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Need answer very quickly please. I had the left lobe of my ...
Sent to Health Experts May 26 10:47 PM

Need answer very quickly please. I had the left lobe of my thyroid removed
almost one year ago due to "cold" nodule reuslts hyperplasia. I would not
take the 0.125mcg due to my labs were fine prior to SX and after SX. I was
told after a totally different SX that I needed to take the Synthroid. Which now
after only 9 weeks my TSH is 0.019L, T4 is 13.0, WBC 11.2, NEUTOPHILS 81.4,
LYMPS 14.5, MONOCYTS 3.6. I have been placed on anitiobiotics 3 times since
March for a cold that I just can't seem to kick. How can I be so moody, sweating,
gaining weight not losing it and having sleeping problems. I hope some one can
tell me since my labs were done 05/11 & AGAIN ON 05/18 and my PCP's office
called 3 minutes before they closed today now I have to wait till after the hoiliday.
I would ask if I'm hyper or hypo?? Why do I feel so sick?

Customer (name blocked for privacy)
Answer
May 27 12:25 AM (1 hour and 37 minutes and 31 seconds later)
         
ACCEPTEDCheck Mark
Sometimes a viral infection or ***stress*** can trigger Graves' disease. Your TSH level is below normal (your TSH is 0.019L; Normal TSH = .3 to 3.0); therefore, you are hyperthyroid (you have an overactive thyroid.) Total T4 or Total Thyroxine normal is approximately 4.5 to 12.5 and your T4 is 13.0 (slightly elevated) which indicates hyperthyroidism. A low TSH result can indicate an overactive thyroid gland (hyperthyroidism) or excessive amounts of thyroid hormone medication. Rarely, a low TSH result may indicate damage to the pituitary gland that prevents it from producing adequate amounts of TSH.

Your wbc's are slightly elevated at 11.2.   An elevated number of white blood cells is called leukocytosis. This can result from bacterial infections, inflammation, leukemia, trauma, or ***stress***. Eating and physical activity can also alter white blood cell values.

Your neutraphils are 81.4 which is elevated. Neutrophils can increase in response to bacterial infection or inflammatory disease.

Your lymphs 14.5 are decreased. Decreased lymphocyte levels can indicate diseases that affect the immune system such as lupus.

Your monocytes are normal (3.6).    

Hyperthyroid usually causes a rapid or irregular heartbeat, sweating, fatigue, muscle weakness, difficulty sleeping, and nervousness or irritability. Hyperthyroidism can be fatal if it's ignored.

Usually radioactive iodine is used to slow the production of thyroid hormones, but sometimes anti-thyroid medications are used, or part of the gland may be surgically removed (or all of the gland, rarely).

The most likely cause is either Graves' disease or hyperfunctioning nodules ("had the left lobe of my thyroid removed almost one year ago due to "cold" nodule reuslts hyperplasia"). If you have hyperthyroidism but your radioiodine uptake is low, you may have thyroiditis.

I recommend another radioactive iodine uptake and thyroid scan. Was your serum thyroglobulin low? If you can't tolerate anti-thyroid drugs and don't want to have radioactive iodine therapy, you may be a candidate for another thyroid surgery.


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Reply
May 27 1:44 AM (1 hour and 19 minutes and 18 seconds later)
         
Relist:
I POSTED A REPLY FOR DR.HANSAN NEEDING
MORE INFO. WILL THE DR. GET THIS POST?
Reply
May 27 2:02 AM (10 minutes and 22 seconds later)
         
Reply to Ryan's Post: I Posted another question listed as
REPLY TO DR. HANSAN. Are you able to
this?
Reply
May 27 2:15 AM (25 seconds later)
         
Reply to Ryan's Post: THANKS CAN YOU CONTACT DR.HANSAN?
OR DO I NEED ANOTHER DOCTOR TO ANSWER
QUESTION. THANKS, I APPRECIATE THE
NEEDED HELP!
Reply
May 27 2:23 AM (2 minutes and 8 seconds later)
         
Reply to Ryan's Post: THANK YOU IT IS SO NICE TO GAVE SUCH QUICK
RESPONSES!
Answer
May 27 2:37 AM (14 minutes and 3 seconds later)
         
REPLIEDCheck Mark
Hello. Can you please answer a few more questions so I can pull all the pieces together into a definitive diagnosis and possibly a "do-able" treatment plan so that you will be free of your scattered CC's and your past dead-end treatments. I will need at least the next hour to do this. Autoimmune diseases affect women disproportionately more often than men; thus the diagnosis and treatment of these diseases can raise issues specific to women. If you have lab results that you can send to me within the next 24 hours on this same question site, then you won't have to re-list your question.

