Had mono and having recurrent symptoms of swollen glands. Have abnormal cortisol levels. Should I be worried of having thyroiditis?
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I recently saw my doctor and requested a full physical because in had mono in 2011 and i am now having recurrent synptoms of swollen glands sore throat and sweats he referred me to infectous disease. Even though my ebv igg and igm are positive he does not feel that it is mono but offers me no alternative because he said my white cell count and hepatic function is normal. I realize that there is no treatment for mono but i recently had such pain in my throat when swallowing and discomfort when touching my chin to chest in my thyroid area. I obtained endocrinologist consult and ultrasound showed 9 nodules. Biopsy of 2 larger nodules negative. Negative antibodies so hashimotos ruled out. I now have thyroiditis of unknown origin. I also have abnormal cortisol levels so i am seeking a adrenal and pituatory work up. I maintain that i could be still positive for mono because i am also having adrenal problems and unable to fight off mono which is causing me to have thyroiditis as well. Could this be the case or do you think something else. Infectios diz doctor just seemed confused and offered no alternative and i am truly sick.
Posted Fri, 22 Nov 2013 in Medicines and Side Effects
Answered by Dr. Ram Choudhary 6 hours later
Brief Answer: Conservative management of mono advisable. Detailed Answer: Hi XXXXXXX Welcome to healthcare Magic! Your symptoms are resembling infectious nucleosis-mono except for absent liver function derangement. Derangement of LFT is common but not invariable. Your IgM positivity for Mono, increased lymph node size and throat discomfort all are suggestive of a relapse of Mono which is seen in 100% previously affect population with mono. You should take rest, ensure hydration and nutrition and take paracetamol for pain and prostration. It should subside soon and at any time if you need antibiotics please avoid amoxicillin and other semisynthetic penicillins because they lead to a dense eruption of rash, making the things complicated. The viral involvement of thyroid is self limiting and subsides in 2-3 months. Patients may need thyroxin hormone supplement in the later phase but early phase may show hyperactivity of thyroid due to excessive release of thyroxine hormone from inflamed cells. Mono can affect the cortisol produced by adrenals but a similar disease is produced by Cytomegalovirus-the CMV as well. It is advisable that you get the CMV antibody levels in the serum as well. I hope the advise would be informative and useful for you. Take Care!
Follow-up: Had mono and having recurrent symptoms of swollen glands. Have abnormal cortisol levels. Should I be worried of having thyroiditis? 2 days later
Hi. Thanks. what is paracetamol? I had some labwork as you suggested (cmv) and i am awaiting results. In the mean time i saw an infectios disease doctor who i am sure thought i was nuts because i had multiple complaints and the day i was in his office i was having severe right neck and shoulder pain and i was sweating profusely and clammy. He was concerned about my recent hx of mono but felt it was very rare to have positive I spent very little time with this doc but he said sometimes sarcoid can cause blockage of parotid and submandibular gland? igm and symptoms for going on two years now. My ear nose and throat doc had ordered a cat scan for swelling on the left side one month prior and now i have swelling on right side of jaw with the current thyroiditis. So inf disease added ct of throat and chest with contrast. I was oerplexed by the results and hoping you can shead some light as i dont have a follow up visit for several months. I will try to attach reading of all. In addition to a tiny 2 mm nodule in the right mid lobe lung showed sutures or clips seen in right breast posteriorly. I had a breast reduction two years ago and he tapered under my right armpit to back. and these should have been removed or dissolved by now. This could explain the shoulder and neck pain. Everything abnormal seemed to be limited to the right side. The ct of the neck showed no evidence of cervical adenopathyor mass to account z4 perceived left sub mandibular gland . I had had a l jaw fx 2 years prior? This ct did show obliteration of right aspect of the vallecula ? Secondary to hypertrophy of r linquil tonsil. Then it says please see other comments and the rad dept would not give me these. Based onthis limited data what are your thoughts. It certainly would explain pain in right shoulder and itching . Sweats right neck and ear pain if this was an infection from retained surgery staples . What would you say and who should i follow up with first and with what testing.
Answered by Dr. Ram Choudhary 2 days later
Brief Answer: get reports and required physical evaluation Detailed Answer: Hi XXXXXXX Paracetamol is an anti-inflammatory painkiller and antipyretic drug. It is also called Acetaminophen. Swelling in parotid region with thyroiditis, nodule in the lung with prolonged symptoms are quite nonspecific features, your clinician is right in casting doubt of sarcoidosis. There can be some autoimmune pathology behind all this. At times there can be a stone in salivary gland duct which can cause swelling on jaw, due to local infection. Acute tonsillitis can also lead to similar picture of presentation. I would like you to get a physical and clinical examination by a physician and an ENT doctor. Recurrent mono may be additive to the the background problem to boost the issues. Please let me know the reports. Please attach compressed JPEG images. Your breast surgeon can give valuable feedback on the surgical staples, personally I do not think it should cause such an issue. It does not seem an infection related to that cause. I hope it should help you.
Follow-up: Had mono and having recurrent symptoms of swollen glands. Have abnormal cortisol levels. Should I be worried of having thyroiditis? 9 hours later
My infectious disease doctor suspected sarcoid but i am questioning it. The same inf disease doctor refused to order any labs and added the ct of chest only because i was getting neck done. I already had my I went back to primary nurse practitioner and she agreed to order cmV. The cmv you suggested was positive for both igg and igm. I have sent you these labs as well as the ct & ultrasound results. I have had my tonsills but not adnoids in childhood. I am curious why someone my age 53 ... Would have residual thymic tissue. As for the retained sutures i am concerned that there may be a an autimmune response to a foreign body. When i was thirty years old i lived in connecticut and worked at XXXXXXX university. I was running a lot marathons and started to get extreme joint pain. I was sent to a rheumatologist who ruled out a typical RA and found to have mixed connective tissue and was assymptomatic for years. The only thing that came up positive Back then was hep c. So i went to specialist at XXXXXXX and he did the more definative proein marjer pcv and it came cack negative up to my last test three years ago. ?
Answered by Dr. Ram Choudhary 2 days later
Brief Answer: Start treatment for CMV and physician review Detailed Answer: Hi XXXXXXX Welcome back. Sarcoid is unlikely in your case, I also bear the same thought. Your CMV IgM and IgG is positive that means an active infection of CMV needing antiviral treatment. You need to consult a local physician and get prescribed the regimen for CMV, dose and schedule your physician will know. You posted two CT reports- same and the CMV report but no ultrasound in your follow up. Please send ultrasound if significant findings. Thymus tissue residual can remain life long without clinical role. Autoimmune response is nearly never seen in the breast surgery clips so that is not a probability as a cause for your problem. Reactivation of hep.C or mixed connective tissue disease is possible. You should start with focusing on CMV treatment and get physical and clinical assessment by a local physician right now and regularly in follow up. I hope the advise will be helpful for you.
Follow-up: Had mono and having recurrent symptoms of swollen glands. Have abnormal cortisol levels. Should I be worried of having thyroiditis? 5 hours later
here is the 2 part ct report. One is for neck the other for the lung. I also enclosed the ultrasound of abdomen. I meant to say i have had my tonsils out but not adenoids in previous question but ipad sent before i could edit. I wish i could start the vancyclovir but primary refused. My primary sent me to infectous disease. I think a virus would explain why i am always really hot and then minutes later cold and clammy... Simplly spike a temp and my fever breaks. That has happened at least twice a day for past few months. My husband is really wortied about me. I am seeing a doctor of osteopathic for a disc injury once a week and she has mentioned on several occasionshow cook and clammy i feel. She now requested i get clearance from my primary before she treats me to protect herself and the physical therapists in her office from getting sick if what i have is contagios. After some coercion on my part my primary sent me to infectous disease. I was soaking wet again when the student doctor with him examined me. The doc was busy in the other room. In had lowgrade temp of 99.8 but i am hypo thyroid so my temp never goes over 99.00. Two days after my ct and cmv test resulted i made another appointment to follow up with inf disease. I pointed out the linguil tonsil on right that would account for some of my right neck swelling and pain ( rad tech wrote down left) as well as my temp. I also told him about my husbands year long bout of bells palsy and skin rash that was successfully treated with vancyclovir and doxycline. He just said "how bad for him". And told me although my igm is positine it is low positive and there is no need to be concerned. As for question of hep c he stated that abot 10% cases spontaneously clear the virus but always have the antbodies for hep c. Since the hcv rna (pcr) had been negative on at least one occasion he said there is no need for further testing. No elevation of whie cells to suggest bacterial. I am getting so exhausted and would love to just rest instead running to appointments only to be not treated. I want to one day return to work but right now i am too sick. All of the doctors i am seeing are in the same network so in order to get another opinion i will have to drive a couple hours to philadelphia and repeat ct because they will not accept the christianna radiologist report and will require the discs. i obtained discs but they are encrypted for christianna only. I made appt with ENT but it is not til december. I am worried i will keep getting sicker in the meantime. If i can hold out until december my plan is to request an mri and then maybe the right neck would be clearer and justify a vancyclivor prescrption? What is my best course of action in the meantime. I started to vomit sunday so went to er and was given zofran by the nurse in triage. Had a temp. Some traumas came in and i was not seen for 5 hours so i left. I have insurance but i getting too sick to run around to appointments so i need to conserve energy and get some advice from you about possible options.I sent attachments . There are duplicates because a couple are difficult to read. thanks for all your help.
Answered by Dr. Ram Choudhary 4 days later
Brief Answer: please reload the investigation and put it briefly Detailed Answer: Hi XXXXXXX Welcome back. Finding difficult to download the numerous reports To my surprise the same report is coming. Will you please load the reports again in compressed format you can easily so it by going to edit picture-compress-email. Please load only one copy of each investigation. It will be easy for me if you could put the previous query a bit briefly avoiding nonmedical details. Thanking you.
Follow-up: Had mono and having recurrent symptoms of swollen glands. Have abnormal cortisol levels. Should I be worried of having thyroiditis? 28 hours later
Okay i get it. I am getting stone walled. I can get that anywhere for free since most doctors sell out to pharmaceutical and insurance companies and go to great lengths to not diagnose and ultimately not treat ( unless its a pill to treat symptoms and another pill to treat side effects of the first pill while never diagnosing the underlying problem) As for the verbose descriptions .... I am just pointing out my symptoms because this is part of the clinical pix and there are multisystem ? Or complex diagnostic results which likely rely on a clinical pix to differentiate what is imp vs what is not. I am As for the zip file.... Your system does not have this option. Ive tried.
Answered by Dr. Ram Choudhary 16 days later
Brief Answer: Conservative supportive management advisable Detailed Answer: Hi XXXX, Welcome back. Managed to download all the files, could not find the ultrasound report at all. The CT of neck and thorax and blood reports have been reviewed. Your doctor is right about his views on hepatitis-C, once you have no RNA copies you can be considered recovered of it. I still think you should get treated for CMV. Ct of neck and thorax show some findings but do not bear much significance because they are of so insignificant magnitude. Doctors at your place are likely to be quite busy but I do not find the rationale for protecting a CT scan CD with that hard password so as to give access to only a certain healthcare authority. The reports are vital for you referals and you should demand for a more versatile CD image from them. Meanwhile have rest and take nutritious and balanced diets and do light exercises. Take care.
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