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Dr. David
Dr. David, Other
Category: Endocrinology
Satisfied Customers: 42857
Experience:  Experienced physician, undergraduate studies at MIT, studied Engineering, qualified to answer your questions.
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I typed a question below but have not had a response?
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Submitted: 1 month ago.
Category: Endocrinology
Expert:  Dr. Muneeb Ali replied 1 month ago.

Hello,

This is Dr. Muneeb Ali, your question was directed at an endocrinologist from John hopkins hospital, we dont have an endocrinologist from john hopkins on the site and none of the doctors currently online have endocrinology as their primary specialty, that is why your question has not been answered as of yet, if you want i can help you on your question otherwise you may have to wait for some time. Let me know as to what you would prefer. Thanks

Customer: replied 1 month ago.
Thank you Dr AliIf you can answer the question that would be appreciated. My TSH is always low and T4 high as well.I have had the blood cortisol done and that is in range, above the halfway mark but still in range.If you are able to help thank you
Customer: replied 1 month ago.
I am from Australia
Customer: replied 1 month ago.
I am just wondering if you Dr Ali is answering, or as you have indicated, referred it to a new endocrinologist within your structure and I am of the understanding that it was supposed to take 30 minutes maximum.Thank you in advance
Expert:  Dr. Muneeb Ali replied 1 month ago.

Im sorry when i didnt get your response i referred it to an endocrinologist as i had to attend to an urgent consult in the hospital, thats why i opted out. i apologise that you had to wait so long but unfortunately the consult was very urgent and i had to rush out. I just saw your reply and i just wanted to update you, sorry again. I have to leave again to see to the critical patient, i hope someone on the site gets to your question and answers it soon.

Customer: replied 1 month ago.
Thank you for your kind notification. I understand that you are busy. I have noticed that a couple of Doctors have looked but no response but appreciate your reply and understand the medical industry and a critical patient takes precedent over and email and appreciate your reply.
Expert:  Dr. David replied 1 month ago.

This is Dr. David

I am another expert here. I don't see your TSH or free T4 levels mentioned.

do you have those results?

Customer: replied 1 month ago.
Hi,TSH Low, T4 High
Expert:  Dr. David replied 1 month ago.

low TSH and high T4 levels tend to mean you are hyperthyroid or have too much thyroid hormone in your body.

Customer: replied 1 month ago.
I also have had Blood Cortisol Done, is is over half way, but not to high, done at 9.30 in the morning - you have the other test results don't you?
Customer: replied 1 month ago.
Do You have the results of the first email, Anti thyroid Peroxidase High, High Prolactin and Chromognin A Gen (Neuro Tumor Marker) Why is this not showing in the MRI........My levels will not Stabalise and my prolactin goes high and low all the time.
Expert:  Dr. David replied 1 month ago.

no, I don't have your test results

you have to upload them to this website.

you can either take a jpg photo of the results and upload them where it says "add file"

or scan them into pdf format

or type the results into the chat box here for me to see.

high anti thyroid peroxidase levels means your body is producing antibodies which are stimulating your thyroid gland to make too much thyroid hormone this is called Grave's disease or autoimmune hyperthyroidism. you would need some medications to try to slow down your thyroid gland and if that doesn't work, you may need to have your thyroid gland removed surgically or destroyed with radioactive iodine I-131.

did you have a brain MRI scan to check on your pituitary gland?

Customer: replied 1 month ago.
I don't have a thyroid gland - it was removed three years ago due to Hyper on one side and Hypo on the other and 16 nodules?Yes I did have the MRI for the Pituitary Gland but this has also being going up and down for the same time so I am assuming that it was never addressed properly in the first instance..I also have low range high of the Chromognin A Gen (tumor marker in Neuro endocrine situations)
Expert:  Dr. David replied 1 month ago.

if your TSH level is below 0.3, then your dose of thyroid hormone is too high that you are taking and your doctor needs to lower your dose.

how high is your prolactin levels? slightly above normal prolactin levels doesn't mean you have a prolactinoma

I am a cancer doctor. how high is your chromagranin A level? higher levels of this doesn't mean you have a neuroendocrine tumor in your body.

