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Suggest Treatment For Persistent Muscle Fatigue
Question: I suddenly started feeling all over muscle fatigue on 11/24. It's now 11/3 and I still have this feeling that all of my muscles are exhausted after something like a long workout. Last night my big toe joint suddenly got sore and stiff. The doc ran a Comp. metabolic panel (14), thyroid, hep, vit D test, and the only thing off was my vit D (around a 21). It's been chronically low for years now... this is at least my 5th vit D prescription. Since everything else looked normal, he shrugged, said he had no idea and referred me to an endocrinologist, yesterday (I'm already on med for hypothyroid). This was prior to the joint flare up last night. Anyway... I feel like this is not related to my PCOS/thyroid. It seems sudden and severe and is affecting my work/daily life to the extreme. Where should I go next?
Brief Answer:
Endocrinologist
Detailed Answer:
Seeing an endocrinologist in-person is a good way to start. As you are already scheduled to see one, I suggest you keep that appointment. When I see someone like you in my practice I make sure they maintain good vitamin D levels lifelong in the range of 30-50. It is not very challenging to achieve. Your endocrinologist will likely prescribe a regimen that will keep your vitamin D levels steady and stable. This should help your muscle and bone health. It would be a good idea to check your HbA1c which is a three month glucose average. Basically it is a screening test for diabetes
Endocrinologist
Detailed Answer:
Seeing an endocrinologist in-person is a good way to start. As you are already scheduled to see one, I suggest you keep that appointment. When I see someone like you in my practice I make sure they maintain good vitamin D levels lifelong in the range of 30-50. It is not very challenging to achieve. Your endocrinologist will likely prescribe a regimen that will keep your vitamin D levels steady and stable. This should help your muscle and bone health. It would be a good idea to check your HbA1c which is a three month glucose average. Basically it is a screening test for diabetes
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Okay, but I've had low vit D (as low as a 6 on one test, and 13 on another, it's 21.5 right now) in the past but never had this kind of full body muscle fatigue which is turning into some muscle pain today, as well as that joint flare up. I'll keep the endo appt, but I feel like this is something else, maybe something I should seen an immunologist for? It's frightening how debilitating this is, whatever it is, and it came on suddenly.
He checked my Hemoglobin A1c. It's 5.8. I'm a bit insulin resistant, likely because of my polycystic ovarian syndrome.
He checked my Hemoglobin A1c. It's 5.8. I'm a bit insulin resistant, likely because of my polycystic ovarian syndrome.
Brief Answer:
Follow up
Detailed Answer:
I follow what you are saying.
When I see a patient with levels of 21.5 I advise them to take 60,000 IU of cholecalciferol orally once a month with food, and check the levels in 3 to 6 months to see if target levels have been attained. If so, I typically keep them on this monthly dose for life.
But I agree such severe muscle aches are not generally seen with vitamin D levels in this range.
I see your thyroid is at goal. I aim for a target TSH of 0.5 to 2 though.
It is likely your blood calcium was also normal in the CMP test. That is another important items to check.
Finally, I recommend you see a Rheumatologist for these joint and muscle pains.
Follow up
Detailed Answer:
I follow what you are saying.
When I see a patient with levels of 21.5 I advise them to take 60,000 IU of cholecalciferol orally once a month with food, and check the levels in 3 to 6 months to see if target levels have been attained. If so, I typically keep them on this monthly dose for life.
But I agree such severe muscle aches are not generally seen with vitamin D levels in this range.
I see your thyroid is at goal. I aim for a target TSH of 0.5 to 2 though.
It is likely your blood calcium was also normal in the CMP test. That is another important items to check.
Finally, I recommend you see a Rheumatologist for these joint and muscle pains.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you. The doctor has placed me on a prescription for 1.25MG (50,000 Units) once a week. 12 doses. I've done this a few times in the past but my Vit D levels always drop back down. The last time I was on this dosage was a couple months ago. I'll talk to him about a permanent dose, or about taking 2000mg a day once I'm off this to try to maintain.
The doctor did mention seeing a rheumatologist even though my sed level was normal. He just took a bunch more blood and is looking for more exotic causes, after the muscle exhaustion turned into some muscle pain / lower leg pain, and a flare up of pain in my big toe joint, as well as achy arm muscles. Once those results are back he'll decide where I go next, though I do have an appt with an endocrinologist next Tuesday. I think this is my final follow-up so if you have anything else to add, that's great, otherwise, thanks for the assist.
The doctor did mention seeing a rheumatologist even though my sed level was normal. He just took a bunch more blood and is looking for more exotic causes, after the muscle exhaustion turned into some muscle pain / lower leg pain, and a flare up of pain in my big toe joint, as well as achy arm muscles. Once those results are back he'll decide where I go next, though I do have an appt with an endocrinologist next Tuesday. I think this is my final follow-up so if you have anything else to add, that's great, otherwise, thanks for the assist.
Brief Answer:
Third follow up
Detailed Answer:
A maintenance vitamin D program would be helpful because otherwise levels with inevitably drop again.
I hope you are able to find the cause of your muscle related symptoms soon. There are muscle disorders that fall in the realm of the Neurologists.
Third follow up
Detailed Answer:
A maintenance vitamin D program would be helpful because otherwise levels with inevitably drop again.
I hope you are able to find the cause of your muscle related symptoms soon. There are muscle disorders that fall in the realm of the Neurologists.
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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