Question: Hello, Doctor..

I have Hypothyroid and I am taking Thyroxin 100. My TSH is between 2 and 4.

Also, I am suffering from low blood pressure (90/60), my heart rate is 50-60. I do workout 3-4 times a week (resistance and swimming). I am feeling:

- Very hard to wake up.
- Feel sleepy no matter the time I sleep, Always sleepy.
- Cold on hands and feet.
- Very hard to lose weight.
- Very tired and dizzy all the time.

Please review and advise..

All the best

Dear Dr. Topiwala,

I would like to thank you for your kind prompt reply.

Please and kindly note the following:

1- Blood tests have been done several times for the last 3 years. they are all in normal ranges. The results below are 3 months old.

- RCB : 5.63
- MCV : 75.5 (!)
- WBC : 6.93
- Hemoglobin : 15.1
- Hematocrit : 42.6
- Platelet count : 232
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- Potassium : 4.7
- Sodium : 143
- Chloride : 99
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- Glucose: 95
- HbA1c: 5.3%
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- AST : 20
- ALT : 25
- AST/ALT : 0.8
- Albumin : 4.6
- Total Protein: 6.2 (!)
- Globulin (Calc): 1.6 (!)
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- BUN : 25 (!)
- Creatininte : 1.17
- eGFR : 59
- Uric Acid: 7.1 (Urine Test I guess)
Note: The numbers above (kidney and liver) were like this as I was not drinking water. The local doctor mentioned to drink water and repeat the test and they are both normal now, just I could not reach the numbers.
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- Calcium : 9.2
- Cholesterol : 184
- Triglycerides : 70
- Direct LDL : 112 (!)
- HDL Cholesterol: 76
- Cardio CRP 0.124
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- TSH : 4.48 @ Thyroxin 100
Note: The XXXXXXX TSH reached was @ Thyroxin 25. The result was : 9
The minimum TSH reached was @ Thyroxin 125. The result was : 0.58, Just I started got tension and not sleeping well.

At 112. I am almost 2ish. and at 100, I am almost at 4.
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- T4 is on the middle range of normal in all ranges. T3 is normal but in the border in the lower (2.18)

Note: If you like, we can re do them.
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- Vitamin D (25 OH): 39.3
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- Cortisol: I have not done this before. I can do at 8.00 AM, however it will be hard through Ramadan time. Please allow me 15 days and I will get back to you.

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- Free Testosterone: 218. This was at 2010. I was 92 KG.
- Free Testosterone: 6.62. This was 2013. I am 72 KG.
- Total Testosterone: 4.27. This is 3 months old, just I have not done Free Testo.
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2- Important points to consider please:

- I have started my workout to lose weight and get in shape on 2012. I have lost almost 25 kg from all fat and muscles. I discovered late (due to lack of information in the area I live) that I need to modify the diet. I have tried several diet (low carbs/high fat), (High protein / low carbs) and so on.

In each time I go low carbs, I am facing problems related to energy. Those problems are hard to be solved even if I got high carbs again. The problems are getting worse when I do fasting. In each time I am in a diet contains fasting, I am facing big problems after spending some times on it, in addition of being with no results.

The best diet that I feel good is a balanced diet with mid carbs.

3- Food contains bread/grain make me feel bad. It also make me accumulate fat in fast pace.

4- I failed to put any kind of muscles and to lose any fat after reaching 75 kg. Either having muscles and fat all together, or losing my muscles and some fat.

5- Waking up is a disaster. Standing up is also a problem. Feeling dizzy all day night and finding it hard to do sport in the morning due to the coldness I feel.

I have a computer (watch with sensor) that measures heart rate and burning calories. I found that I am doing 1000 burned Cal in my workout at 1. PM.

The same workout exactly, tried to be done at 8. Am and the result was 600 Cal burned.

6- Any kind of strong motion will make me more dizzy. I have tried Eye doctor and I have not have any problem. I have tried ear doctors and done all the test and found no problem. He advised that it is almost low blood pressure. I have tried Betacerc 25 twice and felt better at beginning, however I came back to the same result after some time.

7- Due to my several experiments in diets, Any meal that exceed 450g of weight makes me feel too tried. Breakfast is only 250g, otherwise I am too sleepy.

My objective is to lose body fat (under 10%), and to add 4-5 kg of muscles and then maintain a strong physical condition. But before this, we need to check the metabolism and energy problem.

Sorry for being too long, just trying to explain more.

All the best Doc!