Sjorgens Syndrome

[Pissbrainiac259]

I'd look towards possibly Grave's looking more at his symptoms, as I didn't read in great detail prior. A positive ANA is also suggestive of Grave's.

What's your thoughts?

For starters, a properly thorough Hx & Physical Exam is the FIRST thing any badass clinician worth a damn should obtain.

 

[Pissbrainiac259]

Honestly I'm not sure. I threw lupus out there just due to the suggested positive ANA.

Then again, I would like to believe a global picture of him would help. Or so I'd like to believe.

A positive ANA (Anti-Nuclear Antigen) is unreliable UNLESS the ANA titer is markedly elevated e.g. 1:150, 1:200, 1:250. With regards to inflammatory markers such as ESR, ESR, D-Dimer, they are pretty much worthless except in TWO clinical scenarios which you all can ask Dr. Wikepedia or Dr. WebMD or another one of those quack sites. Back to the elevated ANA titer, you'd want to confirm the dx with other tests which have a very high specificity (i.e. very few false positive tests) for SLE such as anti-dsDNA (well done, Stewie) and anti-Sm antibodies. You could also r/o drug-induced SLE by testing for anti-histone antibodies but hey, lots of doctors are stupid.

 

[Dado5]

I did bunch of more specific tests on Friday,waiting for the results.
One of the results came back
Cyclic citrulinated peptide immunoglobulin G - 0.6 U/ml. Which is normal..

 

[rehh]

A positive ANA (Anti-Nuclear Antigen) is unreliable UNLESS the ANA titer is markedly elevated e.g. 1:150, 1:200, 1:250. With regards to inflammatory markers such as ESR, ESR, D-Dimer, they are pretty much worthless except in TWO clinical scenarios which you all can ask Dr. Wikepedia or Dr. WebMD or another one of those quack sites. Back to the elevated ANA titer, you'd want to confirm the dx with other tests which have a very high specificity (i.e. very few false positive tests) for SLE such as anti-dsDNA (well done, Stewie) and anti-Sm antibodies. You could also r/o drug-induced SLE by testing for anti-histone antibodies but hey, lots of doctors are stupid.

Wow sounds like you and stewie has some real knowledge on this stuff!

 

[Dado5]

I'd look towards possibly Grave's looking more at his symptoms, as I didn't read in great detail prior. A positive ANA is also suggestive of Grave's.

What's your thoughts?

Did full bloodwork and everything came back normal, including thryroid tests.
Possible to have graves with normal thyroid test results?

 

[Pissbrainiac259]

I did bunch of more specific tests on Friday,waiting for the results.
One of the results came back
Cyclic citrulinated peptide immunoglobulin G - 0.6 U/ml. Which is normal..

We just call it "anti-CCP Abs" and the brilliant guy who developed that specific Rheumatological test was one of my professors back in the day.

 

[Pissbrainiac259]

Did full bloodwork and everything came back normal, including thryroid tests.
Possible to have graves with normal thyroid test results?

In medicine, one thing you discover quickly is that anything is possible. That being said, all of the thyroid tests have not been done yet. :lightbulb:

 

[Pissbrainiac259]

Wow sounds like you and stewie has some real knowledge on this stuff!

Not really. We just make it up as we go along in a style which can aptly be described as high speed medical ad libs. :headbang:

 

[Stewie]

Wow sounds like you and stewie has some real knowledge on this stuff!

PB is MUCH more versed as a whole, than I. So it's a learning curve for myself.

 

[Stewie]

Not really. We just make it up as we go along in a style which can aptly be described as high speed medical ad libs. :headbang:

I like to take aim 99.9% of the time, although sometimes I do shoot from the hip without accuracy.

 

[Pissbrainiac259]

Did full bloodwork and everything came back normal, including thryroid tests.
Possible to have graves with normal thyroid test results?

Full bloodwork was NOT done esp with your signs/sx's. You should tell your clinician to demand a refund from his med school. :banghead:

 

[Pissbrainiac259]

PB is MUCH more versed as a whole, than I. So it's a learning curve for myself.

"When you think you're done learning, then you really are D-O-N-E."
-some unknown smart guy

 

[Dado5]

Full bloodwork was NOT done esp with your signs/sx's. You should tell your clinician to demand a refund from his med school. :banghead:

these are the test that i did so far.. there was bunch of more i did last Friday and waiting for the results.

everything is normal except 2 i noted. Alkaline phosphate at 33 and ANA positive.



HISTONE ANTIBODY
CYCLIC CITRULLINATED PEPTIDE IMMUNOGLOBULIN
ASPARTATE AMINOTRANSFERASE (AST)
ALANINE AMINOTRANSFERASE (ALT)
SODIUM
POTASSIUM
CHLORIDE
BICARBONATE
BLOOD UREA NITROGEN (BUN)
CREATININE AND CALCULATED GLOMERULAR FILTRATION RATE
GLUCOSE
ANTINUCLEAR ANTIBODY - POSITIVE
SERUM RHEUMATOID FACTOr
ALKALINE PHOSPHATASE - 33 U/L …..normal range 37 -117 U/L
ERYTHROCYTE SEDIMENTATION RATE (ESR)
C-REACTIVE PROTEIN
FASTING GLUCOSE
HEMOGLOBIN A1
CBC (COMPLETE BLOOD COUNT)
WHITE BLOOD CELL DIFFERENTIAL
HEPATITIS C ANTIBODY
URINALYSIS
POTASSIUM
CREATININE AND CALCULATED GLOMERULAR FILTRATION RATE
IRON AND TIBC (TOTAL IRON BINDING CAPACITY)
FERRITINKEVIN
VITAMIN B12 (COBALAMIN)
TOTAL BILIRUBIN
THYROID STIMULATING HORMONE (TSH)
FREE THYROXINE (T4)
TOTAL BILIRUBIN
MAGNESIUM

 

[Dado5]

Another result
C3 and C4 - normal

 

[Dado5]

Basement membrane AB, EIA <1.0 AI - normal

 

[Pissbrainiac259]

Another result
C3 and C4 - normal

Lord have MRSA. The individual who ordered all of these tests clearly has no clue WTF is going on. Of course your complement factors are "within reference range" and you do realize there are more than 9 complement factors that come immediately to mind.

 

[Dado5]

Lord have MRSA. The individual who ordered all of these tests clearly has no clue WTF is going on. Of course your complement factors are "within reference range" and you do realize there are more than 9 complement factors that come immediately to mind.

Dont know, thats what he ordered..

Anything specific to test ?

 

[Pissbrainiac259]

Basement membrane AB, EIA <1.0 AI - normal

<SMH> It is rather surprising he hasn't already performed an LP for CSF to test for Protein 14-3-3 and IgG Oligoclonal Bands. Hell, while he's stealing all of your blood, maybe he'll tack on a Paraneoplastic Panel and Flow Cytometry with immunohistochemistry assays. Run, Forest, run!

 

[Pissbrainiac259]

Dont know, thats what he ordered..

Anything specific to test ?

Indubitably but I will allow Stewie the opportunity to once again strike first, strike hard, no MRSA.

 

[Stewie]

Indubitably but I will allow Stewie the opportunity to once again strike first, strike hard, no MRSA.

You're making it tough on me, lol.

There's several missing thyroid antibodies tests.

While we're at it, may as well rule out Myasthenia gravis. Dado5, if I'm not mistaken didn't you a few years ago have some hypercoagulopathy and breathing issues?