Insulin resistance?

Dr. Ramsetty:
I have hypothyroidism and I have also been diagnosed with PCOS.  I am still experiencing horrible fatigue.  I am wondering about insulin resistance.  I am concerned since I have PCOS as well as relatives with type 2 diabetes.  I asked my doctor about it and he said that my nonfasting serum insulin was normal.  I requested the 2hr GTT w/insulin check.  He felt it was a waste of my time to get this test, but gave me the order to get it done anyway.  I did that today.  What would indicate insulin resistance with this test?  I am considering switching doctors because I am not sure if the doc I am seeing is right for me.  Thanks for your help.

Most recent labs:
November (while on .88mcg Synthroid, 10mcg Cytomel, 200mg Prometrium 18days/mo)
Free T4 1.2 (.8-1.8)
Free T3 325 (230-420)
TSH .22 (.4-4.50)
TPO AB 411

[Anita Ramsetty, MD]

Hello,

Insulin resistance often is not associated with any symptoms per se, especially fatigue. There are markers of insulin resistance including high cholesterol, abnormal glucose handling etc. Having a high insulin level is sometime noted on lab tests. Skin signs like dark skin behind the neck or under he arms is also consistent with this.

I am not sure why you are on Cytomel--while this helps some people with hypothyroidism, it often also causes fatigue, so consider this as a potential cause.  Your TSH is at the lower range of normal and so your overall thyroid hormone doses may be too high for you.
You can certainly seek another opinion it is sometimes very advisable to do so. Be sure you seek help with a reputable specialist if you do.
Take care.