic issues showing up; your blood sugars are slightly high, what we call pre-diabetes. Your cholesterol is high and you have liver inflammation. These conditions are all likely due to being overweight and would improve with weight loss. You may want to discuss taking a lipid lowering medication with your primary care doctor. End Comments. I was NOT impressed with this physician, his demeanor, his "afterthought" to take blood work. I felt like I got no answers. I was sent to him because I am lethargic, do not sleep well (wake several times in the night), hair loss, hoarse throat, cold hands/feet, increased sensitivity to cold, dry skin, inability to lose weight no matter what I try!!! Please help!! We eat fish 2x/week, many garden vegetables, little sweets, I stay away from too many breads/pastas. Family history: Father-diabetic, high blood pressure, stroke, died at 69-colon cancer, Mother-systemic lupus, thyroid removed (don't know why)diabetic in 60's, died at 79-sepsis from UTI.
Brief Answer:
Most of the decribed problems due to excess weight
Detailed Answer:
Good day,
Thank you for the detailed history, which is very helpful in assessment.
Noted your points and the lab works. L
Let us analyze the blood works first. I am afraid that, i may have to agree with your physician's comments.
We may have to re do the TSH again along witth a Free T4. Lipids are elevated and the liver enzymes too. Blood sugar profile is consistent with pre diaetes. The elevated liiver enzymes represents fatty liver.
The fact that you wake yourself up if you snore is suggestive of sleep apnea. This causes day time sleepiness and tiredness.
You have not mentioned your height and weight. Could you provide that please?
If you have difficulty losing weight despite exercise and diet control, then we have to do some hormonal works. Weight loss is important in you because, the prediabetes, high lipids and sleep apnea will improve significantly with weight loss. Even the liver enzymes will improve.
Cortisol is one hormone we should do. This is to rule out Cushing's syndrome .
If the repeat TSH is high, we have to increase Levothyroxine dose which may help you to shed some weight.
If all the hormonal tests are okay, then the next option is bariatric surgery, which would improve most of the symptoms.
Regards
Binu
Most of the decribed problems due to excess weight
Detailed Answer:
Good day,
Thank you for the detailed history, which is very helpful in assessment.
Noted your points and the lab works. L
Let us analyze the blood works first. I am afraid that, i may have to agree with your physician's comments.
We may have to re do the TSH again along witth a Free T4. Lipids are elevated and the liver enzymes too. Blood sugar profile is consistent with pre diaetes. The elevated liiver enzymes represents fatty liver.
The fact that you wake yourself up if you snore is suggestive of sleep apnea. This causes day time sleepiness and tiredness.
You have not mentioned your height and weight. Could you provide that please?
If you have difficulty losing weight despite exercise and diet control, then we have to do some hormonal works. Weight loss is important in you because, the prediabetes, high lipids and sleep apnea will improve significantly with weight loss. Even the liver enzymes will improve.
Cortisol is one hormone we should do. This is to rule out Cushing's syndrome .
If the repeat TSH is high, we have to increase Levothyroxine dose which may help you to shed some weight.
If all the hormonal tests are okay, then the next option is bariatric surgery, which would improve most of the symptoms.
Regards
Binu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My height is 5'7", weight 208#. I did state that I SELDOM snore (according to my husband). When I awake at night, I simply awake...insomnia is more like it. I have tried 10 day cleanses, 2 T. lemon, 2 T. grade B maple syrup, cayenne, and water, coming off of the cleanse for 3 days. I have been doing this consistently every three months. I do this more for health, but I would lose maybe 13-18# which would come right back on as soon as I start slowly eating (healthy food, of course). I am very disciplined and this is very frustrating as I consume very little.
I just looked up bariatric surgery...that is extreme!! Removal of parts of the stomach and small intestines to induce weight loss seem outlandish!! If the body is not working properly, than you still have not addressed the problem, just gone around it and will have to address it again in the future as it seems this would work only for a short time if the cause is not addressed, only the symptom.
I just looked up bariatric surgery...that is extreme!! Removal of parts of the stomach and small intestines to induce weight loss seem outlandish!! If the body is not working properly, than you still have not addressed the problem, just gone around it and will have to address it again in the future as it seems this would work only for a short time if the cause is not addressed, only the symptom.
