Unsure Which Specialist to See for Unusual Symptoms? Here's Guidance

I am feeling unwell and I'm not sure which department to consult. I would like to inquire about referral options?

Hello Doctor: Recently, I have been experiencing the following symptoms and would like to know which specialty I should consult for an examination.

1.
Smelling unusual odors: I have intermittently felt like I can smell burnt or cigarette odors, but people around me say they do not smell anything.
I didn't pay much attention to it at first, but when I was alone at home, I noticed I could still smell these odors.
I began to worry that something might be wrong with my health.
A friend suggested it could be sinusitis or possibly a neurological issue.
2.
Numbness: I have experienced intermittent numbness in my left index finger, right calf, and face.
3.
Night vision issues: Earlier this year, I suddenly noticed that when looking at light sources at night, my vision would show a starburst effect.
I initially thought it might be due to astigmatism, worsening my myopia, or a retinal issue.
I underwent a thorough examination at a university hospital, but the ophthalmologist found no abnormalities, and my glasses prescription was correct.
However, the way I perceive light sources has definitely changed compared to before.
About three months ago, I had a comprehensive blood test, and all my indices were within normal ranges.
However, the technician mentioned that my thyroid function was slightly low (T4).
My main concern is whether I should consider paying out of pocket for a detailed neurological examination.
I am really worried.
Thank you.

Weiwei, 20~29 year old female. Ask Date: 2014/06/07

Dr. Gao Qingyun reply Family Medicine

Dear Wei Wei,
Hello, I recommend that you first visit a family medicine department for diagnosis and discussion with a physician, and I suggest a referral to other specialty care.
Wishing you safety and health.

Sincerely,
Dr.
Gao Qingyun
Attending Physician, Family Medicine Department
Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2014/06/07

More Info

Based on the symptoms you've described, it seems prudent to consider a multi-faceted approach to your healthcare. You are experiencing unusual olfactory sensations, intermittent numbness in your limbs, and changes in your night vision. Each of these symptoms could potentially point to different underlying issues, and it’s essential to address them systematically.

1. Olfactory Hallucinations: The sensation of smelling burnt or smoky odors when no one else can is known as an olfactory hallucination. This can be caused by several factors, including neurological conditions, sinus issues, or even psychological factors. Your friend’s suggestion of sinusitis (nasal inflammation) is valid, as sinus infections can sometimes lead to altered smell perception. However, given that you are experiencing this in isolation, it may also be worth considering neurological evaluations. Conditions such as temporal lobe epilepsy or even early signs of neurodegenerative diseases can manifest with olfactory hallucinations. Consulting a neurologist would be a wise step to rule out any serious conditions.

2. Numbness in Limbs: The intermittent numbness you experience in your left index finger and right calf, along with facial numbness, raises concerns about possible nerve compression, peripheral neuropathy, or even transient ischemic attacks (TIAs). These symptoms could be indicative of issues such as carpal tunnel syndrome, cervical spine problems, or systemic conditions like diabetes or vitamin deficiencies. A thorough neurological examination is warranted here, and a referral to a neurologist would be appropriate. They may recommend nerve conduction studies or imaging studies to assess for any underlying nerve issues.

3. Visual Disturbances: The changes in your night vision, particularly the scattering of light around luminous objects, could be related to several ocular conditions, but since you’ve already had a thorough eye examination with no findings, it may be beneficial to consider neurological causes as well. Visual disturbances can sometimes be linked to migraines, optic neuritis, or other neurological conditions. A consultation with a neuro-ophthalmologist could provide further insights into whether your visual symptoms are related to a neurological issue.

4. Thyroid Function: You mentioned that your thyroid function was noted to be low (T4), which could contribute to various symptoms, including fatigue, mood changes, and even neurological symptoms. It would be advisable to follow up with an endocrinologist to evaluate your thyroid function comprehensively. They may recommend further testing, including TSH and T3 levels, to determine if you require treatment for hypothyroidism.

In summary, given the complexity and potential overlap of your symptoms, I recommend the following steps:
- Neurology Consultation: Schedule an appointment with a neurologist to evaluate your olfactory hallucinations and numbness. They can perform necessary tests to rule out neurological disorders.

- Endocrinology Consultation: Follow up with an endocrinologist regarding your thyroid function to ensure it is adequately managed.

- Neuro-Ophthalmology Consultation: If visual symptoms persist, consider seeing a neuro-ophthalmologist for a specialized evaluation.

It’s understandable to feel anxious about these symptoms, but taking proactive steps to consult with the appropriate specialists can help clarify your situation and guide you toward effective management. Remember to keep a detailed record of your symptoms, including their frequency, duration, and any potential triggers, as this information can be invaluable during your consultations.

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