Thyroid Problems/Too much PMH for 22 y/o
QUESTION: Hi Dr - thanks for taking the time to answer my question. Your opinion is greatly appreciated. 1st thing I should clarify is I don't know that I have a thyroid problem, but it's something I think should be looked at from an endocrinology point of view. My mom is my PCP and I don't know that having her as my PCP is really helpful since I feel like my health is stagnant. PMH - 22 y/o married Hispanic female hx of hyperprolactinaemia that caused hypermenorrhea 01/09-03/09 62 days ongoing - resolved with bromocriptine, prolactin levels have stayed normal since then. First MP age 10. Chronic migraine sufferer taking triptans at least 1 tab po qd because nothing else works. Within the last 3 months I've been experiencing significant insomnia. I went from being able to sleep 7-8 hrs comfortably w/ my snoring husband to being lucky to get 6 with earplugs and a face mask to block all light interference (even little lights i.e. on electronic devices). I sleep lightly and frequently wake up. I am not well rested by any means in the morning. Currently taking 10mg amphetamine salt combo bid to try to make up for the lack of sleep along with coffee. Chronic back pain, cervical, thoracic, and lumbar areas pretty much 6/10 most of the time, sometimes worse. Last CBC (6/13) showed MCV MCH low and RDW RBC count high, so clearly I'm anemic, taking prenatal vitamins to try and make up for a bad diet. I am of normal weight but not physically fit and my diet is satisfactory. I am also significantly lacking any kind of libido which is weird for a 22 y/o. I am pretty much plagued with headaches, backaches, fatigue, insomnia, low libido, ADD, and depression. Being sick all the time makes me pretty frustrated with my life! No PCOS although a couple yrs ago i was borderline polycystic. No birth control. I guess I'm wondering what could be wrong with me. I have considered low testosterone but I'm not sure if it would really fit my hx. I also have "chronic gastritis" and IBS which is likely unrelated. I just don't want to be sick anymore. I am young and I want to enjoy my life but I feel like I'm suffering in silence because no one else can relate to what I'm going through. I have kept to myself because of this situation and I'm getting to the point where I don't know what to do. Can you point me out in the right direction? Thank you again!
ANSWER: Hello Elmo!
Warm welcome to you!
Though Insomnia and increased RBC count, decreased MCV etc are suggestive of hyperthyroidism(grave's disease), we can not conclude on to it without complete thyroid profile testing. This is because your TSH is within normal range. But this could be just the begining of the problem.
Hyperprolactinemia can be triggered by many factors including several drugs, physiological factors like coitus(sexual intercourse), pathologic conditions like hypothyroidism and PCOS. Are you still on bromocriptine for Hyperprolactinemia? I think the reason for you becoming anemic is your hypermenorrhea. You should get peripheral blood smear done to find out the reason for anemia.
Please stop taking coffee and anything that contains caffiene. The caffiene increases the awakeness of the brain.
After reading your symptoms the following probable* diagnosis can be made:
Either its related to thyroid hormones(needs complete thyroid profile testing)
Or may be due to physical/emotional stress.
But you have to note that all these symptoms can be exhibited by depression and anxiety. Do you consume alcohol? If yes how frequently and what quantity? Any history of drug abuse?
My recommendation is you need to consider further investigations like PBS, Thyroid profile, renal function tests. After you get the investigations done then we can discuss further.
Hope that helps.
Take care. Have a great day. Bye.
---------- FOLLOW-UP ----------
QUESTION: I don't have TSH results yet but I wanted to follow up with what I do have. I will let you know what comes of those tests.
I am not sexually active > 3-4x per month due to my general fatigue and lack of libido, so I pretty much ruled out that factor in terms of the hyperprolactinaemia, which seems to be back. I am not taking bromocriptine on a regular basis. I only took it once in 2009 the first time I had a problem with my prolactin level. I can tell its been going on because of almost consistent discharge.
I cannot stop with the caffeine because I have so many headaches. I have tried before.
I do not drink, but I do smoke cigarettes (1/4 pack a day). I feel as though the Adderall creates a craving as I have no desire to smoke at all when I do not take it.
Nice to hear from you!
One thing is we need to come to a conclusion about what is causing hyperprolactinemia. Is it due to the adverse effect of drugs or due to an endocrine abnormality. Because hyper secretion of prolactin seems to be causing loss of libido, fatigue etc. I think you will have to take bromocriptine regularly to keep it under control if its due to an endocrine abnormality. So right now all we can do is wait till the throid lab results come. Also we need to find the root of problem of hyperprolactinemia. But have you discussed the chronic headache with your doctor? Whats causing it? But its 100% true that caffiene wont let you sleep, if you consume it too much.
Ok send the lab results when you get them.