Question: My 68 yr old sister living in Ecuador has had repeated viral and parasite infections, now has swollen knees and unusual for our family, a fatty upper back. Her normal weight as a HS XXXXXXX was 140 and is now 160 at height of 5ft, 7 inches. She is very active, typically, and very fluent in Spanish, but has to be self reliant about what blood tests to ask for. She went off her Synthroid 5 yrs ago when she moved there and her TSH is elevated and I wonder if she should see an endocrinologist in Loja or Cuenca and what she should ask for tests . Our mother was hypothyroid and had several episodes of adrenal collapse, IV steroids to reverse genlized edema, and took Valium for the rest of her teaching career. Should rheumatoid arthritis be ruled out? Are her frequent infections due partly to low thyroid and related to her recent complaint of depression? She does have an 8-10 coca cola habit (diet) , down from 16 cans/day here in WA state! Her blood test last week showed slightly elevated RBC, maybe due to dehydration since it was fasting and it might not occur to her to risk water since even "bottled" is right out of the river...(she now has a lifestraw type filter at her home)
I cannot pass on her blood tests because of her confidentiality request, but can give specifics...Liver and kidney function WNL and the rest of the blood work and urinalysis and fecal samples were NL/unremarkable.

I really wanted a more detailed answer about what, if anything, hypothyroid condition/knee swelling have to do with each other, but did suggest she get ESR and see an endocrinologist since she needs to get back onto throid hormone replacement, judging by elevated TSH and too much will be hard on heart...