Brief Answer:
weight loss by bariatric surgery
Detailed Answer:
Thank you for the reply.Noted your point that you seldom snore.
Most nurritionists and dieticians advice patients to adapt a diet pattern that they can continue daily. I am sorry to hear about the fact that you are unable to reduce weight despite exercise and a reduced calorie diet. Has anyone discussed about bariatric surgery to you ?
I was not a great fan of bariatric surgery before, but it does wonders in improving symptoms. It helps to rapidly reduce weight too.
weight loss by bariatric surgery
Detailed Answer:
Thank you for the reply.Noted your point that you seldom snore.
Most nurritionists and dieticians advice patients to adapt a diet pattern that they can continue daily. I am sorry to hear about the fact that you are unable to reduce weight despite exercise and a reduced calorie diet. Has anyone discussed about bariatric surgery to you ?
I was not a great fan of bariatric surgery before, but it does wonders in improving symptoms. It helps to rapidly reduce weight too.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Like I said before, isn't that extreme?? And if a person has symptoms, don't they come back once the "symptom" is treated? One might lose weight, but then face the weight gain in the future because the "cause" was not addressed, only the symptom. What about adrenal support, i.e., types of vitamins, etc.?
Brief Answer:
Lot of research evidence favouring surgery
Detailed Answer:
Got your point. The area of bariatric surgery has advanced a lot since it was introduced few years ago. We would screen the patient to look for an identifiable cause o obesity before recommending surgery. If no reversible cause identified, only then bariatric surgery is recommended.
There are several types of surgery and the choice is based on each patient's lfe style and metabolic profile.
As an endocrinologist, myself and most of my collegues all over the world, were not keen to promote bariatric surgery when it was introduced many uears ago. But it is proved that carefully done surgery with correct patient seletion, is really helpful. Many government health bodies now support bariatric surgery as an acceptable weight loss measure.
There are reversible and irreversible proocedures in abariatric surgery. It doesnt treat the sympom alone. It treats the cause as well. For example, in sleeve gatrectomy, a part of stomach is removed where the hormone GHERLIN is produced. Absence of Gherlin will cause early feeling of fullness and hunger will reduce too
Lot of research evidence favouring surgery
Detailed Answer:
Got your point. The area of bariatric surgery has advanced a lot since it was introduced few years ago. We would screen the patient to look for an identifiable cause o obesity before recommending surgery. If no reversible cause identified, only then bariatric surgery is recommended.
There are several types of surgery and the choice is based on each patient's lfe style and metabolic profile.
As an endocrinologist, myself and most of my collegues all over the world, were not keen to promote bariatric surgery when it was introduced many uears ago. But it is proved that carefully done surgery with correct patient seletion, is really helpful. Many government health bodies now support bariatric surgery as an acceptable weight loss measure.
There are reversible and irreversible proocedures in abariatric surgery. It doesnt treat the sympom alone. It treats the cause as well. For example, in sleeve gatrectomy, a part of stomach is removed where the hormone GHERLIN is produced. Absence of Gherlin will cause early feeling of fullness and hunger will reduce too
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Role of vitamins in adrenal support
Detailed Answer:
Hi,
I did mention aboout a cortisol measurement to rule out excess cortisol production from your adrenal gland ( which can cause weight gain).
Contrary to popular belief, vitamins do not infuence the adrenal gland function.
Almost all hormonnes in adrenal gland is produced from cholesterol ( adrenal androgens, cortisol, other steroid hormones, catecholamines etc). So vitamins do not have much role there, except providing overall good nutrition. However, consuming fresh fruits and vegetables ( especially dark and deep coloured fruits) provide essential vitamins and antioxidants which is great for the general functioning of various organs of body.
Role of vitamins in adrenal support
Detailed Answer:
Hi,
I did mention aboout a cortisol measurement to rule out excess cortisol production from your adrenal gland ( which can cause weight gain).
Contrary to popular belief, vitamins do not infuence the adrenal gland function.
Almost all hormonnes in adrenal gland is produced from cholesterol ( adrenal androgens, cortisol, other steroid hormones, catecholamines etc). So vitamins do not have much role there, except providing overall good nutrition. However, consuming fresh fruits and vegetables ( especially dark and deep coloured fruits) provide essential vitamins and antioxidants which is great for the general functioning of various organs of body.
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. Chakravarthy Mazumdar
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