Need direction with sweating, GI and other symptoms

I am a 25 y/o female who weighs 125 lbs. I exercise regularly and have never used drugs and drink alcohol sparingly. The only medication I take is Allesse (bcp).

Three years ago, I began experiencing urinary frequency. Tests for UTIs and STDs were negative. Upon a cystoscopy, my urologist noted "mild blushing" of the interior of my bladder. I've tried DMSO, Ditropan and Elmiron with no luck. I also have vulvar pain with intercourse. Vaginal biopsy was negative for skin conditions, and estrogen cream, steriods and Elavil had no effect.

Four months ago, I had a knee arthroscopy. The surgery was uneventful. After, I began experiencing diarrhea 2-4 times a day. I had a colonoscopy in February and the GI noted mild inflammation. He also found a series of ulcers "most suggestive of Crohn's" in the rectum. CT scan showed "slight thickening of the rectum walls" but nothing else significant.

Tests for bacterial infections, including C. Diff, were negative. I had two Remicade treatments with no ease in symptoms. Celiac panel was negative, though the doctor noted slightly high IgG levels, and mild anemia. He has instructed me to take Immodium and is no longer certain of the Crohn's diagnosis.

Along with the diarrhea, I've had little energy and awful cold sweats on my face. There is no redness, and blood serum serotonin levels are normal. 24-hour urine collection was also normal. The cold sweats come on after I eat lunch and can last 8-10 hours. There is no pattern with food or environment and the sweats. I can eat the same thing for breakfast and lunch -- but only experience the sweats after lunch. They feel like I have a severe sunburn on my face, or like I've just eaten spicy food. Benadryl does not relieve the symptoms and I'm never running a fever.

CBC is normal and thyroid TSH test are in the normal range. None of my doctors can explain my symptoms and I'm going crazy! I'm terribly uncomfortable and have had no major health problems before. I have a family history of hypothyroidism (paternal grandma and uncle) and IBD (maternal grandmother had Ulcerative Colitis). Father and paternal grandmother have Type 2 Diabetes.

Is it possible to have a thyroid problem when TSH levels test normal? Is there any other conditions that my doctors can consider? I've been sent to an endocrinologist, but can't get in for a few weeks. Could I be going through early menopause? Are there any other tests you would recommend?

Thanks,

ColdSweats

[Kevin Pho, MD]

Yes, it is possible to have a thyroid condition if the TSH is normal.  If hyperthyroidism is strongly suspected despite a normal or elevated serum TSH value, serum free T4 and T3 should be measured.  Further testing (i.e. pituitary MRI) can be considered based on the results of these tests.

I agree with the endocrinology referral - I would wait for the further thyroid tests (i.e. T4 and T3) level before pursuing other avenues.  If early ovarian failure is a concern, you can consider testing with a prolactin, FSH and estrogen level.  These tests can be discussed with your endocrinologist.  

A urology consult can be considered to evaluate the cause for the urinary frequency.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[ontherecord]

Your endocrinologist, gastroenterologist and urologist will have to work together collectively to get to the bottom of this.  Your internist will act as the gatekeeper and middleman orchestrating your treatment, so follow-ups are essential.  to answer your question, it is unlikely that you have early menopause at the age of 25.  In addition, if your thyroid tests are normal, it is unlikely that there is a problem with your thyroid (unless they got the results mixed up, which is unlikely).  Bottom line: your meeting with the endocrinologist will shed light on the current situation, and with the proper information (which is essential) I predict that your internist will know the proper follow-up measures.