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Forum Name: Endocrinology Topics

Question: Rural Alaska - no endocrinologist in area - PCP says normal?


 Tamera - Wed Dec 13, 2006 8:36 am

43 yo female - registered nurse - no medical history other than lymphatic TB (MAC from patient exposure) w/ right cervical lymph node bx x3 (95,98.03). Cardiac family hx, mother lupus. Currently on topamax 50mg bid for headaches, ambien 12.5 for insomnia, enablex 15mg for nocturia.
Currrent symptoms: Insomnia, nocturia, recent weight gain (no change in diet), SOB, RUQ pain, decrease in monthly cycle w/ increase in flow, headaches (almost daily w/ no change after 8 weeks on topamax), stress fx to feet, lower ext edema, palpatations, facial flushing, hiatal hernia symptoms, heartburn, abdominal distention w/ no gas symptoms, constipation, memory loss, difficulty concentrating, vision changes, changes in peripheral vision, carpal tunnel symptoms, muscle weakness, extreme daytime fatigue, easy bruising, small cuts take longer to heal, back pain, tinglilng hands/feet (started before topamax), increased facial hair, hands intolerant to cold, mood swings, irritability, supraclavicular swelling and fatty area to back of neck (PCP says lympadema from previous lymph node bx),increased thirst, right flank pain, recurrent respiratory infections (3 in 7 months).
MRI was negative. Hormone levels DHEA (16.9); Estrone S (33); Estradiol (39); FSH (7); LH (2); Progesterone (1.1); Testosterone (24); 0800 Cortisol level after 48 hours of 0.5mg dexamethasone q6hr with last dose 0600 (8.5 ug/dl) Midnight cortisol level (5.9 ug/dl)
Thyroid levels: T-uptake 0.75 TU/Units (0.66-1.27) Thyroxine 4.6ug/dl (5.0-12.0); FTI 6.1 (6.33-12.4) Total T3 74ng/dl (90-190) Free T4 0.80 (0.8-1.5)
Glucose tolerance test
fasting 90; 1/2 hr 145; 1 hr 74; 2 hr 98; 3 hr 72; 4 hr 83; 5 hr 93
I had been working with an ARNP, and just saw a general practitioner last week. Both have said levels are normal. The only new test from MD was glucose tolerance test.
Any suggestions? I am having an increase in symptoms and having a harder time working now. I once was able to do 60 hours a week at the hospital with no problems, now I have a hard time climbing my stairs at home. There are no endocrinologists in this rural Alaska area and you cannot get a referral to one in Anchorange without "abnormal tesing" and my PCP here says I am perfectly normal, but my symptoms tell me otherwise. Do you have any suggestions of additional testing I can request or do you feel my test results are indeed normal? I know as a nurse I should be more educated in this, but my knowledge in this area is limited. Thank you for your help.
 Tamera - Sat Dec 16, 2006 12:07 pm

I was hoping to get some help, but it seems no one is willing to venture a reply...thanks anyway...I'll keep trying to find some assistance elsewhere.
 Dr. Safaa Mahmoud - Sat Dec 16, 2006 6:05 pm

User avatar Hello,

Sorry for the delay in response and hope this information will be helpful.

Your symptoms are very confusing because they can be shared with many diseases, at the same time they are not typical for any.

I agree with them your hormone test results are within the normal range, But they are more towards a low normal especially your thyroid results.

The thyroid gland produces primarily T4 with only scant amounts of T3. The majority of T3 present in the blood is produced by conversion of T4 to T3 in peripheral (away from the thyroid) tissue, primarily the liver.
it is important that levels of FT3 be measured in patients exhibiting symptoms of hyperthyroidism and hypothyroidism and normal T4 results.

Having a family history of SLE tests like ESR, CBC, Urine analysis, antinuclear antibody (ANA) test should be done although your symptoms are not typical.

It would be also helpful if you can inform us about the results of your CBC, Urine analysis, ESR, Coagulation profile and bleeding time test, kidney and liver function tests ( if any has been done).
It would be also helpful if you can inform us about any medications taken prior to these symptoms, and if the current drugs improved any of these symptoms or your are getting worse.

There is no replacement for direct clinical ex,mination, I would advise you to follow up with your doctor, inform them that your symptoms are not improving and discuss with them this information.

Keep us updated.
Best regards,

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