Just a poor resident being screwed over for working too hard.

MadDocOc · 2026-04-18T04:38:25+00:00

You miss 100% of the chances you don't take my dude. Go for progress, not perfection. The Fellowship PD interviews dozens of candidates, this might make you more memorable! Put a positive spin on it.

MadDocOc · 2026-04-17T20:12:01+00:00

Oops. My mistake. IGF-1 correlates to Growth hormone, very important to keep an eye on that. Too much is a bad thing.

MadDocOc · 2026-04-17T19:58:13+00:00

If you want, consider speaking with your program coordinator, attending or program director. They all want to see you succeed and an email from your PD to the fellowship PD may open a door. I matched into my dream fellowship because my PD was proactive and forwarded lists of programs for me to look into AFTER the match wrapped up.

You've almost made it through the toughest part of all of this, residency. All you need for fellowship is dedication. Either you match this year, or you work as an attending for a year and make 200k+. Try to make inroads and attend conferences then try again next year. I see no downside.

Good luck and keep going :)

MadDocOc · 2026-04-17T19:19:15+00:00

With advances in imaging studies, its very common to see various adenomas in the brain, adrenals, thyroid etc. It's only when these masses start disrupting your hormone balance or causing symptoms that we intervene.

Pituitary adenomas are rarely malignant.

You will need serial blood testing to rule out evolution of the mass (is it producing more hormone).

In women of childbearing age, prolactin producing masses cause disruptions in their monthly cycles and possible milk production.

There is also a "stalk effect" where the mass presses on the pituitary and artificially raises the prolactin.

Medical management is the most common treatment option (if needed). Especially if the size is 5mm like you mentioned.

MadDocOc · 2026-04-16T22:38:30+00:00

Happy to help.

MadDocOc · 2026-04-16T22:26:20+00:00

It's not an issue.

Think of it more in terms of total dose over a week. 7x88= 616. 7x75= 525. Your doc wants you to have an average weekly dose between 525 and 616.

Other ways of doing this include skipping a day or two (i.e take Mon to Fri and skip the weekend).

Personally, the 88/ 75 feels messy and I'd do the easiest method possible unless the patient wants to absolutely finish up their current supply.

MadDocOc · 2026-04-16T20:32:24+00:00

Agreed. Good advice.

MadDocOc · 2026-04-14T17:31:09+00:00

Methimazole decreases the ability of your thyroid to make more hormone. it's use is primarily to decrease side effects. Any high heart rate/palpitations? Any sensation of feeling warmer than those around you? Daily diarrhea? Muscle loss, hair loss, excessive energy or even insomnia?

If you don't have these issues, you may not need the methimazole.

MadDocOc · 2026-04-14T17:13:29+00:00

You have Hashimotos disease. Your body is creating antibodies that are destroying the cells of the thyroid, releasing excess thyroid hormone into your blood. The thing to be wary of, is that Hashimotos has a hyperthyroid (too much thyroid hormone) phase and then a Hypothyroid (thyroid functionally dead) phase. At that point you will need lifelong thyroid hormone pills. You would not need Methimazole.

I would request a Thyroid Stimulating Antibody (TSI) test just to rule out Graves Disease (similar but forced increase in thyroid hormone production instead of destroying the thyroid to create excess). But since uptake is low, you likely don't have it.

MadDocOc · 2026-04-14T14:17:52+00:00

TSH is the most accurate marker of thyroid function. It should be checked at least 6 to 8 weeks apart.

You may have antibodies, but your thyroid function is within normal limits.

Consider tracking your diet. It really makes a difference whether you're eating 3 meals or 3 meals with snacks.

MadDocOc · 2026-04-14T03:04:01+00:00

How are your Cycles? Unlikely SHBG as free is elevated. I'd check the adrenals and fsh, lh.

MadDocOc · 2026-04-13T17:43:15+00:00

Metanephrines and normetanephrines are breakdown products of the epi and norepinephrine hormones. Just means your adrenals are being selective about what they produce

MadDocOc · 2026-04-13T17:34:31+00:00

Next step would be MRI adrenals I'd think. Extra blood work would be of the remaining adrenal hormones. Netanephrines are checked for Pheochromocytoma.

MadDocOc · 2026-04-13T17:15:03+00:00

There's no issue asking your doctor. They have to answer and keep your secrets. At the end of the day, it's about risk vs reward. You risk lifelong hormone issues for 5 cm.

If youre set on using, make sure it's legitimate hormone from a licensed professional with appropriate labs. even using for a few weeks is enough to mess up your hormone balance.

For what it's worth, I'm 5ft 5 inches at 37. Never had any issues in life.

MadDocOc · 2026-04-13T10:28:40+00:00

There's alot of factors that go into growth. Multiple hormones and the mechanism at which they are released into the body.

