In 2015: Graves disease presents 8 months postpartum. Treated with RAI.
• Thyroglobulin Antibody was high, 5 IU/ml, (Normal < or = 1)
• Thyroid Stimulating Immunoglobulin was high, 281 (normal <140)
March 2018: 37 year old female, 3 months postpartum
• ANA screen Positive, 1:160, Nucleolar pattern
• Sed Rate by Modified Westergren normal: 2mm/h (< or = 20)
• Iron 16 low (40-190) (History of iron deficiency anemia, this result in spite of taking 28mg daily heme iron. GP has ordered me to double my dosage to 56mg daily)
• Ferritin 4 low (10-154)
• B12 850 normal (history of deficiency, already taking supplements)
• Vit D .25-OH, Total, IA: 46, normal (history of deficiency, already taking supplements)
• TSH .02 low (endocrinologist has adjusted levothyroxine dosage accordingly)
• T3 and T4 normal
• Urinalysis, some abnormal results: (GP suggests possible contamination?)
• Leukocyte Esterase 1+ (Normal is negative)
• WBC 10-20 high (Normal < or = 5)
• Squamous Epithelial Cells 10-20 high (Normal is < or = 5)
• Bacteria: few, high (Normal is none seen)
• Hyaline Cast 0-5 high (Normal is none seen)
• All other urinalysis results normal
Symptoms: fatigue, headaches, neck/shoulder/back pain, leg muscles sore especially hip adductors, acid reflux, hemorrhoids with occasional bleeding, history of frequent constipation, frequent gas/bloating, adult acne, small raised red spot on leg, nipples turn purple when exposed to cold, more floaters in vision, hair loss, can't lose weight in spite of exercising and dieting, possible postpartum depression/anxiety
1. Is Graves disease associated with nucleolar ANA pattern?
2. What additional diagnostic tests are needed, if any?
3. How many diseases are associated with nucleolar pattern?
4. What are some good books that might help me?
5. Should I switch to a liquid iron supplement?
6. Are the urinalysis results relevant?