Hello,
Thank you for your query at DoctorSpring.com
I can understand that you have had a rash, diarrhea and some abnormal labs which can be discomforting.
Before we decide whether you can be better helped by a dermatologist (skin specialist) or an endocrinologist (hormone specialist since some endocrine conditions have skin manifestations) it would be helpful for us to have a picture of the rash. Kindly upload a picture onto the website.
Also in your reply, kindly include your age and gender. If you female, kindly provide details of any recent changes in your menstural cycle. If male, kindly ignore the question.
Also so you take any medication regularly?
Have you noticed that your rash becomes worse when exposed to certain stimulants? e.g. pollen / food ingredient?
Do you have any other significant medical history or positive family history?
I look forward to your reply,
Patient replied :
I am 44 years old. Female. Smoker. Drink only socially. I had an right oophrectomy 10 years ago due to cyst on my ovary. Last year a full hysterectomy due to irregular periods and bleeding pain. I do still have my left ovary though but everything else was removed. Hist of endometriosis. I have no family history due to being adopted. I have one son 16 yrs old. Born prematurly with a stroke at birth and has an arachnoid cyst. Only pregnancy. I do not take any medications. I have Mitro valve prolapse. No mental history. I work as a medic for the 911 service here and also a lab so I am exposed to a lot of things but I have never been stuck by a needle or any reason to think I have contracted anything from one of my patients. I did try to upload and send a picture but I do not see it on here. I only have one small itchy pimple looking bump today but that could change throughout the day. I also have numbness in my right nail bed on my fore finger this morning. That comes and goes periodically. usually in that finger and sometimes my thumb.
Hello,
Thanks for posting your query at DoctorSpring.com
I can understand your concern.
I went through your history and investigation results.
The rash that you mention is on and off. In dermatology the first thing that we think of in case of a fluctuating rash is hives and if on the face angioedema. I had a look at the pictures and that's what i thought of. The picture however is a little blurred, if you could send me a few more.
The rash could be associated with the other symptoms that you mention or it could be just co incidental. That can be understood only after a thorough examination and evaluation by a doctor in person.
Angioedema can be idiopathic or it could be secondary to a systemic illness.
In your case you have given a lot of other history and also deranged thyroid profile. However, in addition to a dermatology consult it would be worthwhile to take a physician 's consult as well.
For angioedema, the treatment could be a bit prolonged depending on the response. I would recommend you a course of an anti histamine like fexofenadine once daily for two weeks. If that helps with the rash, it can be slowly tapered off. However it will be important to follow up with a dermatologist who can work with a physician and give you a holistic approach of treatment.
I have given you my perspective, however i am open to any discussion and any questions that you may have.
Take care
Regards.
Patient replied :
I am leaning more towards Hashimoto disease because of my symptoms. I can deal with the rashes but my general daily symptoms are interfering with my work. I feel like i am a walking flu. I sent my labwork. Do i have an autoimmune problem? I also am thinking that my rashes could be related to that or my gadtro problems? What would be my next step? My ANA results are negative. Two years ago i was treated for my thyroid being inflamed. I was put on prednisone one week. No reluef so thyroid scan done. Was negative. Was having rashes on and off since then also but Dr said he thought i was fine. Rash went away and then came back about once a month since. I have self treated because dermatologist said rosacea and perscribed meds made it worse. I have. Given up on Drs cus i seem to get no answers.
Hello,
Kindly note this is the reply of our endocrinologist.
If you have specific queries for both the doctors who replied to you, ask the queries separately and I will forward to both of them :
ENDOCRINOLOGIST REPLY :
You have Autoimmune Thyroiditis (Hashimotos) with Subclinical hypothyroidism. (Raised TSH and normal t4). The diarrohoea could be due to malabsorption - check for Anti-TTg antibodies, for celiac disease as well.
The ANA/AntidsDNA testing needs to be done to rule out SLE.
The facial rash may be related to these autoimmunity.
You need to start treatment for hypothyroidism with Thyroxine 50mcg daily.
Rest of the treatment can wait till investigations are done.
Regards.
Patient replied :
Thank you. I am waiting on the results for the ANA and anti-dna. They should be back today. I will get tested for celiac also.
Hello ,
Thank you for you reply.
I will keep the consult open. You can get back to me one all the reports are ready.
Regards.