Question: I am a 36yo female, only hx of postpartum thyroiditis (hyperthyroid) otherwise healthy. Episodes of weakness/fatigue started 2nd trimester pregnancy 2013 and continued throughout pregnancy, all labs and tests including echo and thyroid normal. Symptoms gone about 3wks post delivery. Returned just prior to diagnoses of hyperthyroidism 7/15. As thyroid levels normalized, weakness significantly improved. Sporadic episodes with very gradual increase since levels normalized last year. Currently no significant thyroid nodules, levels normal. Endocrine plans to remove methimazole over the next 6wks. CP w/exercise once in early XXXXXXX second time early July. 7/21 CP with exercise and severe fatigue. Over the next few days noted general chest discomfort and developing SOB with general weakness. All sxs increase with mild activity. Cardiac workup (ECG, CTA chest, labs, CTA Angiogram, echo, CXR and stress test normal) echo was unable to measure right systolic ventricular pressure and during stress test had chest discomfort, right jaw pain and sob. Started on beta blocker propranolol 10mg BID to rule out microvascular disease without relief after 1wk. I saw a pulmonologist last week who decided I may have asthma/allergies (no history, lungs clear, no rhinorrhea). Treating me with singular 10mg daily and albuterol PRN (no relief). I have an appointment to follow up with him and get PFTs done.
I am a pediatric emergency RN and single mom and I only call out of work in an emergency. I have been unable to work since the end of July due to the severity of the symptoms. I am able to do daily activities but with mild activity I feel fatigued, sob and feel a pressure to the center of my chest. Though the cardiologist did an excellent job ruling out any CAD he has no recommendations in how to proceed and the pulmonologist doesn't seem to be taking me seriously. I am at a loss as to where to go from here but I know that something doesn't feel right and it is not going away. I thought of the possibility of pulmonary hypertension but, of course, I can't be sure. What are your recommendations?

Thank you for your response. I sincerely appreciate your feedback.In the echo that was done, they were unable to measure the systolic right ventricular pressure. Do you think it would be reasonable or a good idea to repeat the echo? I did have a stress test/stress echo done which was normal, except for symptoms during the test. I was told that they do not/did not measure pressures during the stress echo. What constitutes doing a right heart cath? I realize it is more invasive and wouldn't want it done unless necessary but given the symptoms would it be reasonable for me to mention this to my pulmonologist? One more question. Hypothetically if PAH can be ruled out, do you have any other ideas regarding what could be going on? I realize it is difficult to say without having reviewed all results and without an exam. Just thought I would pick your brain. Thank you.