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Hematology/Auto-immune disease


QUESTION: Does a hematologist diagnose auto-immune disorders?  I'm trying to put together the puzzle of my health problems and I'm not sure which doctor to go to?  Many symptoms:  internal vibration, periodic numbness tingling in arms legs, some muscle twitching, brain fog, a lot of muscle and joint aches, some blurry vision etc.  My primary could not find anything (checked for MS, Lyme and others).  I went to a functional doctor and he ran more tests - found positive ANA, positive thyroglobulin antibodies, low AM cortisol, and that I have MTHFR mutation.  He prescribed supplements (vit d, fish oil, methylfolate, probiotic)  it has been two months and I do not feel any different.  I want to find a doctor to help diagnose me - was thinking a hematologist but I'm not sure!  any direction you can provide is appreciated.  thank you

ANSWER: Karen,
Do you have those test reports run by your doctors? Were you screened for thyroid disorders? Well the differential diagnosis for you could be hyperthyroidism, myesthenia gravis. You dont need any specialist doctor for screening the above conditions. Your primary can do it. You can take supplements he gave. But MTHFR mutation never produces life threatening situations. Most of the patients are partially deficient in folic acid. So MTHFR mutation isnt the reason for your symptoms. If you want you can test homocystiene and methionine levels to confirm it. What is your age, height and weight? Any weight loss recently? In such case thyroid should be screened. Also your low corstisol becomes significant in case of weight loss. It could indicate mild  adrenal insufficiency. If you didnt understand any of the thoughts expressed by me pls let me know I will explain in detail. Right now for me positive ANA and thyroglobulin antibodies are significant and will lead you to your proper diagnosis if screened appropriately. Do you take any medicines regularly for any chronic conditions? You can try consulting a rheumatologist and a neurologist, if thyroid screening is normal.

Thanking you!

---------- FOLLOW-UP ----------

QUESTION: Yes I have all of my reports - a binder full.  My primary tested my tsh several times - all within normal range.  The functional doctor (more recent) did a full panel on thyroid:  FreeT3 3.13, FreeT4 .98, TSH 2.13 and of course the antibodies which were positive.  I'm 47, 5.2 and 147lbs - unexplained weight gain this past yr - about 10-15 lbs.  No daily medications at all - I also have chronic daily headaches for over 15 yrs now - so advil is my go to - but I have been using it sparingly (3 to 4 times month)  I did leave one other test result out - the functional order a full stool test - it showed very low good bacteria and a lot of fatty acids.  He said I'm not absorbing most of what I'm eating.  has me on 90 billion probiotic - no difference for me after 2 mos.  I was thinking rheumatologist next also - so maybe I will go that route. My primary told me he doesn't know what else to do for me - that's why I went to a functional doctor.   from what I have read - certain antibodies often signify autoimmune issues - is there such a thing as a full antibody panel - so I can see what else my immune system is attacking?  I ask this bc my symptoms are so diverse and numerous.  Thank you so much for volunteering !!!

I am sure the best way to go ahead is meet rheumatologist regarding high ANA. But there are some questions which need to be probed. Excess fatty acid in stool could not only mean malabsorption but also problems with liver/pancreas or simply SIBO(small intestinal bacterial overgrowth) can produce stool with excess fat. So along with probiotic youll need antibiotics like norfloxacin to kill bad bacterias. I think you should meet a rheumatologist and discuss all your symptoms n show him all the reports. This will help him to give your problems a wholistic approach. Yes there are many antibody tests(you may not require all of them). There is detailed ANA antibody test which can pinpoint the problem. They can be ordered with the guidance of your doctor. Normally if you go to a good doctor for diagnosis, he will screen you for the associated disorders and complications too(like auto immune conditions attacking your gut when thyroid antibodies are positive or different connective tissue disorders when your ANA is positive). Hope you meet someone like that soon. Keep me updated...

Thanking you!


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Dr.Shrinidhi Kulkarni


I can answer all questions related to hematology. RBC, WBC, Platelet and blood forming organs etc and related questions. hematology also includes blood proteins, hemoglobin and disorders related to clotting abnormalities. So questions about all aspects of hematology are welcome!


Working as a Doctor in Primary Health care Centre.

KIMS Banglore

MBBS, Internship in Internal Medicine

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