Doctors Lounge - Endocrinology Answers
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Forum Name: Endocrinology Topics
|lak1975 - Fri Jul 23, 2010 7:48 pm|
I have been having the same health issues for about 5 years(since my son was born), have had continuous weight gain and fatigue despite diet and exercise. I am sometimes able to lose weight only to gain it all back and then some without changing anything. I also have joint and low back pain, body aches, heavy periods and dry skin. I have had several lab draws to chk for hypothyroid but that all come back within normal range. (one free T4 came back low but the doc did not think it was bad enough to treat. I have a family history of hypothyroidism my dad's sisters and mother all had and took meds for it. Have recently began experiencing infertility in the last couple of years. My son was a 9.5lb baby born by c section 2 weeks early. Before pregnancy I was at a healthy weight and continued healthy diet and exercise after his birth. But I still have been unable to lose any baby weight. I recently went to the ER with vertigo and heart palpitations and was found to have slightly low potassium and low sodium. I have been to 6 different docs all of whom told me since my blood tests were normal I just need to exercise more and I was probably eating more than I think.
|Dr.M.Aroon kamath - Sun Jul 25, 2010 6:55 am|
It would have been helpful if you had provided the values of all the thyroid function tests as well as results of other lab tests such as Hb%, ESR etc.You have not indicated if you have a goiter.The other important consideration is your country of residence(iodine deficient or iodine sufficient zone).
As your symptoms seem to have appeared following a cesarean delivery 5 years ago, an condition related to or aggravated by pregnancy assumes priority.
There are two of such conditions are,
- Hashimoto’s thyroiditis and
- postpartum thyroiditis.
By far, the most common cause of hypothyroidism during pregnancy is
Hashimoto’s thyroiditis (one type of autoimmune thyroiditis). Approximately, only about 2.5% of women will have an elevated TSH (>6) and about 0.4% will have a level of > 10 during pregnancy.
In Hashimoto's disease, TSH levels may be normal, as more TSH is secreted by the pitutary in response to declining T4 levels. This drives the remaining healthy thyroid follicles to produce more T4 which then normalizes the TSH. An increasing TSH (after an initial period of stable levels) would indicate that the thyroiditis is progressing and continuing to destroy more and more of the remaining thyroid follicles and therefore the TSH is being secreted in increasing amounts to maintain a euthyroid state.T4 & T3 levels also initially may remain within normal ranges.
Women at risk:
Screening is recommended by some for women with the folllowings risk factors.
- women with goiters,
- women with a strong family history of thyroid diseases,
- women with a past history of postpartum thyroiditis, and
- women with autoimmune disorders(rheumatoid arthritis,
type 1 diabetes mellitus, and lupus erythematosus).
Postpartum thyroiditis: is a mostly temporary, painless inflammation of the thyroid gland of uncertain etiology (thought to be an autoimmune disease akin to Hashimoto’s thyroiditis) that occurs within a year following 5% to 10% of all pregnancies. Resembles Hashimoto's in that it many women with this disease also have presence of certain antithyroid antibodies (Thyroperoxidase antibodies or TPOab) in their blood and that histopathologically also it is difficult separate them. Postpartum thyroiditis has also been noted to occur in women who do not have anti-thyroid antibodies in their blood.
The classic clinical course of postpartum thyroiditis is one of thyrotoxicosis followed by hypothyroidism.
There variations in its course have been noted and they are
- a hyperthyroid phase followed by a return to a euthyroid state,
- a hypothyroid phase alone
- a hyperthyroid phase followed by a hypothyroid phase.
Presentation with hypothyroid phase alone is the commonest.
Post-partum thyroiditis is often missed and its symptoms (both hypo and hyperthyroid) often get attributed to the normal stresses which a woman typically faces following a delivery. Symptoms occur 4-8 months following delivery and may go on for up to 9 –12 months. Most women return to a euthyroid state in about 12-18 months of the onset of symptoms. However, a minority (20-30% of those that go into a hypothyroid phase) will continue to remain hypothyroid.
I am not aware if you have been tested for the aforesaid possibilities.If not, you should consult your endocrinologist and have yourself assessed.
|lak1975 - Sun Jul 25, 2010 3:13 pm|
Thank you so much for you reply. I will speak with my Endocrinologist about what you have indicated at my next appointment.
|Dr.M.Aroon kamath - Sun Jul 25, 2010 10:02 pm|
Thank you for keeping in in touch. Wish you luck.
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