Hello! I was diagnosed several years ago with graves disease and had my thyroid removed due to a large nodule that formed. After the surgery, my ANA started becoming positive (not sure of any tiers) and now my RNP is elevated at 2.5. I have no symptoms except fatigue and brain fog, but I also have a toddler...so that's pretty common :). My rheumatologist said that everything is fine, but I am worried that this will turn into something later on. I want to have more children but I am scared that the pregnancy will trigger the disease. Has anyone had a positive ANA and elevated RNP and it not turn into something later on... or do you have any advice or information for me? thank you so much!
You don;t seem to have met enough diagnostic criteria for your Rheumie to
suspect some Rheumatic or Connective Tissue Disease.
The positive ANA in the lower titers is of poor diagnostic value
and the elevated RNP cannot be diagnostic on its own.
As for your symptoms, fatigue and brain fog, as you said they're far too common and explicable (in your case) as you stated yourself.
Unfortunately, this does not clear you, but, your doctor needs more, before
any diagnosis can be considered
I would suggest you also look into better thyroid hormone regulation, perhaps.
What are you on now?
May be you're not converting T4 to T3 very well, or
there could be thyroid resistance, even if your serum levels are fine.
To be certain you need 3 specific tests : Free T3, Free T4 AND Reverse T3
(not the standard tests T4 & TSH).
Please note that my comments are not intended as a replacement for medical advice.
From the Physician's Guide to Lab Test selection and Interpretation:
Re: MCTD diagnosis (mixed connective tissue disease is the most common with the highest percentage sensitivity when RNP is elevated)
--Indications for Testing:
Rheumatologic disease presentation with overlap features
---Criteria for Diagnosis :
----Alarcon-Segovia criteria (easiest to use)
Serological – antiribonucleoprotein (anti-RNP) ≥1:1,600 plus 3 or more of the following:
-Edema of hands
-CBC – mild anemia, leukopenia, thrombocytopenia common
-ESR – extremely elevated levels suggest possible infectious process
-Connective tissue antibody testing:
*Initial screen – antinuclear antibodies (ANA)
*Centromere pattern – diagnostic; usually >1:1,000
*Speckled pattern – order extractable nuclear antigen (ENA)
*Multiple autoantibodies may indicate MCTD or other autoimmune diseases
*RNP antibodies found in 95-100% MCTD patients
*RNP antibodies considered specific for syndrome if other antibodies negative
*Other positive antibodies include double-stranded DNA (dsDNA) (20-25%), *Smith and ribosomal-P
Immunoglobulins – hypergammaglobulinemia
Rheumatoid factor – often positive
As you see, it is not that simple to suspect & verify the presence of any particular condition, based on your tests and symptoms at this point and
in no way did I imply that you are healthy and clear of any such condition.
We need to respect the position Doctors take, when they appear hesitant to
establish a diagnosis, as most of them avoid to do so, unless certain, since such a diagnosis can be a medical "life sentence", when there's no cure and treatment is limited to mostly ongoing symptom management,
by prescription medications.
When diagnosing, there are other implications associated with medical protocols, insurance , disability etc , which doctors deal with all the time, that
many patients may not be necessarily aware of or concerned with.
The patients just want to know what's wrong with them and what can be done so they can feel better,right?
Red Star is probably right, as Thyroidectomy alone, does not correct nor remove any underlying issues or predisposing factors, however, the big question is, how does one go about it on a practical level, facing a complicated medical system, to effectively deal with such health issues thoroughly.
We can analyse these matters to "death", but how does this translate to
a WORKABLE plan of action, for suffering patients to experience notable health improvement and wellness?
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