Feeling Weak And Shaky With Rapid Heart Rate. Found High TSH Level. How To Diagnose Symptoms?

Posted on Wed, 3 Apr 2013

Question: Hi, almost 3 weeks ago I left work in an ambulance due to rapid heart rate. Ecg's were fine. I was under the usual stress and perhaps 2 coffees more than usual that day. Since, I have had daily bouts of weakness, trembling, eye sockets hurting, sometimes seeing like I'm in a fog and dizzy. I now check blood sugar, I range from 3.9mmol/L to 7.5 in general. I typically feel shaky and weak when it is within 3.9 and 5.8. Did blood tests, fasting, sugar was 4.6 and felt ok. Tsh was 0.65 mIU/L, ferritin was 376 ug/L all others seemed well within range. Doc said tsh was "trending" a bit high, so we redid and tsh came back at 1.03 free T 3 and T4 seemed in acceptable ranges. I now "tend" to get weak and shaky at about 3 and 6 pm so it seems i need to eat to start resolving the shakes. We are now checking electrolytes, something about sugar in cells? Never felt like this before and I am not sure what is going on with me. Male 41 smoker of 12 a day, not a drinker and I am a healthy eater, home made meals, generally healthy in general. WhAt else should I investigate? I am extremely concerned...

Answered by Dr. Sudhir Kumar (2 hours later)

Hi,

Thank you for posting your query.

First of all, I wish to reassure you that your symptoms do not suggest any serious disease.

Your investigations are on the correct track, however, I have a few suggestions:

1. You should go for Holter monitoring (24 hour ECG monitoring) also, as in younger people, sometimes cardiac arrhythmias (irregular heart rate) can produce similar symptoms.

2. Please check the following blood tests too- serum potassium and serum sodium during the episode of weakness, as low potassium (hypokalemia) can also lead to episodic weakness.

3. If your situation is confirmed to be due to low blood sugar, one should exclude a tumor called as insulinoma (of the pancreas), which produces extra insulin, which can lead to low sugar. This condition can be excluded by a CT or MRI of abdomen.

I hope it helps. Please get back if you have any additional queries.

Wishing you good health,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (6 hours later)

Thank you sir. Point 3 concerns me. Would there be other symptoms? Could an x-ray be used or ultrasound? Would a full blood work up not see platelet counts abnormal? We did that and blood cell counts all normal, so too liver examination through blood work. Thank you kindly for your reply.

Answered by Dr. Sudhir Kumar (2 minutes later)

Thank you for getting back with more details.

Let me first reassure you that the likelihood of you having insulinoma (point 3) is very remote, however, I mentioned it only for completion sake.

An ultrasound examination of abdomen could also be useful in excluding that.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (3 days later)

Hello, will be doing abdominal ultrasound tomorrow and check serum insulin, esr(I do not know what that is) and amylase? Can't quite read that word. Just as added information, my muscles feel weak, if I walk down stairs, legs tremble a bit, I notice a bit of shakiness in my hands and in general, weakness, as if I lost power. No pain anywhere. Wondering if you have seen this as I am truly concerned at this stage.

Answered by Dr. Sudhir Kumar (3 hours later)

Thank you for getting back with more details.
Abdominal ultrasound and serum insulin would help us in excluding a diagnosis of insulinoma.
ESR is erythrocyte sedimentation rate, which if high, denotes an infection or inflammation.
Serum amylase is elevated in a pancreatic disease too.
Your symptoms are part of the illness, and if diagnosed and treated, you would improve. Partly, they are because of anxiety too.
I am sure you would improve, so, there is no need to worry.
Best wishes,
Dr Sudhir Kumar MD DM

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar