OpenHealth Q&A

Labs to Consider for Autoimmune Symptoms

### Personal Background: Age: 37, Assigned Female at Birth (AFAB) **Medical Overview:** I've been diagnosed with several autoimmune and auto-inflammatory conditions, including eosinophilic esophagitis (with sensitivities to dairy, eggs, wheat, and some unidentified allergens), hidradenitis suppurativa, and Hashimoto's thyroiditis (though my T4 levels are currently normal). I also experience psoriasis and significant allergies that trigger hives due to temperature fluctuations, alongside vitiligo and episodes of alopecia areata. **Family Medical History:** There is a notable family history of severe autoimmune disorders, including rheumatoid arthritis, sarcoidosis, primary biliary cholangitis, and lupus. **Current Medications:** - Vyvanse 40 mg - Pantoprazole (exact dosage uncertain) - Topical Tretinoin 0.045% (applied only to facial areas) ### Medical Concerns: I began puberty unusually early at eight years old and have been battling significant adult acne since. I was on hormonal birth control until my mid-20s, but had to discontinue it due to frequent migraines. After switching to an IUD, I endured severe pain accompanied by chronic bleeding, which eventually led to a complete hysterectomy while preserving my ovaries. A complication arose in the form of bilateral pulmonary embolism, but I am no longer on blood thinners. After stopping birth control, I noticed an alarming escalation of my acne, along with the onset of male-pattern hair loss and hirsutism. My menstrual cycles became erratic and highly unpleasant, even with the IUD. After several years using the Mirena, and a couple with the Kyleena without relief, I have seen significant worsening of my hidradenitis suppurativa (HS) lesions post-hysterectomy. This is accompanied by hormonal fluctuations that trigger facial breakouts, increased hair growth, mood swings, and marked hair loss. I currently wear wigs due to the thinning patchy scalp hair. Recently, I discovered a hard lump at the site commonly associated with an Adam's apple, which is not soft but rather feels like a firm cartilage formation. Despite the hysterectomy being in August, I continue to experience these symptoms. When my family physician conducted hormone testing without fasting, the results appeared normal for DHEA-S, free testosterone, and testosterone across the follicular cycle; however, my progesterone levels were noted as low, indicating a possible hormonal imbalance. My leukocyte and eosinophil counts have always been significantly elevated, and I hover at the threshold of being diabetic yet have not been prescribed any treatment. My ultrasound before the hysterectomy showed no signs of polycystic ovary syndrome (PCOS), a concern that was initially suspected, since normal hormone levels helped rule this out. **Seeking Solutions:** My physician suggested consulting a private lab to conduct further testing, but the expenses are quite high, with follow-up consultations and medication not covered by insurance. My HS is currently at stage 2, and I’m not on any treatment after experiencing adverse effects from minocycline that made me feel faint and disoriented. I am becoming increasingly frustrated, having days where walking becomes a challenge. Lately, I've also been experiencing unexpected gender dysphoria, feeling increasingly masculine, a shift that has emerged over the past few years without prior signs of such feelings, despite always having a somewhat tomboyish temperament. Is there specific lab work I should pursue that might help shed light on these ongoing issues? Alternatively, are there over-the-counter options I could consider? I had initially hoped spironolactone might assist, but my physician declined to prescribe it, citing my hormone levels as normal. I also cannot afford biologics, and I'm feeling lost in this situation. Any suggestions would be immensely appreciated! If you require more information or wish to see my lab results, I am willing to share. It's hard to maintain any self-esteem when struggling with visible skin issues and hair loss.

Answers (1)

3/20/2025, 3:50:52 AM

OpenHealth AI

Thank you for sharing your detailed medical history; it sounds like you're facing multiple challenges with your health right now. Your concerns about autoimmune conditions, hormonal imbalances, skin issues, and overall well-being are certainly valid, and it's important to address each aspect carefully.

Summary of Key Points:

1. Several autoimmune conditions and hormonal imbalances are impacting your quality of life.
2. You have an increased desire for effective testing to clarify your situation without incurring high costs.
3. You are feeling overwhelmed and need practical guidance on potential lab work and treatment options.

Explanation:

Given your complex background of autoimmune conditions—such as eosinophilic esophagitis, hidradenitis suppurativa, and Hashimoto's thyroiditis—along with your hormonal symptoms and changes in your body, targeted lab work could help clarify your situation. These tests can focus on areas related to both your autoimmune profile and hormonal status.

Prioritized Next Steps:

1. Essential Lab Tests to Consider:

   • Thyroid Panel: Since you have Hashimoto’s thyroiditis, checking TSH, Free T3, and Free T4 levels regularly is crucial to ensure thyroid function remains stable.
   • Hormonal Testing: Consider repeat testing for progesterone, estrogen, and other androgens like DHEA-S and testosterone at specific points in your menstrual cycle (if applicable) to monitor fluctuations.
   • Autoimmune Panels: Tests for inflammatory markers such as ESR, CRP (C-reactive protein), and autoimmune antibodies relevant to conditions like lupus or rheumatoid arthritis might be beneficial.
   • Glucose Testing: Since you're hovering near the threshold of diabetes, monitor fasting blood glucose and HbA1c levels.
   • Allergy Testing: Given your history of significant allergies and hives, evaluating for specific allergens can help manage your sensitivities.

2. Over-the-Counter Options:

   • Supplements: Consider discussing Omega-3 fatty acids or Vitamin D with a healthcare provider, as they can help support immune function and overall skin health.
   • Topical Treatments: For HS and acne, gentle over-the-counter options like benzoyl peroxide or salicylic acid may provide relief when used carefully on affected areas.

3. Lifestyle Modifications:

   • Diet: Continue to maintain a diet that avoids your known allergens; incorporating anti-inflammatory foods (like turmeric and omega-3-rich foods) may help reduce symptoms over time.
   • Stress Management: Engage in mindfulness practices, exercise, or yoga to help alleviate stress, as this can sometimes worsen symptoms of both autoimmune and hormonal issues.
   • Document Symptoms: Keeping a diary of your symptoms, dietary habits, and any potential triggers might help identify patterns or correlations that can be useful in future discussions with healthcare providers.

Moving Forward:

You have a right to seek clarity in your medical journey without the burden of excessive costs. Gather the suggested lab results to foster a better understanding of your condition. Open communication with your healthcare providers about your concerns regarding charges for lab work may help find more affordable solutions or alternatives.

Please remember you are not alone in this journey, and staying persistent in seeking the help and answers you deserve is vital. If you have further questions or need specific insights regarding the lab results once you have them, feel free to reach out!