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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 32589
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Dr. Nelson, I'm a female, aged 43. When I was 35, I was

Customer Question

Hi Dr. Nelson,
I'm a female, aged 43. When I was 35, I was diagnosed with Hashimoto's thyroiditis after gaining weight precipitously, and feeling 1000 lbs. and 100 years old. A blood test was run to determine Hashimoto's versus other causes of hypothyroidism. My doctor said I had come to her with "toxic" levels and I had a goiter. Since then, she put me on Synthroid, which took a long time to get my levels up and then added cytomel when I was not having any metabolism even though I'm very active and eat a healthy diet. She never ran an ultrasound on my thyroid during this whole time. Last year, I switched to Armour because they synthroid was causing me extreme pain in my thighs and thigh muscle weakness. The pain went away with Armour but I've still done nothing but gain weight since I started treatment. I went to an endocrinologist this past September and he dropped me from 90 mgs of Armour to 75 mgs because he said he needed to raise my TSH (my doctor told me my thyroid is dead and experts online say that TSH doesn't matter in my situation). I gained 10 pounds in 3 weeks on his experiment with my body and never went back. I also could not hike during that period and my heart was pounding on one hike so hard that I almost vomited and passed out. I swim laps three times a week, walk on a treadmill for two days a week, and hike in the woods for several miles once a week. I was an athlete as a child, rail-thin up until 15 years ago, and have been exercising faithfully since 1998. Even though my numbers say I'm hyperthyroid now, I have no hyperthyroid symptoms and even more weight gain. I recently quit my doctor as it became clear she was not interested in solving any underlying conditions. I'm finding that doctors seem more interested in numbers by meta-analysis than dealing with challenging diagnoses of people who don't respond the same to treatment that others do and it has been frustrating. Now my cholesterol is soaring (even though I'm hyper- by the numbers), and I'd like my underlying condition that seems to be interfering with my thyroid medication diagnosed. My question to you is how do I present this problem to a doctor in words to get them interested in and solving my problem? What questions should I ask the doctor to find out if they are the kind of doctor interested in solving mysteries? Do you personally have any ideas about what could be causing my issues? If I gain any more weight on this "treatment," I won't be able to exercise, which is how I have always maintained my mental health and managed stress. This is more than concerning to me. Thanks for your help in advance.
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 year ago.

Hello Kelly,
I am Dr. Arun and will be helping you today.
I am sorry that your question was unanswered for long.

I can understand your frustration. Many of the doctors as you mentioned would like to treat the investigations and their numbers than taking an Holistic view and dig deeper.

First thing I would suggest is that you consult an endocrinologist working in a teaching hospital. They are academic oriented, have residents to give them multiple inputs and they can interact with other specialists if need arises as they work under the same roof. The interactive specialist communication is far more than elsewhere as patients are widely discussed and all of these understand that disease processes are not confined to the artificial boundaries of a single organ or a pathology.

Secondly at the outset you may communicate with your doctor that you are not interested in just the prescriptions but also about understanding what is going in the body. Your physician will look after your symptoms, ascertain the signs, investigate you and with your past history, personal habits, family medical history, would try to label you with a diagnosis and then institute the treatment. Quite a complicated phenomenon and never work by logics and inferences. There would be always two opinion on an individual's diagnosis. And since it does not work by logics, many times work by sheer experience; this is the reason they have not been able to make a computer program to give the correct diagnosis and / or treatment. Individual humans behave far more differently than a group of people and doctors give opinion according, how the groups behave. So tell your doctor that while you understand the body's complicated phenomenon and individual responses; still you need to understand what is going on his mind, so you can give some more inputs, if necessary.

It is difficult to give you a diagnosis, but I would get your immunological tests repeated and also get following hormones, if not done;

1) Prolactin

2) FSH

3) LH

4) Adrenal function

5) Estradiol

6) Testosterone

Hormones are delicate balance and work like different instruments in an orchestra. So one hormone or its medication may affect the balance of other and may not get corrected with one treatment; and thus these investigations may point to something more than what had been visualized.

Meanwhile following may be helpful to decrease your cholesterol;

You can take red yeast and omega 3 oil which is likely to help lower abnormal level of lipids /cholesterol in blood. Food and Drug Administration has warned that red yeast rice products could contain a naturally occurring form of the prescription medication known as lovastatin (it may cause muscle pain, as it is statin). So you may need some caution also. Following are the other supplements which are known to help lower cholesterol;

1) Flaxseed

2) Garlic extract

3) Barley

4) Artichoke extract

5) Green tea extract

The cholesterol, triglycerides can also be controlled by the lifestyle approaches and dietary strategies. Following would be very helpful to lower them;

1) Dietary fiber; Soluble fiber is present in foods such as beans, oats, barley, and fruits and vegetables. This decreases absorption of cholesterol.

2) Phytosterols; Phytosterols are present in small amounts in nuts, seeds, and vegetable oils. Numerous studies have shown that phytosterols lower LDL-Cholesterols. There are many products on the market that contain phytosterols for total- and LDL-C lowering. These products are orange juice, yogurt, margarine spreads, salad dressings, breads, cereals, milk, and granola bars. Phytosterols also are available in soft-gel pills.

3) Soy protein is the major component of soybeans and decreases triglycerides and cholesterol.

4) if one is over weight, just weight loss also reduces the cholesterol and triglyceride levels.

5) Physical activity; regular aerobic exercise is effective in reducing blood lipids and proven by many studies.

6) Alcohol; if one takes, limit it to 20-30 ml per day.

Following dietary pattern may be helpful;

1) Red meat in low frequency and amounts

2) Minimally processed seasonally fresh foods

3) Less than five eggs per week

4) An abundance of plant foods; fruits, vegetables, potatoes, breads, grains, beans, nuts, and seeds

5) Olive oil as the principal source of dietary fat

6) Fresh fruits as the typical daily dessert

7) Wine in low to moderate amounts; one glass per day for women.

So life style care measures, diet and supplements would be able to lower your cholesterol.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

Expert:  Dr. Arun Phophalia replied 1 year ago.

It is privilege assisting you.

Please let me know if you have further queries or unanswered questions.

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Thank you.

Wishing you all the very best in life.

Expert:  Dr. Arun Phophalia replied 1 year ago.

Thank you for the opportunity to answer completely your Question. Please make sure to rate me because that is how I am credited for my work.

Now, I will provide an Additional Service offer so that you have this option available on your question list to get a hold of me directly in the future.

This additional service offer can be used for

- if you would like to schedule a new, private email session or to ask me directly a new question. It's up to you.

Thank you.