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Getting blood from throat. Diagnosed with chronic hives, latent TB, acid reflux. Thyroid test came clear. What might be the cause?

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Hello doctor,
i am getting blood from my throat when I split. It happened right now and ocassionally before. I'm sure that its coming from my throat and not from my mouth beacause I'm have feeling that something was inside my throat. I also occasionally observed a brownish colour substance coming from throat.

i will also tell my previous health history which might help you. I am getting serious hives everyday since 8 months ,that means they are chronic now. I am feeling like something was struck in my throat since 3 months. My doctor told me I have TB when i was diagnoised after a skin test which came positive but the chest x-ray showed my lungs are OK. so he told me I might have latent TB. I am also diagnoised with acid reflux .

I have provided all the reports which might help you along with some pictures i have taken so that you can diagnose my condition properly.

Also i want to tell you something. I visited XXXXXXX medicine doctor,dermatologist, ENT specialist and gasentrologist. The gasentrologist told that I have acid reflux , relevant report is uploaded by me so that you can cross check it . Then i visited ENT specialist to check with my problem of feeling like something in my throat. He told he found nothing. I have to tell you something I felt like he didn't check my voice chord and I suspect he didn't check my throat perfectly . When i XXXXXXX him I felt like throat was completely blocked and I also experienced little bit of breating problem. Believe me it was my worst thing i have ever experienced in my life. The throat problem was so severe that time. At that time I observed blood in my mucus when I tried to clear it. I told my situation to my ENT specialist he told I am ok. My general doctor did blood tests (CBC, complete thyroid panel and allergy tests ). He did complete thyroid panel inorder to check why my TSH is 5.4 and all other valuse like Free T4 etc are normal. He told my thyroid was ok for now but he told he will repeat the tests after 3 months. With regard to allergy test performed everything was ok except IgE is 224(abnormal).
He told he will perform skin test to check for allergies.

All these problems started suddenly, I mean at the same time which never happened to me before in my life. I never diagnoised with any medical condition before. since 8 months I am having all these problems. On the positive side I never didn't get ant fever , I didn't felt like I am sick except for the throat problem and the cold i got in this winter once.

So please interpret my medical reports and my present conditions and tell me what might be my problem . Also tell me what to do next, i mean any further tests to properly diagnoise my medical condition.If you need any further information i will provide you the neccessary information immediately.
I am suspecting that the reasons for chronic hives might be ant underlying medical condition or any infection.I am living in USA . Its very hard to get appointments with doctors and also I felt like they take more time to diagnose any problems. Please help me in this regard. If you see my picture with hives you will understand my situation.

Also to note I smoked for 3 years and inow quit completely. Also my stool colour is changed.


with regards,
XXXXXXX




Posted Thu, 25 Apr 2013 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Sumit Bhatti 5 hours later
Hi,

Thank you for your query.

1. I have seen some of your previous queries (along with the different attachments) posted to various specialists over the past few days. I do not know the details of the answers you have received but it seems that you are still searching.

2. The blood in sputum is a new symptom which was not mentioned earlier. The source of fresh blood and clots may be the throat, nose, oral cavity, airway and upper gut. Any brown discoloration is due to the action of gastric acid which denatures the blood proteins. A little bit of blood spotting is not XXXXXXX however I wonder if this is related to and injury or your multiple biopsies during endoscopy (which seems to have been done recently). A Coagulogram should be done, including a platelet count. Your liver function tests are within normal limits. Get a stool examination done for occult blood since there is a change in color. Get a urine test done.

3. In the Thyroid function tests, you have a raised TSH and a raised T4. This is seen in Sub-clinical hypothyroidism, Hashimoto's (autoimmune) Thyroiditis and in patients on thyroid hormone replacement therapy. Get a full Thyroid profile done. This will include, T3. T4. TSH, Free T3, Free T4, Ultra TSH and Anti-thyroid antibodies. Your Free Thyroxine Index (FTI) seems to be normal.

4. Get a Videolaryngoscopy done and share the video and images here if you were not satisfied by your previous ENT examination. Your blocked throat sensation and difficulty in breathing was probably due to acid reflux. You have a mild hiatal hernia. This is linked to acid reflux.

5. As regarding your hives, get a dental check-up done for any dental caries. Sometimes allergens may be absorbed through this route, leading to unexplained hives and urticaria. Get a deworming done.

6. Get your C-Reactive Protein, ESR, Anti- Nuclear Antiodies, c-ANCA, p-ANCA, RF, tests for lupus and SLE done.

7. In addition to skin prick tests, get a Food Intolerance assay done.

8. There may be rickettsia, ticks and lice endemic to the area that you are staying in the US.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Getting blood from throat. Diagnosed with chronic hives, latent TB, acid reflux. Thyroid test came clear. What might be the cause? 23 hours later
Hello doctor,

Thanks for your suggestions.

I will tell you my complete story what I wrote in my dairy so that it might help you .
All the problems started with hives. It started like a small rashes on my forehead when I ate food and slept in the sofa and after 2 hours it disappeared. I thought it might be either due to dust on the sofa or might be food allergy. Note that i never had hives before in my life,this was my first experience. after a week or soon it soon reappeared on my back at evening(7:30 pm) and disappeared soon. It reappeared again almost at the same time after another week and it was continuous since then. Initially I got hives only at the night time.Now they are continuous and occuring at the same time. i observed that my hives are getting worse soon after eating food but later found that even after consuming alcohol i am getting them. So I came to a conclusion that hives are not due to any allergic response to foods . As they are coming everyday without intervention of the food ,I found that it is rearly due to allergy. Even at this point of time I didn't go to doctor but inside I had a strong fear about whats happening with my body. At this point of time i didn't eat food properly.

After a 3 weeks of getting hives one day after taking breakfast i found that I was sick and couldn't tolerate . it seems like something is coming from my stomach till the mouth. I couldn't tell you exactly it is acid reflux but I felt sick. I soon rushed to the nearby urgent care. Doctor told me I am ok , no fever,no BP problem but he advised me to have general blood checkup. As for my surprise he told me everything was ok except my liver enzyme level is abnormal(AST= 147High). Soon he referred me to gasentrologist . He is an Indian doctor . He did physical checkup by beating his hand gently on my abdomen and asked couple of questions. The questions include any muscle injury, any abdomen pain, my family history of having any diseases etc.He then ordered couple of tests,including ultrasonogram on my adbomen. After 3 days he called me and told everything was completely ok with my blood work and told I don't need sonogram. Note that I told him I getting vomiting sensation when I am driving in the car and this problem started happening when my hives problem started. Also told him i am getting little abdomen pain near the penis when he asked for any abdomen pains. After inquiring he told these are normal.

I observed that when i am working out in the GYM I am getting serious itching sensation in my forehands and I can see all my nerves completely when I look into my hands(green colour nerves). This is completely abnormal for me because my forehands are always clear and sometimes red when my wash my hands. From that time this situation is continous. More recently I am getting physical urticaria, I mean when I scratch my body even slightly with finger I can see red line lasting for about 15 minutes ,this never happened for me before.


Right now as i told you before I had feeling like something was struck in my throat ,my stool colour change , severe hives everyday (only when I dont take anti-histamines), having vomiting sensation sometimes when I'm travelling in the car. I getting too much gas . My stool and gas smells like foul smell. i am getting back pain (I got back pain sometimes before also ).

Recently some allergy tests are done and found nothing execpt IgE serum level is 240(high). My doctor told me these allergy tests are partial. I couldn't upload some tests done on Thyroid alone, I mean complete thyroid panel and allergy test reports because I don't have copy of them right now. I uploaded Anti-nuclear Ab(ANA) test which came negative.

Recently I had blood work done for HIV,STD's and some diseases. The results for HIV and STD's are obviously negative but the results showed positive hepatitis A and EBV virus. This is the much recent blood work done along with allergy tests and complete thyroid panel. My doctor told EBV virus is common disease and also told my immune system will also control Hepatitis A. Possibly I will upload this report soon.


So doctor can you tell me whether I have any autoimmune disease or any serious underlying problem which might be causing hives. I am also concerned about cancers since chronic hives can also signal cancer or cancerous growth in the body. As my IgE serum level is high , whether there are any chances for allergies or any infections in my body. Can you tell me why i was diagnised with hepatitis A suddenly because the tests done for 3 months continuously showed negative results. I am also concerned about by TB test results.

I am really sorry for troubling you so much. As I am only 25 years and had good life before ,this situation kept me away from my regular happy life. I am really sorry if I trouble you so much.I will sincerely follow your instructions and possible tests you have advised. I also will be in continuous touch with you.
Please advise me for this query also as I told you my complete picture including my tests.

thank you for your patience.
sorry I am getting hives all the time irrespective of the time now

I also forgot to mention . Now-a-days my right eye and sometimes my left eye are red and with watery.
 
 
Answered by Dr. Sumit Bhatti 37 minutes later
Hi,

Thank you for writing back.

1. There are certain conditions that i have seen in patients earlier:
a. Dermatographic urticaria (red lines on the slightest pressure or scratch)
b. Cholinergic or stress induced urticaria (at the Gym)
c. Cold-induced urticaria.

2. Alcohol may contain allergens or may help them get absorbed easily. Many daily use products contain alcohol.

3. Erosive gastritis due to acidity may also help allergens to be easily absorbed.

4. If you doubt the Hepatitis A report, repeat the test.

5. Chronic hives is unlikely to be due to cancer at your age. An allergic or autoimmune basis is more likely. There are many tests which will have to be done before this can be labelled as autoimmune. Steroids will help in controlling autoimmune conditions.

6. There are many chronic diseases similar to TB such as SLE, lupus which need to be ruled out.

7. red eyes are more in favor of an allergic cause. hence continue your anti-histamine medication regularly.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Getting blood from throat. Diagnosed with chronic hives, latent TB, acid reflux. Thyroid test came clear. What might be the cause? 11 minutes later
Thank you very much for your quick reply.

Can you tell me one thing . As my XXXXXXX test is negative what is my possibility of autoimmune disease. is there any possibility that IgE serum levels conform only allergis or something else.Also Do i need any possible stool tests or urine tests to check for any infections or any problems with gallbladder, colon problems etc.
What might be the reason for bad foul smelly stool and foul gas , maybe due to Hepatitis A or any other infections or gastrics. Also any reason for too much gas.

I forgot to tell you I also suspected My hives might be due to bed bugs in United states. I suffered with bed bugs almost 2 years. But now since 8 months after getting hives i changed my house and completely have no bed bugs in my house.
Can you tell me is there any possibility that person develops any alleritic reaction to common foods at my age eventhough they are not allergic before to that foods.
Also my forehands hands are very reddish now-a-days and are really abnormal
 
 
Answered by Dr. Sumit Bhatti 25 minutes later
Hi,

Thank you for writing back.

1. A negative XXXXXXX test reduces the chances of autoimmune disease. however you need to do all the tests mentioned above.

2. Raised IgE points to allergy.

3. Your abdominal discomfort may be due to your allergy. Indigestion and alteration of the normal gut flora may be responsible. Try a course of probiotics.

4. The rickettsia, ticks, mites and lice mentioned above are bugs commonly found in the US.

5. Allergy (including food allergy) may develop anytime.

6' Red forehands may be due to solar or water allergy.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Getting blood from throat. Diagnosed with chronic hives, latent TB, acid reflux. Thyroid test came clear. What might be the cause? 2 days later
Hello sir,

I have an appointment with my doctor tomorrow. I will tell him about the tests you have advised. Thank you very much for suggesting for my problem.
My doctor told me 3 days back he will do scratch test on me and told he will check for any allergies, so i'm not supposed to take any antihistamines and Omerpazole for acid reflux. I already stooped taking medications 3 days back.

As I told you before I can see my nerves(which are green) on my forehand. Today i observed onething. As usual since I stopped taking anti-histamines ,there is a serious outbreak of hives all around my body. The hives are changing the positions . This is completely ok for me as I expected this and prepared well for this situation. But my real problem is the nerves in my forehands are very itchy and I can now see them completely(i mean I can see nerves completely). Also they are causing me pain. Even one of my finger is little bit swollen and couldn't bend it. When i press my hand on the table for sometime when i was eating,I observed that my hands are really itchy,turned red and my nerves are painful also. I also observed that like my legs are not working (i mean feeling like dumb )and seems like blood circulation had stooped when I am putting even a little pressure. I ate food now and I am getting stomach pain. Note that stomach problem is the major thing .I'm also having low back pain since 3 days , which was improved little bit today.

Any clue sir.....

Anyhow I'm going to XXXXXXX doctor tomorrow . Just suggest me what to tell to him apart the tests you have suggested.

With Regards,
XXXXXX

I'm sorry

Nerves are seen on my palm ....and they are really itchy and causing pain and difficult to fold my fingers
 
 
Answered by Dr. Sumit Bhatti 1 hour later
Hi,

Thank you for writing back.

1. The green 'nerves' that you are seeing in the palm and forehand are probably veins. Either you have a thin translucent skin or the veins are dilated (engorged) due to the chemicals released during an attack of allergy. This is normal and not a cause for worry.