Specifically:

1---antinuclear antibodies (ANAs)?
2---rheumatoid factor (RF)?
3---erythrocyte sedimentation rate (ESR)?

Tests with low sensitivity but high specificity are helpful only if positive e.g. antineutrophil cytoplasmic antibodies (ANCAs) in Wegener's granulomatosis; anti-dsDNA (double-stranded DNA) and anti-Sm antibodies in SLE, and anti-Ro and anti-La antibodies in Sjogren's syndrome.

Please send me any other information that is related to your condition. I am here working on your case.


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May 27 3:04 AM (26 minutes and 59 seconds later)
         
Reply to Dr. Hanson's Post: DR. HANSAN,
MY LABS ARE AS FOLLOWS:
WBC 11.2H
RBC 4.33 Normally lower than 4.01
HGB 14.5
HCT 43.7
MCV 100.7 has been H for 7 years
MCH 33.5 " '
MCHC 33.2
RDW 11.9
Platelets 278
MPV 8.9
Neutrop 81.4H
Lympoc 14.5L
Monocyt 3.6L
Eosinpl 0.1
Basop    0.4
Absolt Lymp 1.6
Bun    9
Creatine 0.6L
LDL CHOL 137 Boarderline H
Glucose 95
HDL CHOL 53
Triglycerides 55
Total Protein 8.1
Album     4.6
Alb/Glob Ratio 1.3
Globulin   3.5
Total Bil 0.3
Direct Bil 0.0
AST (SGOT) 22
ALT (SGPT) 20
TSH 05/11/06 0.038L
TSH 05/18/06 0.019L
Free T4 05/11/06 1.5
T4 Total 05/18/06 13.0H
ANA 1.80 normally stays there
RF 05/12/05 <20 there are none for 2006
SEDRATE 05/12/05 8 there are none for 2006

05/2005 WBC went up to 15,500 and I had to
be rechecked in office because he wasn't sure
why this happened. Nov 2005 11,500 and now
again after I can't kick this headcold.

Shouldn't hyper state have symptom of losing
weight and I'm gaining it?
Alk Phos 82
Answer
May 27 6:28 AM (3 hours and 24 minutes and 52 seconds later)
         
REPLIEDCheck Mark
Approximately 20% of hyperthyroid patients, especially younger patients, gain weight during the active phase of hyperthyroidism. The exact reasons are unclear but studies show that some patients with hyperthyroidism avoid physical activities because they become over-exerted easily. Others may have an increased appetite and crave foods that cause weight gain.

Patients who initially lose weight find that this weightloss isn't sustained when their hyperthyroidism is corrected. Most patients gain an average of five pounds within the first few weeks of treatment with recommended doses of anti-thyroid drugs. These patient's weight gain usually stops after the first 6-8 weeks when the dose of medication is reduced. However, if you have developed bad eating habits or if you continue to have an increased appetite you can continue to gain weight. Usually, though, hyperthyroid patients who begin gaining weight are often able to lose weight when they start the anti-thyroid drugs.

Your Grave's Disease, URI's, allergies to various medications, SLE, vasculitis, and perhaps even your bowel problem are all caused by an inflammatory response due to auto-immunity. I recommend that you be examined by a rheumatologist/endocrinologist to definitively diagnose and treat your autoimmune problem which is causing your other symptoms (e.g. Grave's, etc.). A primary care physician is not qualified, in my opinion, to treat you.


Your labs are insignificant except for your Thyroid panel, WBC, and differential. You do not have SLE because your platelet count is normal. About 95% of SLE patients have a positive ANA test result. If a patient has symptoms of SLE, such as arthritis, a rash, and autoimmune thrombocytopenia (a low number of blood platelets), then they probably have SLE.

