What should I ask my doctor to test for?

August 17, 2012 2:41 PM

Chronic fatigue + thinning hair, what should I ask the doctor to test for?

Obviously, this is something I should ask the doctor but this a doctor I've never seen before and I haven't always had the best experiences with doctors in the past. I realize that I have to be my own best advocate and ask for what I need. I'm not going to be rushed out the door.

I've suffered from chronic fatigue pretty much my entire adult life but the older I get, the less I can cope. The last time I went to the doctor, I discovered my vitamin D was low and I've been taking supplements since then but with no change in energy. My hair has been thinning for the last few years and I didn't really care much but it's started to look bad now so I want to look into that also.

I'm a 31 year old female at a healthy weight and I exercise at least three times a week if it matters.

posted by MaryDellamorte to health & fitness (23 answers total)

thyroid.
posted by fingersandtoes at 2:56 PM on August 17, 2012 [2 favorites]

Seconding thyroid!!
posted by rabbitrabbit at 3:00 PM on August 17, 2012

Thirding thyroid.
posted by catch as catch can at 3:09 PM on August 17, 2012

Even if the thyroid levels are within normal range, you may need to fight. Actual normal is a LOT lower than what's allowed.

Also check your iron levels.
posted by elsietheeel at 3:10 PM on August 17, 2012 [1 favorite]

Also, if thyroid's normal, ask a dermatologist about the hair loss. Hair loss is a dermatologist question and it could be a lot of things, not all of them endocrine, and not all of them are going to be known by a GP.
posted by fingersandtoes at 3:17 PM on August 17, 2012 [1 favorite]

Thyroid and iron deficiency are the two big suspects for fatigue + hair loss combination. There are also some auto-immune conditions that have hair loss as a symptom (and all AI conditions cause fatigue) so maybe get that looked into. Also check for B12 deficiency especially if you are vegan.

You might also want to ask for a sleep study if you've had fatigue for "most of your adult life." Sleep apnea isn't limited to fat middle-aged men and getting it treated can turn your life around.
posted by Rosie M. Banks at 3:18 PM on August 17, 2012 [3 favorites]

Gluten intolerance
posted by yoyo_nyc at 5:03 PM on August 17, 2012

Seconding Rosie M. Banks on possible thyroid, iron or B12 issues. IIRC you are vegan, and you have probably been maintaining a good nutritional balance for years, but if your diet has shifted recently, maybe your iron and B12 are lower than they have been before.
posted by maudlin at 6:37 PM on August 17, 2012

I'm not going to say anything different from what anyone else has said but thyroid and anemia (iron deficiency) are the most likely culprits. You should know that there is a lot of debate about what "normal" is for thyroid. A lot of people test in the "low normal" range that benefit significantly from Synthroid (anectdotally, this is one of the few medications that I and a bunch of other people I know have found the brand name vs. generic makes a difference). If you are falling in the low normal range, you may want to push for a trial period of Synthroid during which you have regular blood work to make sure you do not tip into hyperthyroidism. Also, aside from prescription medication, a Silica complex formula can help with thinning hair, dry skin, brittle nails, etc. I'm not endorsing that particular formula or anything, but I take their vitamins and such, and have even taken that, and felt they were effective and affordable. I'm sure there are other reputable companies out there that sell something similar. B vitamins and iron rich foods could also make a true difference. Good luck!
posted by katemcd at 10:52 PM on August 17, 2012

In addition to iron-deficiency anemia, it could also be pernicious anemia, which can occur even if you're not vegan if your intestines aren't properly absorbing B12.

Also, a re-test of Vitamin D. You might not be absorbing the supplements, or you might be supplementing with D2 (reportedly less effective) rather than D3, or it might not be a high enough dose for you. Anecdotally, some people have to take really high levels before their serum levels of D actually get up to the normal range. Unless you've re-tested since adding the supplement, you don't know if you're one of those people.

And seconding thyroid and sleep apnea as potential causes.
posted by pie ninja at 5:03 AM on August 18, 2012

FWIW, I've had these symptoms even before I went vegan four years ago.
posted by MaryDellamorte at 11:58 AM on August 18, 2012

It's still a good idea to get your B12 levels checked. I've heard it's harder to absorb it as you age so you need more.

And definitely iron levels, Vitamin D levels, and thyroid.

Your lifelong lack of energy might well be due to a sleep disorder. Many times apnea is missed in women, especially if they are thin and pre-menopausal. I'm also convinced that if your bed partners are all male, they sleep more heavily so you have to make quite a racket to get them to notice! Has anyone told you that you do the following: snore, grunt, hold your breath, gasp, mumble and make funny mouth noises, or kick or move around a lot? Do you wake up hot and sweaty even in a cool room? These can all indicate sleep apnea. Push for a sleep test, as it's not normal for sleep to be unrefreshing.

