[37F] With chronic fatigue, thyroid nodules, and psoriasis
Patient Description
A 37-year-old female has been experiencing increased fatigue for over a year, exacerbated by physical activity and stress, sometimes causing urticaria. This fatigue significantly affects her daily life, requiring planned rest periods around activities. She has two benign thyroid nodules, each over 2 cm, present for over a year, with slightly increased but normal thyroid function levels. She also has constant skin and joint inflammation, high white blood cell counts, and was diagnosed with psoriasis in 2014, primarily affecting her scalp and ears. Additionally, she has bone spurs in both feet and ganglion cysts on both wrists.
She experiences daily watery diarrhea without fiber supplements, occurring multiple times a day and not influenced by specific foods. She has low iron and issues with iron absorption. Occasionally, she experiences abdominal pain or cramping with diarrhea but has not had any unintentional weight loss, blood or mucus in her stool, changes in appetite, or changes in her menstrual cycle.
She has tried biologics and TNF blockers, which triggered severe reactions and worsened inflammation. Currently, she takes ferrous sulfate (325 mg daily), meloxicam (15 mg daily), and ergocalciferol (1.25 mg weekly). She has had adverse reactions to psoriasis medications, including Otezla, Skyrizi, Taltz, and Sotyktu. Her family history includes celiac disease, psoriasis, lupus, Ehlers-Danlos syndrome, skin cancer, parathyroid cancer, and heart issues.
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Arora's Assessment
What might be happening
Based on the information you've provided, here are some possible explanations for your symptoms:
Fatigue and Inflammation
- Autoimmune Disorders: Given your family history and your own diagnosis of psoriasis, it's possible that your fatigue and inflammation could be related to an autoimmune disorder. Conditions like lupus, rheumatoid arthritis, or other inflammatory diseases could be contributing to your symptoms.
- Thyroid Issues: Even though your thyroid function is within normal levels, the presence of benign thyroid nodules and slightly increased thyroid function could still be contributing to your fatigue.
- Chronic Inflammation: Your high white blood cell count and constant skin and joint inflammation suggest ongoing inflammation, which can lead to fatigue.
Diarrhea and Low Iron
- Malabsorption: Your history of low iron and iron absorption issues, along with daily watery diarrhea, could indicate a malabsorption syndrome. Conditions like celiac disease (despite previous treatment) or inflammatory bowel disease could be contributing factors.
- Irritable Bowel Syndrome (IBS): IBS can cause chronic diarrhea and may be exacerbated by stress and certain foods, even if you haven't identified specific triggers.
Psoriasis and Joint Issues
- Psoriatic Arthritis: Given your diagnosis of psoriasis and joint inflammation, you might have psoriatic arthritis, which can cause joint pain, stiffness, and swelling.
- Bone Spurs and Ganglion Cysts: These could be related to mechanical issues or underlying inflammatory conditions.
What you can do
Fatigue and Inflammation
- Consult a Rheumatologist: Given your symptoms and family history, a rheumatologist can help diagnose and manage potential autoimmune or inflammatory conditions.
- Manage Stress: Practice stress-reducing techniques such as mindfulness, meditation, or yoga to help manage your symptoms.
- Track Symptoms: Use MDandMe to journal your symptoms, track progress, and share insights with your healthcare provider.
Diarrhea and Low Iron
- Dietary Adjustments: Continue using fiber supplements to manage diarrhea. Consider consulting a dietitian for personalized dietary advice.
- Iron Supplements: Continue taking ferrous sulfate as prescribed. Discuss with your doctor if you need additional tests to evaluate iron absorption.
- Hydration: Ensure you stay hydrated, especially with frequent diarrhea.
Psoriasis and Joint Issues
- Dermatologist Consultation: Continue working with your dermatologist to find effective treatments for your psoriasis.
- Physical Therapy: Consider physical therapy for joint pain and to manage bone spurs and ganglion cysts.
- Topical Treatments: Use prescribed topical treatments for psoriasis to manage flare-ups.
What you should look out for
Given the complexity of your symptoms, it's important to seek medical care for a comprehensive evaluation. Here are some specific signs to watch for:
- Severe Fatigue: If your fatigue worsens or you experience new symptoms like unexplained weight loss, night sweats, or fever, seek medical attention.
- Severe Diarrhea: If you experience severe or bloody diarrhea, dehydration, or significant weight loss, consult your doctor immediately.
- Joint Pain: If you notice increased joint pain, swelling, or stiffness, especially if it limits your daily activities, seek medical advice.
- Skin Changes: Monitor for any new or worsening skin lesions, and report these to your dermatologist.
Remember, while I can provide information and suggestions, it's crucial to consult with healthcare professionals for a formal diagnosis and treatment plan. If you have more questions or need further assistance, feel free to continue the conversation.
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3 mo ago