Medical

Have Medical Questions? Ask a Doctor Online!

Ask a Doctor,
Get an Answer ASAP!

Medical

I have Graves' disease with a very high level of

Customer Question
thyroid-stimulating immunoglobulins. The resultant hyperthyroidism...
I have Graves' disease with a very high level of thyroid-stimulating immunoglobulins. The resultant hyperthyroidism is actually relatively mild. My most distressing symptom is recurrent skin ulcers that are triggered by very minor trauma to my skin (pathergy). Biopsies have ruled out bacteria, mycobacteria, and fungi but are otherwise inconclusive. All that can be seen is a dense infiltrate of inflammatory cells (no vasculitis, although I do get petechiae frequently). I am convinced that the ulcers (occurring on my face and shoulders) are an atypical variant of pyoderma gangrenosum, but no one can say for sure, and I've seen every kind of specialist that exists. The ulcers do respond to topical steroids. In any case, could these inflammatory ulcers be caused by thyroid antibodies? There's a very complex relationship between the skin and the thyroid. I'm convinced that excess thyroid hormone is not blame for the ulcers, especially since my thyroid hormones are not particularly elevated. I think the ulcers are being caused by the antibodies/underlying immune system dysfunction. Is there anything at all, even experimentally, that can target the antibodies/immune dysfunction? Does RAI have a predictable effect on the antibodies? I've read that it can increase them, decrease them, or have no effect on them at all.
Submitted: 1 year ago.Category: Medical
Show More
Show Less
Ask Your Own Medical Question
Answered in 16 minutes by:
1/28/2016
Doctor: Dr. Abid, Doctor replied 1 year ago
Dr. Abid
Dr. Abid, Doctor
Category: Medical
Satisfied Customers: 5,985
Experience: MBBS, FCPS(R)
Verified

Hi there ...

Thank you for your question ...

Please tell me have you had test to rule out the possibility of associated other autoimmune disease with Graves disease which could be the cause of ulcers like scleroderma ?

Regards .

Ask Your Own Medical Question
Customer reply replied 1 year ago
I've ruled out all inflammatory bowel diseases through a colonoscopy with biopsy and rheumatological diseases through a full rheumatological panel (HLA B27, sedimentation rate, cardiolipin antibody, C3 complement, rhuematoid factor, cyclic citrul peptide AB, c-ANCA and p-ANCA, extractable nuclear antigen, and c-reactive protein). I have been tested for anti-neutrophil antibodies, and the test was only positive once (titer 1:80 with a speckled pattern). I was told that was not significant. I've also been tested for immunodeficiencies, and there are none. I do have chronic idiopathic neutropenia, but it has always been mild. It may or may not be associated with the Graves' disease. I don't have any symptoms of scleroderma.
Doctor: Dr. Abid, Doctor replied 1 year ago

Ok thats fine , if everything is normal than it is highly likely that antibodies like thyroid stimulating antibodies have negative effect against skin and skin vessels leading to cutaneous vasculitis associated with ulcer formation .

Suppression of immune system with steroids can be helpful to reduce the frequency and occurrence of ulcers .

I will suggest you to ask your Endocrinologist to have immunosuppresive therapy along with anti-thyroid drugs to see response , if ulcers heal than this is indication that underlying immune hyper function is the reason of skin ulcers .

Because in hyperthyroidism hyperfunctioning of vasomotor center is also associated with skin issues.

Regards .

Positive feedback will be appreciated .

Thanks .

Ask Your Own Medical Question
Customer reply replied 1 year ago
My skin biopsies have not shown vasculitis, as I said earlier, but they didn't rule it out either.To clarify, is it the antibodies themselves that would cause the vasculitis or the excess thyroid hormones (T3 and T4)? Anti-thyroid medications have been known to cause pyoderma gangrenosum, so I do not want to take those and exacerbate my skin condition.Are there any other useful immunomodulating agents besides steroids, which have horrible side effects. What about intravenous immunoglobulin? I know it's expensive, but theoretically couldn't it work?
Doctor: Dr. Abid, Doctor replied 1 year ago

Yes there are other immune modulators but they are not directly indicated once if steroids are not beneficial than those agents are indicated .