Customer: replied 1 month ago.
102 u/ml - this is in Australia.The satablisation of the thyroid is a major issue that has not been achieved since removal. I don't think it was beleived that the situation could be one side Hypo and the other hyper.I beleive I have an adenoma on one of the endocrine glands but how do I determine this?
Customer: replied 1 month ago.
This would explain the reason why it cannot be stablised with Levothyroxine wouldn't it?
Customer: replied 1 month ago.
Sorry Prolaction is 700 u/ml
Customer: replied 1 month ago.
Prolactin
Customer: replied 1 month ago.
Also if the chromagranin Marker is low range High what does it mean usually then. The pathology report indicated the neurological situation.
Expert:  Dr. David replied 1 month ago.

for Nonpregnant women normal Prolactin is 4-23 nanograms per milliliter (ng/mL) or 4-23 micrograms per liter (mcg/L) also (ug/L)

I'm not sure what your units are.

your protactin levels look high.

I hope your brain MRI scan was done with contrast.

low range high of chromagrainin A doesn't mean much, it doesn't mean you have cancer or neuroendocrine cancer.

what pathology report?

Customer: replied 1 month ago.
I am not concerned about cancer - I have a medical background. I have been told that an MRI can miss a prolactinoma if it is growing differently, I also have optic nerve interference. I believe it was done with contrast but may have not been read correctly. Can any of this happen. ?
Customer: replied 1 month ago.
The pathology on the bloods done. It is bizzare to say the least that I cannot stabLise my thyroid levels on Levothyroxine, there is obviously something interfering with the break down ?
Customer: replied 1 month ago.
Ps hope I am not pregnant had a hysterectomy 6 years ago for adenomyosis?
Expert:  Dr. David replied 1 month ago.

thyroid hormone levels can be hard to stabilize.

I have graves disease and had I-131 to destroy my thyroid gland 3 years ago.

you have to make sure you take your thyroid hormone pill on an empty stomach with no other medications.

taking the pill or taking it with other medications can affect its absorption.

if you forget to take the pill daily, it can also affect your levels as well.

you shouldn't be pregnant. your doctors can check your bHCG levels

most likely your pituitary gland is making too much prolactin. this can be treated with bromocriptine to bring your levels down.

Expert:  Dr. David replied 1 month ago.

let me know if you have other questions.

if done for now, please leave positive rating of 3-5 stars so I can get credit for helping you today

we only get credit for helping clients after positive feedback

you can always reach me directly with "a question for Dr. David" in the medicine or oncology categories if you have other questions

here is my website if you need to reach me:

http://www.justanswer.com/medical/expert-dr-david/

Thanks for using JustAnswers.com

Customer: replied 1 month ago.
Hi Dr Daviid
Either you had a really busy day, which is understandable, and did not get all the facts of the the question, or I really do need to speak to an endocrinologist as I asked some questions which were not answered and I am a dissappointed. I do not wish to not pay but would rather give you the opportunity to readdress from the start. Given that it was from 6.20 at night in AU to 1.17 AM AU to get a few responses.If you would like to get it referred I am happy either way.
Expert:  Dr. David replied 1 month ago.

This is Dr. David

I was not the origional expert which answered your question.

I jumped into the question after the first expert opted out of the question.

I am in the USA.

Customer: replied 1 month ago.
what do you want to do? Did you get the Facts of the question or or do you wish to opt back in and we discuss the scenario I am in.
Expert:  Dr. David replied 1 month ago.

I never opted out.

Customer: replied 1 month ago.
is the first part of the question answered were they answered by someone else with your picture or do we go back to the start
Expert:  Dr. David replied 1 month ago.

I don't know what you are seeing

and these pictures.

I am here to answer your questions.

and to strive for excellent service

you want someone else, that is fine.

