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Taking Synthroid for Hashimoto's syndrome, absolute neutrophil low. Is dehydration the reason for abnormal reading?

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Practicing since : 2001
Answered : 7 Questions
I have Hashimotos syndrome and have been taking Synthroid since 1998. I was in for my physical today and as the doctor was reviewing my blood work we were having our usual celebratory dance as I am a very healthy 49 year old female. Cholesterol, liver, kidney all numbers were fine. Just one number was way off. My Absolute neutrophils where at 198 (normal 1500 - 7800 cells/uL) So extremely low. I had just come back from a 20 mile bike ride, and feel great.. No infections, sore throats, fevers, etc. AT ALL! The day they took the blood work I just came out of the gym after a strenuous work-out. I am wondering if dehydration might have anything to do with this very abnormal reading? The numbers had been checked manually! I am re-testing... But would love to have a bit of input as it is now a weekend and I am reading all this scary stuff online - leukemia and auto immune disease... My next test is also testing for B12, folate, etc.
Posted Sat, 21 Jul 2012 in Blood Disorders
Answered by Dr. Ajith Puthillath 3 hours later
Thanks for writing in.
While I understand your concern, I dont think we should be drawing premature conclusions about leukaemia or other disorders.
Generally speaking, dehydration has nothing to do with a low while blood cell ( which includes your neutrophils) count. Also, Hashimotos thyroiditis in general does not cause neutropenia.

In order to assist you further, I would request you to answer the following questions:
a. Are you on any other medications other than synthyroid ?
b. Did you have any recent infections
c. IS your hemoglobin and platelets normal?

I agree with checking Vit B12/folate and TSH. I would also like to repeat a complete blood count(CBC) to check indeed if this was accurate reading.
The next step would be to do repeat a CBC and follow up.

Awaiting your reply

Above answer was peer-reviewed by
Follow-up: Taking Synthroid for Hashimoto's syndrome, absolute neutrophil low. Is dehydration the reason for abnormal reading? 5 hours later
Hi Doc,
Thanks for getting back to me.

To answer your questions:

A. I am not taking any other medication other than my thyroid medication.

B. I have not been ill or had any infections.

C. My platelet count was 207 with "few giant platelets noted"
My hemoglobin level was 13.2
My overall White Blood Cell count was 2.2
My TSH level was 0.64
There were a "few atypical lymphocytees noted" as well.
I did scan the front page of my lab work and attach. Did you not get it? It is called 6.26.12.

I am anxiously awaiting your input.
Thank you,
Answered by Dr. Ajith Puthillath 18 hours later

Neutropenia, as seen in your case could be a transient event. A review of the blood work that was attached shows no other alarms. I agree with current work up ordered including XXXXXXX

I would reiterate that I see no evidence of leukemia.

In the interim if you develop any fevers/ cough/ bring it to the attention of your doctor.

Above answer was peer-reviewed by
Follow-up: Taking Synthroid for Hashimoto's syndrome, absolute neutrophil low. Is dehydration the reason for abnormal reading? 9 hours later
Good to hear you do not see evidence of Leukemia. The re-test came back.
Now my overall WBC is 2.7 (up from 2.2) and the Absolute Neutrophils is 527. Still low but a bit better.

I have a suspicion of milk allergy and have started a strict vegan diet as proposed by Dr. McDougall. I expect the numbers to turn around as I follow this diet.

I have had some arthritic joint symptoms in my fingers, my knees are very painful and starting to limit my activities (cannot do squats at the gym, etc), as well as neck and ankles that creak and crack constantly.

Having had the auto immune track record with Hashimotos, it makes sense to me that a continuation of this is likely to wreck havoc on my health unless I remove the offending food staples.

I suspect some rheumatoid arthritis to be happening, and molecular mimicry in my body is making me attack my own wbc as long as the offending animal protein molecules are present.

What do you think?

I have attached the results of the re-test.

Thank you so much!
Answered by Dr. Ajith Puthillath 11 hours later
Hi and thanks again,

As we have discussed, I believe the neutropenia should slowly get better by itself. Milk allergy by itself will not cause neutropenia.

If you have early morning stiffness, then you can discuss with your doctor about working this up. Rheumatoid arthritis can cause decrease neutropenia - but still not very common.

I would repeat the CBC once again in a week and I believe it will show improvements. If it continues to be in the lower end, then a referral to a local hematologist will be appropriate to monitor.

There is a phenomenon called "cyclical neutropenia" which is seen in young women, usually around their menstrual period with evidence of mouth ulcers. This is not your case though.

The XXXXXXX is negative, which is again good.

Hope this is reassuring.

All the best

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