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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes fatigue, muscle weakness and ridges in fingernails?

Answered by
Dr.
Dr. Shehzad Topiwala

Endocrinologist

Practicing since :2001

Answered : 1663 Questions

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Posted on Mon, 27 Jun 2016 in Thyroid Problem and Hormonal Problems
Question: I am a very healthy 65 year old female working as a professional. I typically exercise regularly and until the past month I have run on average of 3-4 miles at least 3 times per week. In the month of April I ran 60 miles in 30 days. I am followed regularly by a primary care doctor and have seen several medical specialists lately. In the past 6 months my health has deteriorated rapidly and extensively. I have a history of hypothyroidism. My primary care doctor did my annual exam in February of this year and noted a change in my thyroid studies wherein she indicated my current T4 level indicated suppression of the thyroid so she dropped the dose from .125 to .112. Since then I have developed the following symptoms:
Tiredness/fatigue throughout the day
muscle soreness/weakness, especially in the buttocks and legs
Raynauds (actually signs were present prior to the thyroid dose change)
ridges in my fingernails with yellow discoloration
depression/crying
Recent lab studies aside from the thyroid studies that were abnormal included:
Anti-Thyroperoxidase (microsomal) AB My value 20.6 Standard range <5.61
ANA Titer/Pattern - Speckled - My value 640 Standard Range <80

Do I have a serious situation?
doctor
Answered by Dr. Shehzad Topiwala 1 hour later
Brief Answer:
Thyroid

Detailed Answer:
Sorry to learn about your bothersome symptoms.

When I see someone like you in my practice, I typically order the following blood tests in addition to a detailed physical examination:

CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your 3 month glucose average)
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH
Free T4
25 hydroxy Vitamin D

None of these tests require any fasting and can be done at any time of the day.

The positive antibodies indicate that your thyroid is likely not functioning adequately. it is quite possible that it is not making any thyroid hormone at all and consequently you need thyroid medication for life.
So it is not alarming as such.

The positive ANA requires further evaluation to see if you have rheumatological coditions like lupus or not.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shehzad Topiwala 31 minutes later
I have had all of those tests and only gave you the results of the abnormal studies. My liver function tests fluctuate between slight elevations at times to normal at times.

My biggest concern is the rapid progression of symptoms over the past 2-3 months that have prevented me from running which is the one activity I enjoy most in life and no appointment scheduled until mid July.

I have been on thyroid medications for the past 40 years and it rarely fluctuates so I'm confused about the changes being related to thyroid or rheumatological.
doctor
Answered by Dr. Shehzad Topiwala 11 hours later
Brief Answer:
Follow up

Detailed Answer:
I follow your point.

Well the ANA merits further assessment to see if there is any rheumatological problem going on.

The positive TPO is not representative of any emergency because as long as the TSH and Free T4 are on target , it cannot cause any symptoms.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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