As I previously stated, your lymphs (14.5) were decreased. Decreased lymphocyte levels indicate diseases that affect the immune system. If you will also please notice that in your elevated differential I have previously listed "inflammation" as a cause of these elevations. Also, you have mentioned in your most recent "re-listed question" that you have been treated in the past for diagnoses of "vasculitis", "SLE", "COPD", and "Thyroid disease". Most likely you have Grave's Disease. In each of these specific diseases (vasculitis, SLE, COPD, and Grave's Disease there is a common cause of INFLAMMATION. Not all diseases have inflammatory causes. In fact, most diseases are caused by exogenous pathogens. Auto-immune diseases, on the other hand, produce an inflammatory endogenous reaction leading to specific symptoms for each of the specific auto-immune diseases. As a matter of fact, auto-immune diseases are related because of their "inflammatory" response.

Auto-immunity is caused by the body’s immune system attacking the person's bodily systems just as if it were attacking an infection e.g. the person's thyroid is attacked by the auto-immune response in Grave's disease, the joints in rheumatoid arthritis, the connective tissue in SLE, etc. Autoimmune diseases occur when the body produces an immunological or allergic reaction to itself, instead of reacting to an external substance. In most cases, we don't know why this occurs. Some patients with auto-immune diseases have signs of other diseases caused by an overly-active immune system e.g. arthritis, skin rashes, various allergies to specific allergens and to various medications (e.g. penicillin, erythromycin, sulfonamides, etc.). Auto-immunity is characterized by the progression of various symptoms often over a period of several weeks, months, or sometimes years. However, at the root of each of these auto-immune diseases and their symptoms is one common measurable symptom---INFLAMMATION. Normally, inflammation is a process in which the body's white blood cells and other chemicals protect us from infection and foreign substances such as bacteria and viruses. In some diseases, however, the body's defense system (immune system) triggers an inflammatory response when there are no foreign substances to fight-off. In these diseases, called autoimmune diseases, the body's normally protective immune system causes damage to its own tissues. The body responds as if normal tissues are infected or somehow abnormal.

You have GERD and Irritable Bowel Syndrome (IBS). You should be tested for inflammatory bowel disease which is not the same thing as irritable bowel syndrome (IBS). Inflammatory bowel disease refers to two chronic diseases that cause inflammation of the intestines: ulcerative colitis and Crohn's disease. What are your bowel symptoms that caused your physician to arrive at the diagnosis of IBS?

Wegener's granulomatosis is a disease, in which the blood vessels are inflamed ("vasculitis"). This inflammation damages important organs of the body by limiting blood flow to those organs and destroying normal tissue. The first symptoms of Wegener's granulomatosis are often vague and frequently include upper respiratory tract symptoms, joint pains, weakness, and tiredness. The most common sign of Wegener's granulomatosis is involvement of the upper respiratory tract ("URI", "COPD"), which occurs in nearly all patients. Kidney involvement occurs in more than three-fourths of people with Wegener's granulomatosis ("kidney stones").

Treatment for Wegener's granulomatosis consists of a combination of a glucocorticoid (a steroid) and a cytotoxic medicine. http://www.clevelandclinic.org/health/health-info/docs/0200/0214.asp?index=4757

Nonsteroidal anti-inflammatory drugs and 5 to 10mg per day of prednisone may be useful in treating your symptoms. Selective Cox-2 inhibitors decrease the gastrointestinal side effects of nonsteroidal anti-inflammatory medications.


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May 28 1:47 AM (19 hours and 18 minutes and 53 seconds later)
         
Reply to Dr. Hanson's Post: Dr. HANSON,
Thank you for taking the time to review
my labs and sorry the other question got
duplicated. Just so that you are aware I
went to a Reumatolist - they diagnosed SLE
LUPUS with some arthiritis years ago. I
do have a great Endocrinolgist too. My
PCP tries to prevent me from having to
see so many other doctors because he
feels that I need a break actually my
body needs a break. Still don't understand
how I can have Grave's since no one told
me that I had it after SX. Anyway my PCP
actually is an internal medicine physician
he is right on for his diagnosis but he
wants visable tests to confirm his Dx for
Tx plan. I get frusterated because when I feel
so sick it takes weeks to have an answer.
Maybe I should feel lucky that I am tested
so often because lets face it - there are
good doctors and bad ones who just listen
CC and do nothing about them or making a
patient feel its "physchosymatic" when they
truly have a real problem. Thanks for your
reply, I have been walking everyday so I
quess I need to do it more for the weight to
get back down to 115 lbs. I really don't eat
alot since I've gained the extra lbs.
thanks again.
Answer
May 28 2:11 AM (23 minutes and 42 seconds later)
         
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