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What Causes Fatigue, Hypersomnia, Numbness In Right Side, Joint Pain And Depression?
Posted on
Sun, 5 Jun 2016
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Sun, 5 Jun 2016
Answered on
Tue, 5 Jul 2016
Last reviewed on
Question : Symptoms:
50 yr old female, 5ft 1, 186 lbs
Sleep apnea, narcolepsy, bipolar depressive , degenerative disc disease @ age 40, fatigue, sleepy ALL the time. .asleep in less than 1 min. Can nap 2-3 hrs every day, average 7 hrs sleep per night, numbness,tingling mainly right entire side, occasionally head too. Last yr reoccurring blister rash of single line on both sides off neck, sometimes with enlarged lymph nodes under ear,10 mm thyroid nodule on left, 3 head traumas within 6yrs-lost conciousness once, less than 1 min, slightly enlarged atrium, heart mumur, isolated incidents of rapid heart rate, eye pain, 2 incidents of BPPV, ACDF C-4 to C-5, C-5 to C-6, all-over joint pain, occasional several sharp joint pains , 24/7 buzzing in ears, constant swelling of right palm/thumb, several rounds of ECT during severe depression, hyper active reflexes, low thyroid,meds: Nuvigil 250mg (max dosage, lithium 2-300mg (cut from 600/day 1 yr ago),Lexa pro 10mg (cut from 30mg/day within 6 months ) wellbutrion 300mg, lamactial 100mg (cut from 200mg last 6 months ) synthroid 25mcg, amytriptline 0mg-cut from 200mg last 6 months , 81mg baby aspirin, multipal vitamin, fish oil, multiple normal brain MRI's, cervical MRI's, EEG,abnormal EKG, several normal CBC's, normal nerve studies, normal rheumatic all testing, 2 normal Lyme tests, impaired memory and confusion episodes (with dozens of examples of mental impairment), every few months lasting about a month. 25yrs as operations mgr of company with sales of $2million plus $.now have had 3 entry level jobs in last 5 years have quit 2 b4 I was fired for erratic mental performance, fired from one job for same reason. TOTALLY FRUSTRATED, READY TO GIVE UP!
50 yr old female, 5ft 1, 186 lbs
Sleep apnea, narcolepsy, bipolar depressive , degenerative disc disease @ age 40, fatigue, sleepy ALL the time. .asleep in less than 1 min. Can nap 2-3 hrs every day, average 7 hrs sleep per night, numbness,tingling mainly right entire side, occasionally head too. Last yr reoccurring blister rash of single line on both sides off neck, sometimes with enlarged lymph nodes under ear,10 mm thyroid nodule on left, 3 head traumas within 6yrs-lost conciousness once, less than 1 min, slightly enlarged atrium, heart mumur, isolated incidents of rapid heart rate, eye pain, 2 incidents of BPPV, ACDF C-4 to C-5, C-5 to C-6, all-over joint pain, occasional several sharp joint pains , 24/7 buzzing in ears, constant swelling of right palm/thumb, several rounds of ECT during severe depression, hyper active reflexes, low thyroid,meds: Nuvigil 250mg (max dosage, lithium 2-300mg (cut from 600/day 1 yr ago),Lexa pro 10mg (cut from 30mg/day within 6 months ) wellbutrion 300mg, lamactial 100mg (cut from 200mg last 6 months ) synthroid 25mcg, amytriptline 0mg-cut from 200mg last 6 months , 81mg baby aspirin, multipal vitamin, fish oil, multiple normal brain MRI's, cervical MRI's, EEG,abnormal EKG, several normal CBC's, normal nerve studies, normal rheumatic all testing, 2 normal Lyme tests, impaired memory and confusion episodes (with dozens of examples of mental impairment), every few months lasting about a month. 25yrs as operations mgr of company with sales of $2million plus $.now have had 3 entry level jobs in last 5 years have quit 2 b4 I was fired for erratic mental performance, fired from one job for same reason. TOTALLY FRUSTRATED, READY TO GIVE UP!
Brief Answer:
Hormone tests
Detailed Answer:
Sorry to learn about your bothersome symptoms.
Lithium can affect thyroid. I see you are on thyroid medication. it is important to get the dose right.
The thyroid nodules will require thorough evaluation in the form of physical examination by an endocrinologist.
When I see someone like you in my practice, I typically order the following blood tests in addition to a detailed physical examination:
CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH (checks your thyroid)
Free T4 (this too checks your thyroid) Thyroid autoantibodies : Anti Thyroid Peroxidase (TPO) antibodies and Anti Thyroglobulin antibodies
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)
None of these tests require any fasting and can be done at any time of the day
Hormone tests
Detailed Answer:
Sorry to learn about your bothersome symptoms.
Lithium can affect thyroid. I see you are on thyroid medication. it is important to get the dose right.
The thyroid nodules will require thorough evaluation in the form of physical examination by an endocrinologist.
When I see someone like you in my practice, I typically order the following blood tests in addition to a detailed physical examination:
CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH (checks your thyroid)
Free T4 (this too checks your thyroid) Thyroid autoantibodies : Anti Thyroid Peroxidase (TPO) antibodies and Anti Thyroglobulin antibodies
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)
None of these tests require any fasting and can be done at any time of the day
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Topiwala,
Thank you for responding so quickly.
One thing I forgot to mention-double vision but I was just diagnosed with Cranial 4th Nerve Palsy, so that rules out anything vision related.
I've uploaded the bloodwork that I have had done. Some of them you have suggested, but there are some that I don't think that I've had done.
Could you take a look and give me a list of what bloodwork I have NOT had done and note whether anything warrants further investigation on the tests that I have had done?
Thank you SO much!
XXXXXXX
Thank you for responding so quickly.
One thing I forgot to mention-double vision but I was just diagnosed with Cranial 4th Nerve Palsy, so that rules out anything vision related.
I've uploaded the bloodwork that I have had done. Some of them you have suggested, but there are some that I don't think that I've had done.
Could you take a look and give me a list of what bloodwork I have NOT had done and note whether anything warrants further investigation on the tests that I have had done?
Thank you SO much!
XXXXXXX
Brief Answer:
Follow up
Detailed Answer:
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)
Thyroid autoantibodies : Anti Thyroid Peroxidase (TPO) antibodies and Anti Thyroglobulin antibodies
These three tests are not in the attached reports.
Follow up
Detailed Answer:
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)
Thyroid autoantibodies : Anti Thyroid Peroxidase (TPO) antibodies and Anti Thyroglobulin antibodies
These three tests are not in the attached reports.
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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