Brief Answer:
Information

Detailed Answer:

Hello,

If you think you may have Hashimoto's disease, there are tests to diagnose this. I recommend going in to your primary doctor and requesting a thyroid panel which should include TSH (thyroids stimulating hormone), T4 or T3 (thyroxine level) and in addition, thyroid antibodies, which indicate Hashimoto's disease.

I assume that your doctor diagnosed EBV from a blood test. Are they treating you for EBV? I am asking because that can cause a number of symptoms similar to Hashimoto's thyroiditis.

Hope I have answered your query. Let me know if I can assist you further.

Thank you.

Regards,
Dr. Bonnie Berger-Durnbaugh
General & Family Physician

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Brief Answer:
Information

Detailed Answer:

Hi,

There is no set protocol for treating chronic EBV, but there are medications that immunologists and rheumatologists use to try to treat it based on anecdotal results.

Chronic EBV isn't that common and some immunologists in the US don't even recognize it. (I disagree with them - I believe it does exist.)

There is a proposed guideline for diagnosing chronic EBV. Chronic EBV diagnosis must meet all 3 of the following criteria:
(1) Persistent or recurrent infectious mono like symptom
(2) Unusual pattern of serum (blood) anti-EBV antibodies with raised anti-VCA (anti viral capsid antigen) and anti-EA (anti early antigen), and/or detection of increased EBV genomes in affected tissues, including the peripheral blood
(3) Chronic illness which cannot be explained by other known disease processes at diagnosis.

Therefore, I think the first order of business should be to rule out more common causes of symptoms, including anemia, and thyroid/Hashimoto's disease.

In addition to that, if your doctor is calling this recurrence of EBV, some tests should be done such as:
anti-EBV antibiody titer
anti-VCA titer (antiviral capsid antigen)
anti-EA (anti early antigen titer)

along with

CBC with differential and manual peripheral smear
TSH, free T4, antithyroid antibodies
Chemistry panel (including glucose, electrolytes, calcium, renal and hepatic function tests)
ANA (antinuclear antibody - which is a non-specific marker for several autoimmune disorders)
Testing for Lyme disease is another thing to consider.

There are other causes of chronic fatigue symptoms which include sleep apnea and side effects from medications. If sleep apnea is a possibility, there is a test people can do while they sleep at home using a special recording device which is then mailed in to a center for interpretation.

Depending on what these results show, you will have more information for a direction to go in.

Hope I have answered your query. Let me know if I can assist you further.

Thank you.

Regards,
Dr. Bonnie Berger-Durnbaugh
General & Family Physician


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Brief Answer:
Thoughts on this

Detailed Answer:

Hello,

The answer to this unfortunately is 'an open minded doctor' and one who is experienced and knowledgeable. There are many doctors who will laugh at the idea of chronic fatigue and chronic EBV. It may take seeing a few different doctors. You can start with an internist or family medicine doctor, ask for some of these tests specifically, and then be referred based on what problems the test results point to. I think that would be the best route.

If you have had fevers with these symptoms, you can try an infectious disease specialist at the university hospital in your state. If joint pain and fevers, a rheumatologist.

However, it probably is best to start with a primary care doctor (internal medicine or family medicine - physicians, no PA or NP as they won't know enough) and then get referred by them accordingly.

Hope I have answered your query.

Thank you.

Regards,
Dr. Bonnie Berger-Durnbaugh
General & Family Physician


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