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Re: Longstanding undiagnosed problem- PCOS? Hypothyroid?
From: Nancy (anonymous@obgyn.net)
Thu, 16 Nov 2000 13:44:21 -0600 (CST)
Saw my PCP who preferred that my OBGYN be the one to determine whether I
should have a PCOS workup. He said, that when they have discussed this
in the past, the OBGYN was not in favor of evaluating people that could
not be treated anyway. My real issues at this point in my life are
insulin resistance and mildly elevated Cholesterol- total 220, LDL 140,
HDL 46, Triglycerides around 170. FBS ranges 115-125. Post prandial BS
are usually in the 80-90 range but I can barely stay awake if I eat
anything but very low carb. PCP did not think metformin was indicated.
I've gained 50 lbs that I just cannot seem to lose. I was hoping
Metformin might help me. Have 90% of the symptoms of hypothyroidism too
with a cystic nodule but beautiful labs. I don't think my OBGYN will
wish to pursue the PCOS diagnosis because my symptoms are not impressive
enough and fertility is no longer desired. I'm more concerned about my
longterm risk of vascular disease and of course I'd like to lose weight.
At Sat, 11 Nov 2000, Kelly Shanahan, MD wrote:
>
>At Fri, 10 Nov 2000, Nancy wrote:
>>
>>Currently I have insulin resistance, slightly elevated cholesterol with
>>increased LDL, HDL around 40, and normal triglycerides. 43 years old
>>and 50 lbs overweight for last few years. Cycles are 25-28 days
>>occuring monthly. Frequently have mild pain with ovulation (can feel
>>every footstep I take in my ovary). Had 3 closely spaced pregnancies
>>with preterm labor beginning early and diagnosed by 20 weeks each time,
>>requiring double tocolytics. Also had gestational diabetes each time
>>requiring insulin.
>>At age 18 I started having severe,excruciating pain every month
>>immediately FOLLOWING my period and lasting until about the time of
>>ovulation. This pain usually only lasted from about 1 or 2 AM until
>>about 6 or 7 AM. I would go to sleep feeling ok and be awakened by pain
>>that caused me to writhe in the bed. Pain also ended pretty abrubtly
>>but would reoccur the following night for a week to 10 days! Eventually
>>had a laparoscopy which did not reveal the cause. Later a sono found a
>>cystic appearing mass in the lower left posterior wall of my uterus.
>>Later evaluated by reproductive endocrinologist who thought by sono that
>>it was a fibroid but then on lap and hysteroscopy, could not detect it
>>and it was near major uterine arteries which he did not want to risk
>>exploring, knowing I planned another pregnancy (after 1st child). He
>>mentioned on the operative report, "normal appearing ovaries. Corpus
>>luteum in left ovary." I was taking Synarel at the time of this surgery
>>because he wanted to shrink what he thought was a fibroid and planned to
>>remove it. This weird pain syndrome responded immediately (first cycle)
>>to both Danazol and Synarel, although I had been told it would take a
>>few months to even notice a difference. Had BTL 1 yr after 3rd child
>>and lots of adhesions were noted but no mention of anything else
>>abnormal. Have had few problems with cycle since then other than
>>worsened PMS.
>>For the last few years I've had fatigue, weight gain, often feel cold,
>>dry skin everywhere except face and upper trunk, hair now starting to
>>come out enough for hairdresser to mention. Several years after these
>>symptoms, I've developed a thyroid nodule-mostly cystic. TSH 0.85, T4,
>>T3U Thyroxine index all mid range. Free T3 and Free T4 near bottom of
>>normal range. Does any of this sound like it could be PCOS despite
>>"normal appearing ovaries"?
>
>It sounds like the textbook of PCOS.
>
>Why the thyroid nodule and normal labs with
>>hypo symptoms?
>
>Labs can be normal for a while-- althogh the low TSH is not suggestive
>of hypothyroidism
>
>Also, my Mom is treated for hypothyroidism for 25 years
>>following 2/3 removal of her thyroid for a benign nodule. With this
>>treatment, her weight dropped 50 lbs, glucose and cholesterol normalized
>>in 6 months. She also tried to get pregnant for 8 years before success
>>and had long history of painful very heavy periods. Also currently have
>>8 year old daughter with sudden onset of significant weight gain over
>>past 3 years and she now has acne- she's seeing an endo next week. Sorry
>>this is so long but no one has ever been able to find anything wrong
>>with us and this seems very abnormal to me and I think it must all be
>>related. Hope someone can give me some ideas to at least get checked
>>out.
>>
>>--
>>Nancy
>>
>If you are not currently on glucophage for the insulin resiatnace, you
>hsould discuss it with our doc -- and if you haven't seen an
>endocrinologist yourself, you should
>
>--
>M. Kelly Shanahan, MD, FACOG
>South Lake Tahoe, CA
>
>This information is for educational purposes only and does not construe a doctor-patient relationship. It does not replace the need for you to consult your own doctor.
>
>***private e-mails will be deleted without reading. Please respect my family time
>
--
Nancy
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