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Feeling feverish without a fever (in fact, a lower that usual body temp persists). My blood work looks good, except they discovered thyroid issue (hyper) last month. I do work in an old 1940s building that worries me; they are doing construction work and I have continuous immune and sinus/lungs issues.
Can you describe what you mean by feeling feverish? Are you sweating abnormally?Any rashes? Any joint pains? Any muscle pains?Any post nasal drip? Cough? Is the cough productive?Other medical conditions? Medications?Do you have the reports of your labs available? Did you have a ESR and ANA done?
Well you are right, this is a complex problem and without additional labs to look through its very difficult to come to some diagnosis and infact even if i had the labs, without a clinical examination it would be difficult to determine the cause. Now inspite of that i believe i can give a few possiblities where further investigations should be done.One is that the feverish feeling and the joint and muscles pains plus the flu like symptoms can be related to the Hyperthyroidism . it can also cause diarrhea, sweating, tremors and insomnia as well. this can be autoimmune in nature. Now if this is the cause then simple thyroid blocking drugs or radio iodine treatment can help in treating the condition and you should feel better.Now the thing here is that you have several conditions which are occuring at the same time one of which is the post nasal drip, this can lead to chronic cough which can be dry or even productive. This can cause shortness of breath even over time plus the increased in coughing on lying down can be due to two other conditions which i will get to later. This post nasal drip can be due to chronic sinusitis which can also cause the feverish feeling etc. This can ruled out with the help of a CT scan of the sinuses.Now the other two conditioons which can cause the cough to increase on lying down are GERD which is commonly known as reflux and the other one is heart failure which can cause cough but should also cause swelling of feet and shortness of breath so i think GERD is a more likely possiblity for your chronic cough alongwith chronic sinusitis. So in addition to the CT scan, a trial of OTC prilosec for 4 weeks should be implemented to see if that helps.Ok so another condition which can explain all the symptoms is that of an autoimmune disease, now which disease exactly thats hard to say as autoimmune disease are usualluy diagnose don basis of lab tests. But these symptoms can fit in avariety of diseases like lupus for one as multiple organ systems are involved. The tests which are usually done for this initially are ANA and ESR alongwith CRP. If ANA comes back negative and lupus is trongly suspected then Anti dsDNA can be done because ANA is negative in 3% of cases of lupus. Another possiblity based on your history of brain inflammation is that of Vasculitis which is an autoimmune disease in which the vessels are inflammed. This can be of various types and the tests are essentially the same with the addition of ANCA among oithers.The increased feeling of fever, well that most likely fits into the thyroid problem, but again as you have several problems occuring at the same time its difficult to say if thats the case. Another possiblity is that of adrenals, which you do say are damaged (well epidural steroids shouldnt damage the adrenals with just 3 injections), if the adrenals are not producing enough stress hormones then it could be that you habve addisons disease in which all these symptoms could fit. A simple 24 hr urinary cortisol level and serum cortisol level could determine that.Also if you have multiple endocrine organ involvement such as thyroid and adrenal, then there is a syndrome known as polyglandular autoimmune syndrome type II. This occurs in adults and causes the involvement of several organs of the body at the same time and it is autoimmune in nature. There is no test to check for it but the organs which can be involved can be predicted and treated accordingly. Nornally the adrenals, testes, pancreas, thyroid are involved alongwith development of celiac disease.As you can see the possiblities are quite a few, and i would recommend that you go through these with your doctor, and if possible consult an internist and an endocrinologist plus a visit to the rheumatologist to rule out all the autoimmune problems is also worthwhile. I hope this helps
Thank you--I will visit again. This was first time on something like this. You made a difference. Can I ask for you, specifically, in the future? I am grateful to you for your skill and generous help, Dr Muneeb. Thank you.