ANA Panel Question

[pjwg]

Will a general ANA panel show anything about thyroid levels or does there have to be an additional "check the box" marked off for thyroid antibody to be investigated?  After my visits to the ER for chest pressure, my doctor referred me to a cardiologist to humor me basically since EKGs looked fine.  Good news is that I likely am not going to have a heart attack. :-).  Bad news is that the pain is probably esophageal spasms and the doctor authorized a liver panel, ANA Panel, and test for RA.  I am pretty sure it is going to come back positive for CREST from what I see in myself, maybe RA also, though lots of things could explain the joint pain.  But what I am wondering is if this test is going to be a back-door way for me to find out anything about what I think might be Hashimoto's (my doctor would only test for TSH).  Will the panel give any clues in that regard?  At the very least, if I am positive for another autoimmune disease, maybe she will finally acquiesce to my request for an endo referral, but it would be nice if the blood work could tell me something about all the thyroid symptoms I have been "enjoying" lately.  Ha!

Thank you for your input.

[Barb135]

A rheumatologist is unlikely to be willing to treat thyroid disease.  A rheumy most often only treats RA, Lupus, MS - or others autoimmunes that directly attack muscles/joints, etc.

A good pcp or internist can deal with thyroid issues, so long as they are willing to test and treat properly.

[goolarra]

Any of them can manage thyroid...the question is whether you want them to or not.  As Barb said, some doctors aren't particularly interested in thyroid, some only look at TSH, and some think once in reference range you are no longer hypo.  The important thing is to make sure the doctor is monitoring FT3, FT4 and TSH EVERY time you have blood work and is willing to adjust meds until you are symptom-free, not just until your numbers are right.

[pjwg]

I think I am going to need a rheumatologist for the autoimmune disease(s) i feel is going to come back positive.  Is a rheumatologist/internist able to manage thyroid?  

[Barb135]

I'd agree that if the ANA comes back positive, you might be in a better position to request/demand a referral, but it doesn't sound like there's any guarantee your doctor will give it to you even then.

I had a doctor pretty much like yours, who kept ignoring my symptoms (for years) and often even belittled me for feeling badly. He put my muscle aches/pains down to arthritis because "you are getting older", 30 lb weight gain in 3 months, went down to "it's your age and you just need to MOVE MORE". The huge brown bags under my eyes were from lack of sleep. It goes on and on.......  He pretty much labeled me a hypchondriac and was totally amazed when I finally got his NP to order the thyroid tests and my TSH was 55+, with FT4 at the very bottom of the range.  Why am I telling you this?  Because doctors like these don't usually come around.  I had to kick mine to the curb and get another, you'll probably have to do the same.

Do be careful when selecting an endo; just because they are endos, doesn't mean they are good thyroid doctors, since many of them specialize in diabetes.  Often when it comes to thyroid, they look only at TSH or reference ranges and anything "within range is normal".  

[goolarra]

Tachycardia (rapid HR) ironically can be a symptom of both hypo and hyper.  For many of us, it seems to be a symptom of "thyroid not right".  

Another thing you might try correlating it with is your menstrual cycle.  Reproductive hormones interact with thyroid hormones, so you might be getting a double whammy there (to use a technical term...LOL).

[pjwg]

Thank you for the input.  Dang but I was hoping I would somehow get a freebie for the thyroid in that test. :-)

I am working on getting a new practitioner but don't want to let the old one go until it is a done deal.  I am hoping she will be more open-minded about the testing.  I think, if the ANA comes back positive (and not that I am hoping to have an autoimmune disease, but I sure would like confirmation I am not crazy), that will put me in a better position to be asking for an endo referral.  I don't see how I can keep working with a physician who gives no credence to my symptoms, tells me I am just getting older, refuses to see what is staring her in the face.  There is no trust left.

Since I am picking your brains :-), I have had a couple incidents where I am not exerting myself in any fashion but can sense my heart beating like a son of a gun.  Blood pressure is fine (on ACE and calcium channel blockers), but my pulse is 112, 114.  Could this be a swing from hypo to hyper since it goes with days when I am not quite so drag-*** tired?

Thanks for your help!  At least I have plenty to keep me occupied by looking all this "fun" stuff up while I wait for the lab results.

[Barb135]

You will need to have the thyroid antibodies, Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TGab), to specifically test for Hashimoto's.  Positive ANA only tells if you have an autoimmune disease; it's  often linked to lupus, though positive ANA does not diagnose lupus.

TSH is, at best, an indicator of thyroid status.  You need also to have the Free T3 and Free T4 tests done; these are the actual thyroid hormones and these, along with symptoms are the best indicators of thyroid function.

[goolarra]

Aren't those symptoms fun???  LOL

Any autoimmune disease can affect ANA.  So, if you have more than one, it's not going to differentiate.  

If you're thinking you might be hypo, ask for TPOab (thyroid peroxidase antibbodies) and TGab (thyroglobulin antibodies).  Elevation of either of these indicates autoimmune thyroid disease, Hashi's (hypo, mostly) or Graves' (hyper).

If you think you could possibly be hyper, add TSI (thyroid stimulating immunoglobulin) to those.  TSI is the definitive test for Graves'.

If your doctor continues to refuse to refer you to an endo, you can order these tests online without a doctor's order.

In addition to the antibody tests, you should also ask for FT3 and FT4 (also available online if your doctor is really stubborn).