I am trying my best to help you

Customer: replied 1 month ago.
OK, Lets start again. I am happy.I was diagnosed in 2010 with Multinodular Goiter, to which then grew to a point that it started choking me, A series of Biopsies and multiple Ultrasounds confirmed the growth and indicated that the gland on the Right was Hypo and the land on the Left was Hyper (understanding it is one gland) I had no treatment for prior to the removal of the gland over three years as every endocrinologist told me it was menopause which was not the case as I had already been there.........
I also struggled in that time with elevated prolactin too.
I have lost my family and my husband because of the ups and downs of this which is tragic as the medico's did not beleive what was happening. I had the gland removed and there were 16 nodules within it. Two extremley large.
As indicated I have battled with regulating the hormone levels since it was removed and my endocrinolgist has done a panel of tests recently to see where I sit. This is after my old PCP and Endo kept saying that the "figures" were in range and all was good, all the while still going hyper and hypo.
The Present scenario is that I DO take my medication every day - I am 56 years old, I have adenoma's removed all my life, and the MRI shows nothing. I was done with and without contrast but I beleive that an adenoma can grow and NOT show on the MRI. I have Optic Nerve interference now and the antithyroid peroxidase antibodies are still high, my prolactin goes up and down and is current 700 M/iul
No macro-prolactin was detected. All specimens with prolactin > 500
IU/L
have been screened for macro-prolactin since 23.6.14. Macro-prolactin
is an
inactive form of the hormone that can falsely increase serum
prolactin. - this is copied from the pathology.
I also have 102 U/g;l Chromagranin A Gen
I still believe that there is an adenoma growing on my pituitary as I am from a medical background and another doctor has questioned the report. ?
Can the Contrast used be a factor?
I also have elevated Urea - in my Urine only 8.9 mm/ol.
My TSH is at 1.2 and my T4 is 19.0 This has been the pattern for so long.
I believe this to be more than just medication I beleive this to be unseen on the MRI - I have been told that this is possible.
As the OPtic Nerve is involved as well and has been for some time and the Doctor (friend) indicated there is a posibility it is not seen.
I Thank you and do not walk away and look forward to answwering anything you require.
I am stil Diagnosed as Hashimotto's yet nothiing was ever down about the Graves and I know that is an issue because of the Palpatations and Loss of hair and sweating and tremors.
Adrenal Adenoma's would show up How? on blood tests, and can Thyroid nodules regrow on your wind pipe without a thyroid given I had so many.
I thank you in advance
Customer: replied 1 month ago.
I assume it is normal to have an undetecable testosterone level
Expert:  Dr. David replied 1 month ago.

something is making the prolctin.

the adeno can still be very small and not seen on MRI scan.

TSH of 1.2 is in normal range. why do you think your optic nerve is involved?

have you seen an eye doctor?

if the pituitary is so small to not be seen on MRI scan of the brain, it is probably too small to be pressing on the optic nerve. with your TSH level of 1.2, your thyroid levels are not causing your palpitations and sweats and tremors

do you have excessive anxiety symptoms? excessive anxiety disorder can cause palpitations, sweats and tremors.

Customer: replied 1 month ago.
Agreed, something is making the Prolactin.The T4 at 19 is still too high, and yes I have had an eye Doctor involved, this is how it escalated. I don't have anxiety and as such has been ruled out.Can the adenoma be growing in a way that can't be seen on the MRI
Customer: replied 1 month ago.
With Chromagranin elevated something is going on as well.
Expert:  Dr. David replied 1 month ago.

free T4 is more important to know

total T4 is not as reliable.

yes, a small pituitary adenoma can grow in the pituitary without being seen.

get a copy of your MRI scan of the brain and check for contrast use.

chromagranin A of 102 doesn't mean you have a neuroendocrine cancer.

Customer: replied 1 month ago.
Hi David
That is my Free T4.
I am not concerned of cancer as I know that it is a low level, High is Cancer and low is endocrine.
They say on the MRI before contract and after Contrast.
Can an Adenoma be actually inside the pituitary - don't laugh, Everything that ever happens in my life is rare........the measurements seem extreme for a pituitary gland
Customer: replied 1 month ago.
I can take a photo of the MRI and send through as a JPG file
Expert:  Dr. David replied 1 month ago.

T4 (thyroxine) Free (serum) should be 0.8 - 1.8 ng/dL or 10 - 23 pmol/L

so if your level is 19pmol/L that is within normal range.

http://www.globalrph.com/labs_t.htm

and MRI scan has many different slices,

your jpg image files are not good enough image quality to look at a brain MRI scan

you should just get your brain MRI scan report.

Customer: replied 1 month ago.
In AU the Free T4 is 9-19I have the report but that does not explain what I am saying. Can an adenoma grow within or behind.I understand the slices, but the one that is evident is the side view and measurement slices.Prolactin and Chromagranin does not get produced for no reason???? I can upload the scan of the one i am talking about
Expert:  Dr. David replied 1 month ago.

a small adenoma can be within a normal appearing pituitary gland.

your chromagranin A level is not that high

it seems like you are convienced that there is a dangerous medical condition causing your levels.

I keep reassuring you, but you don't seem to want to be reassured.

your free T4 level is normal your TSH level is normal. your thyroid hormone levels are normal.

you should be on bromocriptine for your prolactin levels. did your doctors give that to you?

