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My tsh level is 4.36. have low energy, headache. Daily

Customer Question
My tsh level is...

My tsh level is 4.36. have low energy, headache

Doctor's Assistant: Is the headache episodic or daily? And what about nausea?

Daily headache....loss of appetite...some mild nausea

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

Multiple sclerosis, depression, anxiety

Submitted: 8 months ago.Category: Medical
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Answered in 5 minutes by:
11/10/2017
Doctor: Dr. Arun Phophalia, Doctor replied 8 months ago
Dr. Arun Phophalia
Category: Medical
Satisfied Customers: 38,753
Experience: MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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Welcome to Just Answer.
Answers here are for education and information.
I will respond shortly with an answer, or further information request.

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Doctor: Dr. Arun Phophalia, Doctor replied 8 months ago

What is your age and gender?

Since how long are your symptoms?

What are the other investigations done?

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Customer reply replied 8 months ago
44 year old female.
a year at least.
ultrasound on kidneys due to chronic UTI.
Doctor: Dr. Arun Phophalia, Doctor replied 8 months ago

Thanks for the additional information. I am writing the answer for you and will get back to you in 4-5 minutes. If you get a phone call request, you may ignore it as that is an automated site trigger. Thank you.

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Doctor: Dr. Arun Phophalia, Doctor replied 8 months ago

The causes of chronic fatigue are;

Thyroid disease

Connective tissue diseases

Chronic anemia

Neoplastic disease

Chronic infections like Epstein Barr virus

Endocrine diseases (Addison disease).

Chronic fatigue syndrome

Myasthenia Gravis.

The investigations needed are;

Complete blood count (CBC)

Liver function tests

Thyroid function tests

Erythrocyte sedimentation rate (ESR)

Serum electrolyte level measurement

Immunoglobulin M (IgM)/immunoglobulin G (IgG) coxsackievirus B titer

IgM/IgG human herpesvirus 6 (HHV-6) titer

IgM/IgG C pneumoniae titer

Autoimmune panel

Anemia panel.

A chronic UTI can also cause chronic fatigue and headache.

Following approach for the chronic / recurrent urinary tract infection may be helpful;

1) An estimation of residual urine. This is done by an ultrasound examination. An ultrasound is done with full bladder. Then you are asked to void and ultrasound is repeated. If there is a residual urine amount more than 50 ml; that is considered as significant amount. An high residual urine in bladder will not let the UTI eradicated. In a high residual urine following investigations would be done;

a) CMG (cystometrography); this tells about the bladder muscle and sphincter functions. A problem in these would not let the bladder empty properly and thus the recurrent UTI.

b) Pelvic floor EMG; tells about the pelvic muscle dysfunctions and help in above.

These will need medications to improve bladder emptying.

2) Medications which alter urinary pH helps in eradicating the recurrent or chronic UTI with the antibiotics.

3) Culture for the mycobacterium; this if grown will need different kind of medication regime specifically for the mycobacterium bacteria which do not respond to the antibiotics.

4) Gynecological examination; to see for the major cystocele (bladder prolapse). This also predisposes for the recurrent UTI.

5) If above do no help the other investigation contemplated are;

a) Cystoscopy; camera exam to look for bladder diverticulum or any other abnormality.

b) MR urography (magnetic resonance urography to look for infective nidus elsewhere in the urinary tract).

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.

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Doctor: Dr. Arun Phophalia, Doctor replied 8 months ago

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Doctor: Dr. Arun Phophalia, Doctor replied 8 months ago

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Wishing you all the very best in life.

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