So I wish you should start steroids .

Good luck .

Positive feedback will be appreciated .

Thanks .

Ask Your Own Medical Question
Doctor: Dr. Abid, Doctor replied 1 year ago

Even if biopsy are not suggestive of inflammation or vasculitis but still once you should have trial of steroids .

Regards .

Positive feedback will be appreciated .

Thanks .

Ask Your Own Medical Question
Ask Dr. Abid Your Own Question
Dr. Abid
Dr. Abid
Dr. Abid, Doctor
Category: Medical
Satisfied Customers: 5,985
5,985 Satisfied Customers
Experience: MBBS, FCPS(R)

Dr. Abid is online now

A new question is answered every 9 seconds

How JustAnswer works:

  • Ask an ExpertExperts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional AnswerVia email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • 100% Satisfaction GuaranteeRate the answer you receive.

JustAnswer in the News:

Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.

What Customers are Saying:

I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me.

Susan O.USA

I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much

Corrie MollPretoria, South Africa

I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well!

ClaudiaAlbuquerque, NM

Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion.

KevinBeaverton, OR

Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
I feel better already! Thank you.

ElanorTracy, CA

Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem.

JulieLockesburg, AR

You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions.

John and StefanieTucson, AZ

< Previous | Next >

Meet the Experts:

Family Physician

Family Physician

Doctor

2,592 satisfied customers

Emergency Medicine and Family Practice for over 26 years

Dr. Ketch

Dr. Ketch

Board Certified Physician

76 satisfied customers

Medical Degree, Former Assistant Professor at School of Medicine at Yale University

DrRussMD

DrRussMD

Board Certified Physician

51,160 satisfied customers

Internal Medicine--practice all of internal medicine, all ages, family, health, prevention, complementary medicine, etc.

Dr Basu

Dr Basu

Experienced Specialist

20,734 satisfied customers

MD

Dr. David

Dr. David

Board Certified Physician

224 satisfied customers

Treat children/young adults, former chief resident, multiple publications

Dr. D. Love

Dr. D. Love

Doctor

17,064 satisfied customers

Family Physician for 10 years; Hospital Medical Director for 10 years.

Dr Chip (M.D.)

Dr Chip (M.D.)

Doctor

13,486 satisfied customers

20 yrs. in practice, includinge surgery, general medicine, addiction medicine and pain.