Customer: replied 1 month ago.
never
Customer: replied 1 month ago.
I am not convinced of a "dangerous" medical condition as the levels indicate benign anyway.This has been escalating for 3 plus years,
Customer: replied 1 month ago.
i dont want it to get to a situation of Dangerous.......... this has happpened not only to me but to other members of my family
Expert:  Dr. David replied 1 month ago.

never what?

your endocrinologist never treated your high prolactin level?

Customer: replied 1 month ago.
Correct, Never was I treated for Graves either, Levothyroxine was only given after the removal of the thryrod.........The PCP and did not believe the Ultrasound Radiologist.
Customer: replied 1 month ago.
If the Optic nerve is involved there is something happening not seen too as per the eye doctor
Expert:  Dr. David replied 1 month ago.

you were treated for your thyroid issue by having your thyroid gland removed and now you are on thyroid hormone pills

and your thyroid hormone levels are NORMAL. you don't need treatment for graves now.

there is no optic nerve involvement. that is something you are concluding.

it was not seen on the brain MRI scan

the pituitary gland is normal size

Customer: replied 1 month ago.
Thanks - and your expertise is Cancer is that correct.
Customer: replied 1 month ago.
I dont like to be told that I am concluding the optic nerve involvement when it is has been diagnosed by the Ompthamologist.
Expert:  Dr. David replied 1 month ago.

yes, I am a cancer expert.

and I have grave's disease myself and my thyroid gland destroyed by I-131 and I take levothyroxine myself daily.

and I review MRI scans often for patients

you just said your eye doctor didn't see anything which causes optic nerve involvement.

Customer: replied 1 month ago.
At 1.11, i indicated the optic nerve was involved..............please see - If you are trying to do other people fine, but please do not make me out to be something that I am not.I am trying to find answers when for three years 16 nodules grew and had sever dysphagia and I was told it was menopause and lost my family because of it so please excuse me for wanting to get to the bottom of this.Not all things seem to be as they are from the outside.
Expert:  Dr. David replied 1 month ago.

what do you mean at 1.11?

I don't know what you are talking about?

Customer: replied 1 month ago.
The time 1.11 go 2 back and you will see the optic nerve
Expert:  Dr. David replied 1 month ago.

I have no idea what you are talking about

I have searched this whole thread.

there are no post at 1:11

you said you have "optic nerve interference", but you have never shown evidence of his and your eye doctor hasn't seen it

so I asked you how do you know you have optic nerve interference.

and you haven't answered that question.

Customer: replied 1 month ago.
never what?your endocrinologist never treated your high prolactin level?13 October 2016 01:10
Correct, Never was I treated for Graves either, Levothyroxine was only given after the removal of the thryrod.........The PCP and did not believe the Ultrasound Radiologist.
13 October 2016 01:11
If the Optic nerve is involved there is something happening not seen too as per the eye doctor
Just copied and pasted straight from screen
Customer: replied 1 month ago.
You may of misread this?The Optic Nerve is involved as per the eye Doctor, he actually was the one who first suggested MRIMy apologies.
Expert:  Dr. David replied 1 month ago.

well, did you talk to your eye doctor after you had your MRI scan?

what did your eye doctor say after you had your MRI scan?

Customer: replied 1 month ago.
Sorry I got caught up with work,The Opthomolgist did a series of test which clearly showed the loss of vision. He also was not convinced on what the MRI scan read as wel as he could clearly see interference and pressure.
Expert:  Dr. David replied 1 month ago.

then you have to ask your opthalmologist why you are having these vision loss symptoms

did you have a visual field test?

when something is pressing on the optic chiasm, it can cause visual field vision loss.

I bet your visual field testing will come out normal.

Customer: replied 1 month ago.
Interesting - that was the test that he did and that was the reason it all started.
Expert:  Dr. David replied 1 month ago.

I would get a copy of your brain MRI scan and talk to your opthalmologist

I suspect now he will say that you don't have involvement of your optic nerves

Customer: replied 1 month ago.
My field test was NOT good and I have had eye problems
Expert:  Dr. David replied 1 month ago.

what sort of eye problems?

get a copy of your eye field test.

I would be happy to review it with you.

Customer: replied 1 month ago.
I have a pretty good idea now of what is happening so will finish.
Tganks
Expert:  Dr. David replied 1 month ago.

please leave positive rating of 3-5 stars so I can get credit for helping you today

we only get credit for helping clients after positive feedback

you can always reach me directly with "a question for Dr. David" in the medicine or oncology categories if you have other questions

here is my website if you need to reach me:

http://www.justanswer.com/medical/expert-dr-david/

Thanks for using JustAnswers.com

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