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DrRussMD
DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 64410
Experience:  Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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Hello, I am a 28 year old Caucasian male from the UK and Ive

Customer Question

Hello, I am a 28 year old Caucasian male from the UK and I’ve been struggling with an as yet unknown health problem since a holiday in Spain in August last year. I was typically completely healthy up until then, trained in the gym at 4-6 times a week for most of the year and had no health complaints for 3 years prior. I have seen a number of doctors and specialists in the last 7 months and while I have made some progress towards clearing my symptoms, they have never completely resolved. I work in a highly demanding and stressful job in the IT industry.

My current symptoms are:
- Elevated thyroid free T3. TSH and other thyroid tests normal and no prior thyroid problems.
- Elevated bilirubin. All other liver tests normal. Previously suffered jaundice when both a child and teenager caused by malaria and bilharzia. Liver tests following this time have always been normal until now.
- Daily dizziness and vertigo sometimes causing nausea. The severity of this varies. On a good day it is manageable, on a bad day it becomes difficult to maintain my own balance and causes anxiety and stress. Domperidone 10mg sometimes helps with this but not always.
- Trouble visually tracking moving objects smoothly without my eyes skipping.
- Trouble maintaining my own balance on a bad day when watching a moving object and I am still.
- Trouble fixating on a point without my eyes involuntarily wandering or zigzagging side to side across the point of focus until they settle on it again.
- Odd reactions to stimulants such as caffeine, sugar and alcohol. They seem to worsen my dizziness on bad days and I can often feel them ‘kicking in’ almost like an adrenal rush after consumption which never used to be the case. Sometimes I feel like my body is going to fly off my chair after coffee for example. On good days these don’t seem to affect me whatsoever.
- Worsened symptoms after alcohol consumption or after a poor night’s sleep.
- Increasingly frequent flashes of light in visual field, foggy visual field and tunnel-like vision on a bad day, some very similar to migraneous aura. Noticeable increase in floaters on eyes which often obstruct vision on computer monitors for example.
- Brief sensations of my body feeling like it is dropping after I stand up.
- Some days very run down and exhausted despite having a good night’s sleep.
- Instant worsening of dizziness when walking into a shop, supermarket or similar. I believe this is due to the large number of objects my eyes have to process. If I am outdoors in the open my symptoms aren’t nearly as bad.
- Noticeable visual difficulty focusing on complex/busy patterns. E.g. the steps of an escalator, pinstripe shirts, text on a page.
- Noticeable increase in brain fog and trouble with memory. This could be related to the stress I am under from this problem and my working environment.
- I seem to have a vacancy to me on bad days. I zone out a lot and struggle to maintain concentration, almost as if I am mentally exhausted. This again could be stress related.

I have my full history since August typed up I can share but I will have to heavily summarise here as there is a limit.

I should point out that this started suddenly whilst on holiday. I was hit quite hard in the eye by a tomato at a tomato festival and did present with many symptoms of concussion about 6 hours later. That is one of the first days I can remember having problems. I was also travelling a lot at around this time so could easily have contracted a virus. I did present with symptoms of a virus, diarrhoea, stomach and lower back pain, fever etc on this same trip which doctors thought was kidney infection but it was not.

I was diagnosed by 2 separate neurologists as having silent migraine or migraine presenting without headache. MRI was normal and naproxen helped mask the migraines for a few months. I was advised they would go away but they did not.

After some time I noticed the migraines were being triggered by sound and was experiencing problems with my right ear not popping while flying. I was eventually diagnosed with potential mastoiditis or an inner ear infection by a family friend. I did present with tenderness behind my ear and while moving my jaw back and forth. He prescribed a strong dose of Amoxycillin 875/ potassium clavulanate 125mg 2x daily 5 days as well as ear drops locacorten vioform. I was then given a further 5 day course of a weaker different antibiotic as my right ear drum was still reddish in colour. I had been suffering daily migraines presenting without headache for the first 4 months and these instantly disappeared. I still find this odd as my ear was never actually painful which I thought was common in ear infection.

I have improved slowly to a point since then but never recovered completely. The fact this started so suddenly leads me to believe it was either caused by the impact to my eye or whether I caught a virus which I still have.

Any advice appreciated.
Submitted: 3 years ago.
Category: Medical
Expert:  DrRussMD replied 3 years ago.
Hello
I am not really sure what your question is for us, although I understand the situation.

Can you state specifically what it is you are asking?
Expert:  DrRussMD replied 3 years ago.
simply use "reply to expert" to use q and a
Customer: replied 3 years ago.

Apologies if I wasn't clear.

I would like some advice around what further lines of investigation into these problems I can take, particularly around my elevated free t3 and bilirubin in my bloods. What other tests do you recommend I ask for to rule out a virus?

Do you have any ideas on other possible conditions that might explain my problem and I can then ask my doctor to test me for these?

I have ruled out anything sinister with my MRI, my eyes have been tested and I've seen an endocrinologist who did a comprehensive thyroid and hormone test which all came back as unremarkable but I still don't accept that nothing is going on.

Expert:  DrRussMD replied 3 years ago.
An isolated elevated bilirubin is Gilbert's syndrome, by definition, and is not something that needs intervention.

An Isolated elevation in T3 is also not something that needs intervention.

What was your TSH value exactly?
Customer: replied 3 years ago.

Apologies, it was actually my free T4 that was elevated to 31 pmol/L. TSH was 2.53 mU/L. Bilirubin was 38 umol/L and transferrin was also slightly up at 42umol/L.

I am aware of Gilbert's syndrome as it came up in my research but believe this can be caused by viruses can't it? I am having a liver scan done soon to help rule out other liver problems.

Expert:  DrRussMD replied 3 years ago.
You are actually somewhat in the hypothryoid, not hyper.
I would have the TSH repeated.
Anything over 2.5 can be considered hypothyroid, and if it is even higher, then this is a problem, and I would simultaneously get thyroid antibodies to see if there are further indications of thyroid problems.

Clearly anxiety is a component here, but many of your symptoms are seen in people with a relative magnesium deficiency, vitamin D deficiency, and gluten sensitivity, and I would check for all of these, among other things.

Your doctor probably does not have functional medicine training or advanced training in nutrition and hormones.

However, we did train a group of UK doctors in functional medicine over a year ago now...and if you call the IFM they can give you some contacts.
www.functionalmedicine.org

Use reply to let me know if you have further questions [click reply to expert].
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DrRussMD and 4 other Medical Specialists are ready to help you
Customer: replied 3 years ago.

Thank you so much for your help! I will get your suggestions tested for as after a quick read up on them they sound like possible causes.

Expert:  DrRussMD replied 3 years ago.
You are welcome anytime
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