Consult Surgeon for fissurectomy operation after physical examination and Good fiber diet Tab FS for low iron

You can reply in a professional yet patient-friendly way: Thank you for providing such a detailed history. Based on the information you’ve shared, several factors may be contributing to your symptoms. Your HbA1c of 5.8% suggests prediabetes and possible insulin resistance, although this alone may not fully explain difficulty losing weight. A TSH of 5.7 mIU/L with normal T3/T4 is consistent with subclinical hypothyroidism, which may contribute to constipation and mild metabolic slowing in some individuals, but treatment depends on repeat thyroid tests, symptoms, and thyroid antibody status. Iron deficiency can also cause fatigue and reduce exercise tolerance, so it should be corrected. Your BMI is approximately 23.8 kg/m², which is within the normal range. Therefore, medical weight-loss medications are generally not recommended unless there are specific obesity-related indications. Since your weight is only mildly above your desired target, lifestyle optimization remains the safest and most effective approach. Given your long-standing constipation, bloating, and incomplete evacuation, I would recommend evaluation for chronic constipation causes, including serum ferritin, vitamin B12, vitamin D, fasting insulin (or HOMA-IR if indicated), anti-TPO antibodies, repeat TSH after 6–8 weeks, and screening for celiac disease (tTG-IgA with total IgA). If symptoms persist, a gastroenterology evaluation for pelvic floor dysfunction or slow-transit constipation may be appropriate. Management should focus on correcting iron deficiency, optimizing thyroid status if indicated, ensuring adequate hydration, gradually increasing soluble fiber, regular physical activity, and using evidence-based constipation treatment (such as polyethylene glycol or other agents if prescribed). A low-FODMAP diet trial may also help if bloating

You have Near Normal BMI . Don't think too much about weight. Follow a balance diet good in complex carb don't eat refined foods . For more you can consult

Basically your sub clinical hypothyroidism is decreasing you basic metabolic rates It can be done once you heal gut as after protien if u feel gut issues it means you to restore gut health

Need a few more details please consult for further evaluation and treatment

Better focus on muscle gain and inch loss

Avoid fried and spicy food Water intake more Green leafy vegetables more Fiber meal Walk Do connect and consult Will help you

Pl consult endocrinologist and surgeon and Nutritionist.

Sure