post brain surgery possible hypothyroid/metabolism difficulty ?

[saoirse1]

Thank you for taking my query. Am 47 yr old F. I had a craniotomy in May to remove a 3.0 cm right convexity meningioma. I know that some "issues" are related directly to that, but now am having exacerbating metabolism sypmtoms. Weight gain (15 lbs in 3 mos-never gained weight like this before) Fatigue,feel cold most of the time. Have noted most of hair on arms is gone, very sparse growth legs. Periods heavier, legs seems puffy (specially about knees).Some puffiness/face.  Problems w/ dry skin/scalp. Night sweats. Have had some left side paresthesias I know are residual from surgery (arm) but also has developed bilaterally in chin/lower face. And now top left foot.  Asked GYN to do hromone tests,resposne was negative, since my periods seem "regular" to him. Insisted on at least thyroid test. He did TSH  <?>  which came back at 6.  

Reported symtpoms to neurologist last visit, he agreed to refer to endocrinologist. Now I see this appt is with Internist, not board cert. endo. Getting that sorted out. Are these symptoms related to thyroid difficulty? Pituitary?  I feel at moment ALL hormones out of whack. What might I expect at first endocrinology visit?  

Thanks again for your time.

[saoirse1]

Thanks so much for taking the time to answer these questions. I will print this out. I am going back to my very good PCP to ask for either an endo referral or for him to at least do these tests. The doc I am referred to as "endocrinologist"  by neuro's  office assistant, is an internist, which I already have. Assistant and I are having a "disagreement" about this. So as said above, will go to my own internist, start again from there, report this disagreement to the neurologist at my next follow-up in early November.  

Thank you again :)

[tnt406]

HI DR.MARK SORRY TO BOTHER AGAIN.I AM NOT ON MEDICINE.I JUST GOT MY BLOOD RESULTS FRIDAY.I HAVE NOTICED LATELY MY HAIR IS COMING MORE,AND I CAN SEE MY SCALP IN SOME AREAS.ALL SO I AM HAVING A LOT OF PROBLEMS WITH MY BOWELS,THEY DON'T WANT TO MOVE.I AM ON MEDICINE FOR DEPRESSION,AND THE DOSE HAS BEEN RAISED BUT THE DEPRESSION IS COMING BACK.I DON'T EAT THAT MUCH AND MY CARDIOLOGIST WANTS ME TO LOSE WEIGHT,BUT I AM HAVING PROBLEMS WITH THAT.IT DOESN'T WANT TO COME OFF.I HAVE BEEN TRYING SINCE JULY.IT IS NOW SEPTEMBER.SHE WANTED ME TO LOSE 10 POUNDS BY THE TIME I CAME BACK IN OCTOBER.MY APPOINTMENT IS ON THE 17th.I STILL WEIGH THE SAME.ONE DAY I JUST DRANK LEMON AND WATER,AND DIDN'T EAT.I STILL DIDN'T LOSE.MY CARDIOLOGIST WANTS ME TO GET DOWN TO 130.I WEIGH 160,MY HEIGHT IS 5'4.I HAD A HEART ATTACK LAST YEAR.AND A STROKE THIS YEAR.I KNOW YOU SAID I WAS PROBABLY GOING HYPO.BUT DO YOU THINK THE FREE T4 AND FREE T3 WILL SHOW MORE NOW?THANK YOU INADVANCE TNT406.

[Mark Lupo, M.D.]

It's important to have a full pituitary evaluation -- this includes tsh, t4, t3, acth, cortisol, prolactin, fsh, lh, estradiol (likely normal with menstrual periods) and possibly growth hormone.  Also check sodium level - but it doesn't sound like you have diabetes insipidus (these patients have severe thirst and inc'd urination).  The TSH alone of 6 may be a primary thyroid problem OR a pituitary problem, but more likely primary thyroid.  Also note any visual changes or headaches -- the labs will be the key to any endo eval....good luck.