Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Gaining weight despite incredibly strict diet, rapidly losing function. Seeing second specialist (rheumatology this time) next week.I apologize for the length of this. I want to be thorough, and I need some reassurance while I wait for my referral to the second specialist from the first specialist:32f Utah 5 4 (current weight 186, up from 130) Non smoker/non drinker/no recreational drugs.Medical conditions/history: GERD, migraines, Graves, hashimotos (yes, both. REALLY.) seizures of unknown origin (not epilepsy.) gallbladder removed, sinus surgery for chronic infections, hysterectomy (one ovary left) for severe endometriosis and bleeding. Seeing a rheumatologist next week on a referral for ankylosing spondylitis based on current test results between November and now.Medications: Naproxen, Benadryl, promethazine, lamotrigine, topiramate, tizanidine, pantoprazole, Zantac, rizatriptan, gabapentin. Recently discontinued magnesium, potassium, and hydrochlorothiazide. Botox injections for migraine every 3 months.With all of that said: I finally went to the doctor for the first time in November when my symptoms first peaked. My labs were mostly normal at that point. I had gone from 130-160 very rapidly despite barely eating and it was causing extreme pain, particularly in hands/feet/abdomen. Thyroid/heart/liver/kidneys all looked fine. I didnt respond to the diuretic other than to end up in the ER with low potassium.I have changed my diet from what it was then (literally had been eat a small bowl of rice or noodles, if I ate anything, once a day, and then a few bites of dinner for months because of stomach/intestinal discomfort. Lots of water, but also drank 2/3 cans of soda a day.) I started eating fruits, vegetables, lean protein, extremely limited processed foods (essentially: yogurt, cheese, unsalted nuts, unsalted almond butters, unsweetened almond milk, low sodium/low sugar hot sauce or mustard, occasional olives, sparking unsweetened water, low salt seaweed, organic unsweetened or low sugar low salt anything if its in a bag or jar and I am not prepping it raw) I do dry beans, chicken breast, bone broth, plain Greek yogurt, plain coconut water, plain eggs w/ pepper. Kale, spinach, cauliflower, broccoli, beets, peppers, tomatoes, berries, cucumbers, etc. maybe 1/2 can of soda every 2 weeks. About 1 serving of complex whole grain/seed grains a day MAX.Despite this, and still limiting my calories (mostly due to abdominal pain and diarrhea/constipation) and also pushing through the increasing joint pain and muscle pain/spasms to be as physically active as possible (I even swam in a lake and hauled kayaks, went on a couple hikes.. although most days, I can hardly open my own medication, and have fallen in the bathroom and while dressing myself) I have gone on to gain an additional 26 lbs, up from 160-186.Most recently, the doctor my PCP referred me to repeated the blood work and my platelets have remained slightly elevated, as were my eosinophils.. but not clinically significant. My potassium has continued to be a little low. ANA was negative, ESR normal, CRP was normal, thyroid, heart, kidneys, liver still normal. 24 hr free cortisol was normal. HLA-B27 (I think thats what its called?) was positive and MRI positive for ankylosing spondylitis.In addition to the progressive weakness and pain, I have also lost control of my bladder 3x since December, have had several episodes of either very high or very low blood pressure, nights like last night where if I breathe too deeply it feels like someone is sitting on my ribs... sort of right along the level where the sternum ends. I struggle to walk on stairs and get electric shocks through my arms, hands, and legs when I walk down them or bend my neck to the side.Since the rheumatologist had my doctor tell me to take Naproxen while I wait to be seen, Ive had a bit less swelling in my ankles, I can actually see the bone. I get a couple hours where I am at least slightly less uncomfortable. I still feel like my skin is on fire. It gets itchy when I get too hot and often turns bright red. My stomach and hands balloon up when I move around, and the soles of my feet get hot and painful and sometimes turn blue. (The soles.. not raynauds... cold and heat dont change it, and its not something that affects the digits.)Does that really explain the rapid weight gain and abdominal pain despite restrictive diet? I am genuinely scared about the loss of function Im experiencing.. ### Response: Just a quick clarification. You mention your complex history of thyroid disease (Grave's and Hashimotos), and I think we need more info, especially as hypothyroidism is a common cause of weight gain. You say that your lab results for your thyroid were 'normal', but with either one of these diseases the lab results would almost certainly not be normal. For reference, thyroid labs usually come in various flavors: TSH, Free T4, and depending on the occasion T3/antibodies. Do you know the specific results of those tests? Also, none of your medications is for the thyroid, and with either of these treatment is usually necessary. Did you have radioablation or surgery in the past?While both autoimmune diseases, Graves and Hashimoto's have opposing outcomes. This would make for an interesting and complex clinical picture, and with more information we might be able to help.And of course, maybe it has nothing to do with the thyroid, but common things being common I still think its worth looking into..