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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Medical
Satisfied Customers: 7201
Experience:  Neurologist/Internist with academic and clinical experience.
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have puffy face, swollen eyelids, 3 weeks duration, thyroid

Resolved Question:

have puffy face, swollen eyelids, 3 weeks duration, thyroid tests T4 & T3 good, white blood count normal. parotid glands swollen
Submitted: 8 months ago.
Category: Medical
Expert:  Dr. Frank replied 8 months ago.

neuromd2012 :

Welcome, as an Internist I will try to answer your Medical Question, for informational purposes only, please see your doctor as needed.

neuromd2012 :

Hello

neuromd2012 :

I am waiting for you to come online

neuromd2012 :

hi

neuromd2012 :

did they do a TSH for hypothyroidism?

neuromd2012 :

as well?

neuromd2012 :

do you smoke cigarettes?

neuromd2012 :

any cough?

neuromd2012 :

did you get a CBC (white cell count?)

Customer:

Yes did TSH also T4 & T3 all good. No, I don't smoke nor do I have a cough, but the swelling in neck/throat can occasionally make my thoat "croaky"

neuromd2012 :

ok

neuromd2012 :

has anyone considered Sjogren's syndrome?

neuromd2012 :

or Sarcoidosis?

neuromd2012 :

I will get you a webpage on Sjogren's

neuromd2012 :

look at the picture

neuromd2012 :

http://emedicine.medscape.com/article/332125-overview

neuromd2012 :

this is the classic presentation with bilateral parotid gland swelling

neuromd2012 :

you usually have dry eyes, a dry mouth

neuromd2012 :

and can have joint pain

neuromd2012 :

and muscle pain etc

neuromd2012 :

if you look at that webpage, they will list the symptoms

neuromd2012 :

you check this with a few blood tests.

neuromd2012 :

sedimentation rate.

neuromd2012 :

SSA/SSB

neuromd2012 :

anti-Ro antibody

Customer:

I do not have dry eyes or dry mouth, but do have parotid gland swelling. No pain in joints or muscles

neuromd2012 :

then it is unlikely

neuromd2012 :

there is a test called the shirmer's test, to check your eyes, but without symptoms it is unlikely

neuromd2012 :
Table 1 Differential diagnosis of bilateral parotid swelling






































































Inflammation or infection
Bacterial
Viral (mumps)
HIV sialopathy
Chronic sialadenitis
Autoimmune diseases
Chronic recurrent parotitis
Sjögren disease
Granulomatous diseases
Sarcoidosis
Wegner's granulomatosis
Kimura's disease
Miscellaneous
Sialadenosis
Polycystic disease
Pneumoparotid
Radiation sialadenitis
Neoplastic diseases
Papillary cystadenoma lymphomatosum (Warthin tumour)
mucosa-associated lymphoid tissue lymphoma
Pseudolesion
Masseteric hypertrophy
Customer:

What do you suggest I should check first from this list with my doctor ?

neuromd2012 :

well my approach

neuromd2012 :

would be to look at if there is some inflammatory process going on

neuromd2012 :

now

neuromd2012 :

they put you on steroids already

neuromd2012 :

that can wreck the testing

neuromd2012 :

so I would say to get your rheumatological marker testing done first

neuromd2012 :

for sarcoid, sjogren's

neuromd2012 :

Mumps viral titers

neuromd2012 :

get a C reactive protein for autoimmune diseases

neuromd2012 :

and a sedimentation rate

Customer:

I did have rectal adino carcinomer 18 months ago, only 3 lymph nodes removed with tumour were magnant, followed by fol/fox chemo, but all tests currently show all is well

neuromd2012 :

I see

neuromd2012 :

I do not think it is related, but you need to do a serum protein electrophoresis

neuromd2012 :

to see if you have a monoclonal gammopathy, which is an increase in an immunoglobulin as from a paraneoplastic syndrome

neuromd2012 :

from rectal cancer

neuromd2012 :

but I would say it is unlikely

Customer:

i see, can print this off to show my doctor?

neuromd2012 :

yes

neuromd2012 :

I will switch this to the question and answer section

neuromd2012 :

you then right click on the page with your mouse

neuromd2012 :

and hit print ok?

Customer:

ok

neuromd2012 :

I hope I was able to help

neuromd2012 :

please come back anytime if you have questions ok?

neuromd2012 :

Dr Frank T

neuromd2012 :

please rate my service if you can

neuromd2012 :

good luck to you in NZ

neuromd2012 :

Dr Frank T

neuromd2012 :

bye

Dr. Frank, Board Certified Physician
Category: Medical
Satisfied Customers: 7201
Experience: Neurologist/Internist with academic and clinical experience.
Dr. Frank and 7 other Medical Specialists are ready to help you
Expert:  Dr. Frank replied 8 months ago.
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