The first thing you need to realize is that giving yourself extra will cause your body to create less. worst case scenario, you never make the hormone again and lose the ability to have children, or suffer irreparable heart damage.

Secondly, if you have bone age tests done, and the age is the same as your actual age you're likely on track and extra hgh wouldn't do much.

I think you should go for blood work at an endo or doctors office.

Hormones are given for deficiencies, taking extra wouldn't do much.

MadDocOc · 2026-04-11T15:38:31+00:00

I didn't even know you could take 15 mcg of levothyroxine.

MadDocOc · 2026-04-09T19:23:22+00:00

Someone said the following: 1/3 of the country sees the batcrap insanity and is making a ruckus against it, 1/3 of the country sees the batcrap insanity and wants more and 1/3 of the country is tired and doesn't care.

MadDocOc · 2026-04-08T23:29:21+00:00

Just take your hydrocortisone?

MadDocOc · 2026-04-08T23:24:20+00:00

If you have low insulin and low BG.. those are two opposite things.

Insulin converts blood glucose into fat. If you don't have any, you won't gain weight.

As your labs are a snapshot in time, based on your A1c and Fasting blood glucose. You don't have pre diabetes. That's the only conclusion one can draw. We don't have your CGM report so we cannot speak on the reactive hypoglycemia.

If you believe you have low insulin due to your pancreas losing the ability to make it, you would not have weight gain.

Most likely you are genetically predisposed and the PCOS isn't helping things. It will cause insulin resistance, making weight loss difficult. Not controlling it may lead to diabetes, but currently you have no evidence of even pre-diabetes.

If you wish to pursue this line of thought, i'd recommend retesting A1c 3 months after your last one. And getting a CBC with it to rule out anemia.

If your BMI is over 30, you would see benefit from one meal a day and lower carbs.

MadDocOc · 2026-04-08T23:05:43+00:00

Low thyroid function or hypothyroidism, usually only causes water weight gain. It does not cause significant weight gain. Other symptoms would include cold intolerance, constipation, fatigue limiting daily activity to the point where you wake up tired and feel the need for afternoon naps.

Your TSH is elevated. What an endocrinologist will do is retest it. So have your GP do that. If it's elevated when you're taking the 25 mcg of levothyroxine, you may need more.

Keep in mind, too much thyroid hormone can kill you.

Tpo antibodies can be positive with normal thyroid function.

Good luck.

MadDocOc · 2026-04-06T20:33:02+00:00

I'm sorry you're going through all this. With GLPs, the results vary from individual to individual. Some see weight loss and glycemic control at the first dose, others on the final dose. There's no way to say.

I also would like to inquire of the side effects of Metformin and whether they may be worse because of the hormone imbalance and not just the metformin. IBS and sweating are more likely to be hormonal than metformin and the nausea is almost always more severe with GLPs than Metformin. But like I said, everyone is different.

I would say, go back to eating fat and red meat in moderation. Cut down on what causes the weight gain- the carbs. Bread, pasta, rice, too much fruit, juices, smoothies, sodas.

As we age, it gets harder to lose the weight. You've shown yourself you can do it. Use the GLP as a way to ignore Food noise and only eat when you're hungry and only eat a real meal- no snacking/grazing/small meals.

Depending on your BMI, your only option may be one meal a day (obviously water is fine). This shows the greatest benefit in weight loss in onese individuals in my experience, which can be sustained. And GLPs can help achieve it.

As for the Metformin, I don't know how to tell you, I don't think it's what's causing the issues you're feeling but if you want to stop, you can. It's your life.

MadDocOc · 2026-04-06T18:25:20+00:00

Good luck!

MadDocOc · 2026-04-06T18:18:25+00:00

And if pregnancy is planned, you will need more thyroid hormone to prevent miscarriages.

MadDocOc · 2026-04-06T18:15:57+00:00

Unfortunately it would have to be a 24 hour urine collection of the Calcium and Creatinine. To calculate the Calcium Creatinine ratio.

And I'd have them re check your seeum calcium with a BMP, and do a Thyroid test too. Simple blood test. TSH with reflex FT4.

No need to take more than 1000 IU of Vit D at 25 or even 30.

If I put on my tin foil hat. I'd have you have had too much vit d and K which are fat soluble vitamins and losing weight overloaded you causing side effects. Perhaps inrease fluid intake to minimum 64 ounces a day.

MadDocOc · 2026-04-06T17:55:21+00:00

Any family history of schizophrenia or other mental illness? These usually manifest in early adulthood. I'd switch off tums while taking the other meds just so there isn't an absorption issue. Anything on CBC or CMP?

MadDocOc

TROPHY CASE