For a stopgap until you can get a sleep test, you can try a Breathe Right strip on your nose (get the ugly beige ones, they stick better) and see if you wake up more refreshed. It helps me a lot during allergy season.
posted by Rosie M. Banks at 12:10 PM on August 18, 2012

I don't snore or grunt but I sometimes make noises because I'm trying to wake myself up from a terrible lucid dream. I'll sometimes wake up basically panicking or crying. I definitely toss and turn and I get terribly hot and sweaty at night no matter how low I turn down the AC. I'm a terrible sleeper and wake up at least 10 - 15 times a night and I have never woken up refreshed. It's a tremendous struggle to just get out of bed every single morning.
posted by MaryDellamorte at 12:48 PM on August 18, 2012

I don't snore or grunt but I sometimes make noises because I'm trying to wake myself up from a terrible lucid dream. I'll sometimes wake up basically panicking or crying. I definitely toss and turn and I get terribly hot and sweaty at night no matter how low I turn down the AC. I'm a terrible sleeper and wake up at least 10 - 15 times a night and I have never woken up refreshed. It's a tremendous struggle to just get out of bed every single morning.

Dollars to donuts you have a sleep problem. Insist on a sleep test. Tell the doctor exactly what you told us. Treating those sleep issues can make you feel like a whole new person (and might work with the thinning hair - lack of good sleep creates stress which can make your hair fall out). And of course IANAD or a sleep specialist but all that tossing, turning, and waking up panicked or crying could very well be an indicator of a sleep breathing problem - your body is waking you up because you are suffocating in your sleep, and you feel panicked because you can't breathe.
posted by Rosie M. Banks at 12:53 PM on August 18, 2012

I second the sleep disorder... and not just making noises or moving a lot in your sleep are symptoms. I always thought that I slept like a baby but my trouble was getting out of bed and getting energy. Turns out, my brain basically wakes up (Alpha waves) over 25 times an hour so even though I was sleeping I wasn't getting restful sleep and going through all the correct phases. Definitely keep your sleep in mind and get referred to a sleep specialist who is preferably a neurologist or specializes in narcolepsy. This way you have someone who knows the FULL RANGE of sleep disorders, not just sleep apnea.
posted by 5Leepy! at 3:41 PM on August 18, 2012 [1 favorite]

by the way, lucid dreams are a symptom of narcolepsy. You can also look into Idiopathic Hypersomnia (IH). Check out the forums at talkaboutsleep.com
posted by 5Leepy! at 3:44 PM on August 18, 2012

Ok I will insist on a sleep study. Even as a kid, it was hard for me to get out of bed and I've been having lucid dreams for as long as I can remember. Can't believe I've waited this long to do something about it.
posted by MaryDellamorte at 3:59 PM on August 18, 2012

Iron deficiency/Anemia and Ferratin levels. It turned out I had severe anemia!
posted by floweredfish at 9:36 AM on August 20, 2012 [1 favorite]

So I got my blood results back and everything is fine according to the doctor. The doctor also said that they couldn't check my ferratin or B12 levels unless my hemoglobin was low otherwise the insurance company wouldn't pay for that test. Something about needing to have a diagnosis of anemia. My TSH was at 2.9.

I did get a referral to a sleep specialist so hopefully that will pan out with something.
posted by MaryDellamorte at 8:52 PM on August 24, 2012

This is many months later, but insist on the ferratin test if you haven't already had it. I have Restless Leg Syndrome, wjich is aggrivated by low ferratin, but it wasn't caught for a long time because all my other levels came back normal. I was a vegetarian at the time, but even going back on a meat diet I need suppliments or it gets too low.
posted by [insert clever name here] at 6:31 AM on October 18, 2012

I recently had my sleep study and everything was fine according to the doctor. My other doctor said she can't order the ferratin test if my hemoglobin is within the normal range otherwise the insurance company won't pay for it.
posted by MaryDellamorte at 6:43 AM on October 18, 2012

I would pay for the test myself if I were you. Order online if you have to, it's cheap (http://www.healthonelabs.com/pub/tests/test/pid/60) and you just go to a local lab (not affiliated with that place, it was just the first that came up). Low iron stores can wipe you out. They're common in women, more common in vegetarians and vegans, so you've got two strikes against you. You want your serum ferritin to be above 50. When mine was first tested in 2007 it was 13. At 12 I would have started showing signs of anemia. Below 18 is "officially" considered deficient, but doesn't cause anemia until much lower. When doctors treat for hair loss or restless syndrome they want it over 50, which I believe is also where runners try and keep it.
posted by [insert clever name here] at 7:37 AM on October 18, 2012

Wow that is cheap and there's a lab a few miles away from me. I'm going to do the tests for ferritin, thyroid panel (my doctor only tested my TSH level) and female hormones.
posted by MaryDellamorte at 4:56 PM on October 18, 2012