2. Dilated veins get engorged and venous blood stasis occurs. The toxic metabolites which are normally carried away build up causing pain. This is similar to what happens in cases of varicose veins.

3. Just follow the above instructions. These symptoms should settle down as soon as you restart the medication.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Getting blood from throat. Diagnosed with chronic hives, latent TB, acid reflux. Thyroid test came clear. What might be the cause? 11 minutes later
SORRY TO BOTHER YOU....I USED TO HAVE A THICK SKIN BEFORE AND I NEVER SAW MY VEINS LIKE THIS BEFORE. THIS STARTED HAPPENING 7 MONTHS BACK WHEN MY CHRONIC HIVES STARTED.

ALSO THIS CONDITION LIKE TOUCHING MY PALM WITH MY OTHERHAND AND RUBBING IT GENTLY PRODUCES REDNESS AND ITCHINESS OF MY VEINS ,EVEN AFTER TAKING ANTI-HISTAMINES. CAN YOU TELL ME REASON FOR STOMACH PAIN SOON AFTER EATING FOOD
 
 
Answered by Dr. Sumit Bhatti 14 minutes later
Hi,

Thank you for writing back.

1. Dilated engorged veins due to the hives will show through even thick skin.

2. The redness on the palm after touching and gentle rubbing is due to dermatographism.

3. When an allergy develops, many chemicals and substances such as histamine, cytokines, interleukins, leukotrienes, and prostaglandins besides others. We do not have antidotes for all these. For example, anti-histamines counteract the histamine not the others. Anti-leukotrienes block leukotrienes. Steroids block some more but not all. Allergy is a complex cascade or reaction and not all components are explained or understood yet.

4. You stomach pain is probably due to acidity or a diffuse inflammation due to these hives which affects the entire body.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Getting blood from throat. Diagnosed with chronic hives, latent TB, acid reflux. Thyroid test came clear. What might be the cause? 4 minutes later
I really appreciate for your knowledge and patience.

I sincerely thank you very much for educating me and explaining every detail.

I will posts my test results to you as soon as possible.

with regards,
XXXXXX
 
 
Answered by Dr. Sumit Bhatti 44 minutes later
Hi,

Thank you for writing back.

Your questions are always welcome.

Wishing you a good recovery,

Regards.
Above answer was peer-reviewed by
 
Follow-up: Getting blood from throat. Diagnosed with chronic hives, latent TB, acid reflux. Thyroid test came clear. What might be the cause? 22 hours later
Hello doctor ,

Today I went to the doctor's office and had allergy test done. you can go through the details. He also gave copy of thyroid full panel today. You can also find this attachment . I asked him to do the tests what you have suggested. He gave a conclusion that I had hashmitos thyroiditics and told my reason for hives is idiopathic. He told my XXXXXXX test and ESR are ok so I don't need any further tests.

I also asked him reason for blood coming from my throat. He referred me to pulmonologist.

Any advice sir ?

with regards, XXXXXX
 
 
Answered by Dr. Sumit Bhatti 34 minutes later
Hi,

Thank you for writing back.

1. I cannot see the allergy and thyroid panel results in the attachments.

2. So Hashimoto's Thyroiditis is under investigation as suggested in Point No. 3 of my first answer. Get an FNAC (Fine Needle aspiration Cytology) of the thyroid done. Has any anti-inflammatory or other medication been started?

3. With idiopathic hives, only symptomatic treatment is recommended.

4. You may seek the opinion of the Chest Physician.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Getting blood from throat. Diagnosed with chronic hives, latent TB, acid reflux. Thyroid test came clear. What might be the cause? 5 minutes later
hello doctor,

I have uploaded the reports related to allergy and thyroid.

Have a look at it....
Previously the doctor did ultra sonogram on thyroid and Heart ....The report told ok with my thyroid and small problem with heart.

If you want I can upload them also...

Can you tell me as XXXXXXX and SED test are ok ...so I'm with other autoimmune diseases?

The doctor already referred me to pulmnologist ....

 
 
Answered by Dr. Sumit Bhatti 10 minutes later
Hi,

Thank you for writing back.

Your files have not uploaded. May be there is a limit.

Only the original 10 files are seen:

Reports attached to this Query
• 0000_0000.jpg
• 0000_0000.jpg
• 0000_0000.jpg
• 0000_0000.jpg
• 1.png
• h2.pdf
• 0000_0000.jpg
• h1.pdf
• g1.pdf
• Scan.pdf

Regards.
Above answer was peer-reviewed by
 
Follow-up: Getting blood from throat. Diagnosed with chronic hives, latent TB, acid reflux. Thyroid test came clear. What might be the cause? 3 minutes later
I think you can see the reports now...
 
