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Dr Basu
Dr Basu, Experienced Specialist
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Experience:  MD
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My wife, age 60, has been sick off and on for three months.

Resolved Question:

My wife, age 60, has been sick off and on for three months. Her major symptoms are; nausea, being cold, and dizziness. My PCP is too busy to see her, plus he was on vacation for two weeks until after Labor Day. She has been in ERs in three different hospitals, and they have diagnosed her with pneumonia, acute sinusitis, and Hashimoto's Hypothyroid. Her prescriptions have sequentially included Z-pac, levoquin, and Bactrim. At the last two trips to the ER, it has been suggested that she suffers from anxiety because she gets frantic because no one will/can help her. She is Chinese and the healthcare system there is much more prompt than here. Her sister, a retired internal medicine specialist thinks it may be hormonal, even though she is post-menopausal.

With this sketchy information, can you help her?
Submitted: 1 year ago.
Category: Medical
Expert:  Dr Basu replied 1 year ago.

Mysticdoc :

The views expressed by me are for educational purposes only and do not establish a doctor patient relationship.

Mysticdoc :

Hi there,


I am Mysticdoc, experienced Internal Medicine Specialist.


I am here to help you with your concerns.

Mysticdoc :

Do you know if she is taking thyroid hormone for hypothyroidism?

Customer:

No, the diagnosis occurred only early this week.

Mysticdoc :

Ok

Mysticdoc :

Hypothyroidism can cause all these symptoms.

Mysticdoc :

THyroid hormones are major metabolic hormones.

Mysticdoc :

In their deficiency, body does not function properly.

Mysticdoc :

Hashimoto's means autoimmune thyroid disorder.

Customer:

Her thyroid hormone level is 5.79 with the tops of the normal range being 4.89

Mysticdoc :

Nowadays we consider 2.5 as upper limit.

Mysticdoc :

So 5.79 is high and shows moderate thyroid deficiency

Mysticdoc :

Besides thyroid problem, she may have problem with the pituitary gland, adrenal glands.

Customer:

Two MDs we have seen do not think that hormone level is sufficiently high enough to warrant concern.

Mysticdoc :

Hence, further testing is required like serum cortisol level in morning, IGF1 level ( to rule out growth hormone deficiency), serum estrogen level, LH and FSH level, prolactin level, serum androgem levels.

Mysticdoc :

androgen --

Mysticdoc :

You need to consider seeing an endocrinologist.

Mysticdoc :

She should be started on low dose levothyroxine for now.

Mysticdoc :

And frequent infections can be due to the immunodeficiency as well.

Mysticdoc :

So, a blood count with differential and peripheral blood smear is essential.

Mysticdoc :

If there is hematological maligXXXXX XXXXXke leukemia or lymphoma, that can cause these symptoms as well.

Mysticdoc :

Also age appropriate cancer screening --colonoscopy, mammogram, pap smear should be done.

Customer:

Those were not check. Let me retract my numbers; her level is 4.79, with a top range of 3.89

Mysticdoc :

still that is elevated.

Mysticdoc :

also free T4 level should be checked.

Mysticdoc :

TSH may not be that high if she has pituitary gland problem which i located in the brain.

Mysticdoc :

Pituitary gland is the master gland which controlh controls all other glands in the

Mysticdoc :

body

Mysticdoc :

So more comprehensive testing is required.

Mysticdoc :

Also do you know her albumin ( protein ) level?

Mysticdoc :

this is included with liver function test

Customer:

I did not mention that she had a CT scan of her head, revealing the sinusitis. Plus, she has a CT scan of her abdomen, that showed no abrnroamlties

Mysticdoc :

That is reassuring the Ct scan of abdomen is normal.

Mysticdoc :

CT scan of brain is not that sensitive to look for pituitary gland problem.

Mysticdoc :

But it does rule out any infection or stroke etc.

Mysticdoc :

I strongly belive she does have hormonal problem.

Mysticdoc :

Also, please check her blood count and protein level.

Customer:

I am not capable of reading the blood screen results, but everything else was normal, expect the creatinine level was very slightly elevated (1.25)

Mysticdoc :

ok

Mysticdoc :

In that case, hormonal problem is more likely.

Mysticdoc :

thyroid and menopause combination.

Mysticdoc :

however, I will also suggest the above hormonal tests to make sure other glands are functioning normally.

Customer:

On one of the blood test results, her albumin level was 4.1

Mysticdoc :

ok that is in normal range.

Mysticdoc :

and her white cell count?

Customer:

If one ER doctor diagnosed hypothyroid, why were not these other tests also done? (and forgive my typing)

Customer:

She has been stuck so many times, I hate to have her subjected to that again, so soon.

Mysticdoc :

Understand that.

Mysticdoc :

That is the problem if an endocrinologist is not consulted after the first blood test/

Mysticdoc :

You may wait for a week or two to get the other tests done.

Customer:

Where would I find the white cell count on her blood results?

Mysticdoc :

it should say WBc or leucocyte count.

Mysticdoc :

CBC or complete blood count heading

Customer:

No, white cell count not listed.

Customer:

Is there anything she can take OTC to help her symptoms? She has significant GERD.

Customer:

Her next appointment is not until Monday at 2:00 p.m.

Customer:

And her symptoms are chronic; with constant GERD.

Customer:

You have been the most helpful doctor I have talked with during this ordeal. I thank you profoundly.

Customer:

Total protein level is 7.0

Customer:

I think she would more comfortable if she could get some relief from her GERD. She has been prescribed famotidine for that and it is not working.

Mysticdoc :

ok

Mysticdoc :

In that case she can try omeprazole 20 mg daily

Mysticdoc :

this is available over the counter.

Mysticdoc :

Very welcome

Mysticdoc :

It was my pleasure to help you today.
Best wishes,
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Dr Basu, Experienced Specialist
Category: Medical
Satisfied Customers: 23146
Experience: MD
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