Doctor has almost given up....

[nathanm]

I am 28 years old with severe fatigue. I have high blood pressure as
well and take 20mg of lisinopril per day, and have sleep apnea and
sleep with a CPAP machine nightly. My CPAP is confirmed as working as
of 01/09. I went to my primary care Doctor in January. 2009.

Calcium - 10.3 mg/dl
vitamin D - 14 ng/ml
B12 low

I was put on vitamin B12 shots, and continue those monthly now, and
also was given a weekly vitamin D prescription for 50,000 IU's per
week.

My Doctor next texted ionized calcium, and that came back normal. The
Doctor then re-ran calcium, and PTH, and calcium was 9.8 this time,
with a PTH at 37 pg/ml.

She then tested total testosterone which came back as 225 ng/dl. She
ordered an MRI of my brain as well, and that came back as normal.

My Doctor referred me to an endocrinologist.

He ordered a 24 hour urine calcium test which came back at 223 mg/day
which he said was normal.

He also tested:

aldosterone - 5.9 ng/dl
renin - 24.5 ng/ml/hr
Plasma metanephrines normal
A.M. testosterone 219 ng/dl
LH 3.8 mIU/ml
FSH 3.6 mIU/ml

I have absolutely no signs or symptoms of low testosterone.

Next, my endo ordered:

Calcium, PTH, and vitamin D again, (after completing my Vitamin D
therapy) total serum estrogen, and FSH, LH and prolactin.

Calcium - 9.8 mg/dl
PTH - 25 pg/ml
Vitamin D - 23/ng/ml
total serum estrogen - 133 pg/ml which he said was a bit high...
FHS, LH and prolactin levels were all normal.

I just talked with him again following another round of testing. He
said that the total testosterone level is still low, but that the
protein that binds the testosterone is also low so he is not concerned
about my low total testosterone. My estrodial is slightly elevated.

Basically, he has said at this point that he does not know what is
causing my fatigue.

Can you help? Can you see anything here, or suggest anything
additionally that I need to try or look for? Thank you in advance... I
am really, really frustrated.

[dlstump]

Hi Nathanm,

Has your doctor run a Thyroid Peroxidase (TPO) ab blood test on you yet, this is for the Hashimoto's?  Has your doctor done a CT scan or an MRI of your adrenal glands and ovaries?  Don't give up, sometimes changing your endo doctor helps.  Go to RateMD.com and look for a doctor in your area with 5 stars.  Since my mid 20's I have been suffering from weight gain (up 100 lbs now) Hair growth on my neck, chin and upper lip.  These are the noticable signs and I was mis-diagnosised.  Thyroid problems run in my family, I don't know anyone on my mothers side that doesn't have a thyroid problem.  For years the doctors would run the TSH and T4 and they would tell me that I'm in the normal range and wouldn't do anything for me, well I finally went to rateMD.com and found someone who had 5 stars rated by his patients and  scheduled an appointment and sure enough, he is great.  He ran every test available for every Thyroid condition and the Thyroid Peroxidase (TPO)ab blood test was off the charts, this means I have Hashimoto's.  All other doctors I went to never tested me for this.  Now because of being mis-diagnosised for years, I felt as if I was almost dead.  3 months ago my doctor put me on Armor, he started with 30mg for two weeks then up'd me to 60mg now he just up'd me again to 90mg.  I don't yet feel normal yet but I feel a lot better.  I'm also almost a diabetic (hypoglosimic) and my bad cholesterol High and my good cholesterol is low because of Hashi's.  If your doctor is giving up, go to someone else.  By the way, my doctor's name is Dr. William Abelove, he is in Weston, Florida.  Awesome Doctor, I can't say more for him.  Don't give up, get a new Doctor or tell your doctor to to test you for every possible thyroid condition.  

[Mark Lupo, M.D.]

You didn't mention any thyroid testing....I assume TSH and T4 are normal

The initial calcium was a bit high, but further testing including PTH has been normal on two separate labs.

At this point I don't have any further recommendations.

[nathanm]

Also wanted to mention that I have leg twitches that are sometimes really bad. I was given Mirapex, which initially seemed to help some, but after a few days the twitches were back and just as bad. I also have head and neck pain constantly. In the morning after waking up, every single day I crack my neck (middle of my neck) usually at least 5 times. This is something I feel that I have to do throughout the day. It doesn't make the pain go away.... I do have headaches, but the pain in my head and neck doesn't seem to be from a headache.

Thank you again.