 
Answered by Dr. Sumit Bhatti 31 minutes later
Hi,

Thank you for writing back.

1. Anti thyroglobulin antibodies are positive, hence thyroiditis is a possibility along with SLE (Hepatitis A antibodies are positive. Hence conditions such as Infectious Mononucleosis, Syphilis and Liver problems will have to be ruled out by your physician.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Getting blood from throat. Diagnosed with chronic hives, latent TB, acid reflux. Thyroid test came clear. What might be the cause? 28 minutes later
you mean tests should be done to rule out SLE , mono and liver problems?

So can you suggest me now what are the possible tests to be done to ruleout the diseases and any other conditions associated with my condition and disease.

The test done 6 months back showed elevation of AST(147) while ALT is normal.
The immediate test done after this test showed AST and ALT are within normal levels. The test done also includes muscle tests .

Even though my XXXXXXX and SED rate are negative, Is there any possibility of SLE still. Can you corelate my tests with serum IgE(high).

Also to note Treponemal is negative . What you saw is just an interpretation. I didn't attach the related document. There it showed negative.

Is there any possibility that infections can effect antithyroglobulin values. Also can you tell me why my TSH came to normal levels after high levels. IS there any possibility that i don't have Thyroiditis . Also can you tell me infectious mono is XXXXXXX . May be because of that my throat as been blocked before or anything else. Also any relation to blood from my throat. Is mono if there in my body can be treated.

Can you please corelate my conditions along with these tests. Also tell me any further tests needed...
 
 
Answered by Dr. Sumit Bhatti 8 hours later
Hi,

Thank you for writing back.

1. You will require a full diagnostic work-up for SLE (skin biopsy test for IgG, IgM, IgA, complement 3 & fibrinogen should be done. Only co-relation with XXXXXXX or raised IgE is difficult.

2. Infectious Mononucleosis is usually a self limiting infection with lifelong immunity thereafter. Hence this is not a cause for worry.

3. Get an FNAC of the thyroid to rule out Hashimoto's.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Getting blood from throat. Diagnosed with chronic hives, latent TB, acid reflux. Thyroid test came clear. What might be the cause? 7 hours later
Thank you very much sir....I will do the same.
Hello sir,

please go through the ultra sonogram on my thyroid and cardiogram on heart. Hope this might be useful to you....

Are these reports tell anything ?
 
 
Answered by Dr. Sumit Bhatti 2 hours later
Hi,

Thank you for writing back.

1. Your USG Thyroid is within normal limits. The FNAC will settle the issue.

2. Your Cardiac 2D Echo report is also excellent. Mild Tricuspid regurgitation is not considered significant. However it is also seen in SLE and other autoimmune disorders. Hence further evaluation is advised.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Getting blood from throat. Diagnosed with chronic hives, latent TB, acid reflux. Thyroid test came clear. What might be the cause? 2 days later
hello doctor,


Sorry doctor , I didn't understand "FNAC will settle the issue"
.did you mean if FNAC was ok then most probably i don't have autoimmune?
I'm going to have an appointment with immunologist because my doctor is reluctant to do any tests further.

He confirmed that i only have hashmitoo's and concluded that my hives are idiopathic .


Anyhow I am meeting immunologist soon. Can you tell me after doing FNAC and if the test say everything was ok, what are the changes of having Hashmitoos.

Are there any particular reasons for having high anti Thyro- immunoglobins sometimes. Do you think I really had Hashmitoos .

Are there any cases that sometimes people have these anti thyro- immunoglobins and don't have autoimmune disorders.


As you saw in my report my Anti thyro-immunoglobin is 62H instead of (0-40).
Do you think sometimes harmonal imbalances and pressure had some effect on the results.

What are the chances of I having other autoimmune disorders eventhough my SED rate and XXXXXXX are negative.
 
 
Answered by Dr. Sumit Bhatti 19 hours later
Hi,

Thank you for writing back.

1. In Hashimoto's Thyroiditis, there is a infiltration of the thyroid tissue by inflammatory cells. The FNAC will show if this has taken place.

2. Anti-thyroid antibodies may be positive in normal people without any symptoms. This is usually unexplained.

3. ESR and XXXXXXX are also non-specific markers and may also be raised in normal people.

I hope that I have answered your query. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
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