[31F] Experiencing weakness, fatigue, and hair loss

Patient Description

A 31-year-old female is reporting a 2-day history of muscle weakness, primarily in the arms and legs, fatigue, and shakiness. The symptoms improve with sleep but worsen towards the night. The patient has a decreased appetite but no significant weight change, despite efforts to lose weight. Additionally, the patient has noticed hair loss. There is a history of high blood pressure, long COVID, and mast cell activation syndrome, with the latter diagnosed 6 months ago. The patient experienced pulmonary emboli about a year ago, presenting with significant breathing difficulties. Medications include Montelukast (10 mg once daily), Naltrexone Hydrochloride (4.5 mg once daily at night), and Xarelto (20 mg once daily). The patient has a family history of PCOS but no known thyroid or endocrine disorders. The patient is allergic to alcohol. There is no current chest pain or shortness of breath.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible explanations for your symptoms include:

  • Chronic Fatigue Syndrome (CFS): This condition is characterized by extreme fatigue that can't be explained by any underlying medical condition. The fatigue worsens with physical or mental activity, but doesn't improve with rest. This condition is also known as systemic exertion intolerance disease (SEID) or myalgic encephalomyelitis (ME). Sometimes it's abbreviated as ME/CFS.

    • Treatment for CFS can include cognitive behavioral therapy, graded exercise therapy, and medication to control symptoms.
  • Hypothyroidism: This is a condition in which your thyroid gland doesn't produce enough of certain crucial hormones. Hypothyroidism may not cause noticeable symptoms in the early stages. Over time, untreated hypothyroidism can cause a number of health problems, such as obesity, joint pain, infertility and heart disease.

    • Treatment for hypothyroidism involves daily use of the synthetic thyroid hormone levothyroxine.
  • Anemia: This is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body's tissues. Having anemia can make you feel tired and weak. There are many forms of anemia, each with its own cause. Anemia can be temporary or long term, and it can range from mild to severe.

    • Treatment for anemia usually involves taking iron supplements and making changes to your diet.
  • Side effects of your medications: Metoprolol, Montelukast, Naltrexone Hydrochloride, and Xarelto can all cause fatigue and weakness as side effects.

    • If you suspect your symptoms are due to your medication, do not stop taking them without first consulting your doctor.

What you can do

You should consult a healthcare professional about your symptoms. They can provide a formal assessment and order relevant tests if necessary. In the meantime, you can try the following to manage your symptoms:

  1. Rest and take care of yourself. Make sure you're getting enough sleep, eating a healthy diet, and taking time to relax and do things you enjoy.
  2. Stay hydrated. Dehydration can make feelings of fatigue worse.
  3. Try gentle exercise. While you should avoid overexertion, gentle exercises like walking or stretching can help boost your energy levels.

What you should look out for

You should seek immediate medical attention if you experience:

  • Severe weakness or fatigue that prevents you from doing normal activities
  • Difficulty breathing or chest pain
  • Severe dizziness or fainting
  • Any other severe or worsening symptoms

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for appropriate examination, testing, and care recommendations.

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10 mo ago

People Also Ask


What are the common symptoms of Chronic Fatigue Syndrome (CFS)?

Common symptoms of Chronic Fatigue Syndrome (CFS) include extreme fatigue that worsens with physical or mental activity, sleep that isn't refreshing, difficulty with memory, focus, and concentration, and dizziness that worsens with moving from lying down or sitting to standing.


How is hypothyroidism diagnosed and treated?

Hypothyroidism is diagnosed through blood tests that measure levels of thyroid hormones, such as TSH and T4. Treatment typically involves daily use of synthetic thyroid hormone levothyroxine, which normalizes hormone levels and alleviates symptoms.


What are the potential side effects of Montelukast, Naltrexone Hydrochloride, and Xarelto?

Potential side effects of Montelukast include headache, stomach pain, and fatigue. Naltrexone Hydrochloride can cause nausea, headache, and dizziness. Xarelto may lead to bleeding complications, fatigue, and weakness. It's important to consult a doctor if you suspect side effects.


How can anemia be managed and treated?

Anemia can be managed by taking iron supplements and making dietary changes to include more iron-rich foods. In some cases, treating the underlying cause of anemia is necessary. It's important to follow a healthcare provider's recommendations for treatment.


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