< Previous | Next >

Related Medical Questions
Thyroid papillary carcinoma diagnosed, thyroid removed two
Thyroid papillary carcinoma diagnosed, thyroid removed two weeks ago, currently taking T4 Levothyroxine 100 mcg daily, is it recommended to take T3 50mcg daily 25 a.m. + 25 p.m. daily as well for opti… read more
Dr. Sohaib
Dr. Sohaib
Consultant Internal Medicine
Post-Doctoral Fellowship in Medicine
3,285 satisfied customers
I got my results and it says: Hep surface antibody and under
Hi I got my results and it says : Hep B surface antibody and under component says Hep B S Ab and the value says Positive (A) and the ref.range says negative . Can you tell me what's going on ? Do I ha… read more
Dr. Bob
Dr. Bob
Staff Physician
Doctoral Degree
2,215 satisfied customers
I'm just curious as I was diagnosed as hyperthyroidism, my
Hi. I'm just curious as I was diagnosed as hyperthyroidism, my most recent blood work showed my T4- 1.08, which is good, but my TSH was .008. My Dr. reduced my current medication from 10 mg down to 7.… read more
DrRussMD
DrRussMD
Board Certified Physician
51,160 satisfied customers
I hyperthyroidism. But I got my blood tests back and I have
I hyperthyroidism. But I got my blood tests back and I have low t3 and low tsh. How can I have both? … read more
Dr. Bob
Dr. Bob
Staff Physician
Doctoral Degree
2,215 satisfied customers
I have just been told that i have the herpies antibodies in
i have just been told that i have the herpies antibodies in my blood system , i have been in a intimate relationship with the same woman for the past 15 years we have been having unprotected sex she n… read more
Dr. D. Love
Dr. D. Love
Doctor
Doctoral Degree
17,064 satisfied customers
I've been asked to test for thyroid antibodies because my
I've been asked to test for thyroid antibodies because my TSH was high (6.5). Does it mean that I am suspect of Hashimoto's disease or is this test done for some other reasons? Thank you.… read more
Dr. D. Love
Dr. D. Love
Doctor
Doctoral Degree
17,064 satisfied customers
I would like to research Necrotizing Autoimmune Myopathy.
I would like to research Necrotizing Autoimmune Myopathy. Could you provide me with some URLs to look that up on line? … read more
Dr.Saleem
Dr.Saleem
Consultant Cardiologist
Doctoral Degree
729 satisfied customers
I have pernicious anemia, and a few other autoimmune
I have pernicious anemia, and a few other autoimmune diseases. I may have had a "mini"stroke last week, and am just now calling my doctor's nurse to report it, even though I feel fine now. will a stro… read more
Medicaldoctor
Medicaldoctor
postgraduate resident,MD
Master\u0027s Degree
91 satisfied customers
Thyroid globulin antibodies of 845. what does that mean,
thyroid globulin antibodies of 845. what does that mean … read more
DrRussMD
DrRussMD
Board Certified Physician
51,160 satisfied customers
My aunt has an autoimmune disease- sounds lile we or well-
My aunt has an autoimmune disease- sounds lile we or well- something … read more
Dr. Phil, MD
Dr. Phil, MD
Internal Medicine Physician
Doctoral Degree
2,622 satisfied customers
Is the combination of thyroid disorder, alopecia areata, and
is the combination of thyroid disorder, alopecia areata , and herpes simplex symptoms of a more serious autoimmune illness? … read more
Dr Uzair
Dr Uzair
FCPS (R) General Surgery
M.B.,B.S. FCPS
3,660 satisfied customers
Positive RNP and Negative antibodies, but Positive ANA, No
Positive RNP and Negative smith antibodies, but Positive ANA … read more
Dr Basu
Dr Basu
Experienced Specialist
Doctoral Degree
20,734 satisfied customers
I tested positive for the HEP C antibody It said reactive at
I tested positive for the HEP C antibody It said reactive at 1.85. Tested forHCV PCR QT results: not detected <=11 Teased for HCV PCR Log results not detected. HCV GENO test was canceled due to an … read more
DrRussMD
DrRussMD
Board Certified Physician
51,160 satisfied customers
If a patient is diagnosed with lupus anticoagulant antibody
If a patient is diagnosed with lupus anticoagulant antibody and needs to have warfarin reversed why would it be recommended by the doctor if he previous ffp transfusions not to use ffp to reverse the … read more
DrRussMD
DrRussMD
Board Certified Physician
51,160 satisfied customers
Is it possible for a UTI to 'kickstart' another Autoimmune
Hi there Is it possible for a UTI to 'kickstart' another Autoimmune condition? I have lichen planus, had a UTI a few weeks ago and now having aches in my hips and groin.Is it possible the UTI kicked o… read more
DR. EHTISHAM
DR. EHTISHAM
Consultant Physician& Rheumatologist
Doctoral Degree
1,351 satisfied customers
What is anti-mag antibody associated neuropathy? What is
Was diagnosed. Says there is little that can be done, chemo has not been to effective. What is the outcome?… read more
Dr. David
Dr. David
Radiation Oncology Attending Director
Post-Doctoral Degree
13,043 satisfied customers
I take Levothroxiine for hyperthyroidism...and metoprolol
I take Levothroxiine for hyperthyroidism...and metoprolol .....what E/D pill can i get for my e/d problem...i get a ok erection at the start...but i go soft about 12 ..15 minutes in … read more
Dr Chip (M.D.)
Dr Chip (M.D.)
Doctor
M.D.
13,486 satisfied customers
Is it possible for someone with negative thyroid antibody
Is it possible for someone with negative thyroid antibody count to reverse autoimmune condition by strict diet and exercise alone. Went from levothyroxine to armour back to the other one and wondering… read more
Dr. Phil, MD
Dr. Phil, MD
Internal Medicine Physician
Doctoral Degree
2,622 satisfied customers
Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

Show MoreShow Less

Ask Your Question

x