WG and thyroid issues

[JanW]

Today at my usual appointment, my rheumy ordered blood work to check my thyroid function. He's concerned because my heart rate is in the 90s and my BP has been 137/80 the last six months of visits (prior to dx last January, a normal reading for me would have been 120/80 or even 120/70).

All of the WG type blood work is in the normal range, although normal for me is still abnormally high (the lab doesn't report numerical values) c-ANCA and P3 around 65. I feel terrific -- like I've never been sick at all, good energy, good appetite, etc.

I'm wondering if people here have ever had thyroid issues that were attributed to WG. Treatment looks pretty straightforward, but it's strange to me that both (perhaps) developed at the same time. He does believe there is a chance that my BP is getting high without this underlying issue, but wanted to check it out.

The good news from the appointment, however, is that we will start reducing WG meds in March provided things are as good as they are today.

[Jack]

I would be perfectly happy with heart and blood pressure results like that. Pulse is a little high, but you were visiting the doc so that may explain. 120/80 might be the ideal for a fit healthy person, but I'm afraid that you are not one! ;)

I used to have to explain this to the nurses in hospital when I struggled to reach their targets. I'm an ill person, I'm not going to produce normal readings!

[Sangye]

Jack, I disagree. A consistent systolic pressure of 137 is not okay. It's not enough to treat with drugs, but it does require that a few things are ruled out, hyperthyroid being one of them. It's reasonable to check thyroid function.

[JanW]

I think that given that he is very familiar with the overall state of my health, he is really curious as to why the BP is this high. I had wondered too, and was going to ask about it at this visit, when he brought up that he had been tracking it. I don't normally get 'white coat anxiety' either, so I don't think that's it.

[elephant]

JanW, I developed hypothyroidism in 97' and take synthroid. I could be that the WG attacked my thyroid but not sure. I have to stay on tenormin because my heart rate and blood pressure go up. I take between 12.5 ti 25 mg a day, I take my blood pressure daily. Sometimes twice a day to make sure it's not going up.
Increasing Blood pressure and heart rate can be so many things, and need to be ruled out since your heart rate is in the 90's. Getting your thyroid checked is appropriate. Did you ever have a echo done on your heart? I ask because this is what my physician ordered to find out why my heart rate was so high. They found nothing.
Do you drink caffeinated drinks?
Medications can increase BP and Heart rate too.

[ScreaminMeanie]

Jan, I had Hashimoto's Thyroiditis in conjunction with my first WG flare in 1991. But at no point (that I'm aware of) did I have increased thyroid function. The thyroid just "died" and function went away. When I finally figured out what it might be and went to the doctor specifically about that, my TSH reading (normally between 1-5) was 104!

If it turns out it is not the drugs (steroids in particular can raise your heart rate/BP), check to see if there are any autoimmune conditions that cause hyperthyroidism. It is apparently not uncommon for autoimmune diseases to occur in clusters, as was my case with the WG and Hashimoto's.

[JanW]

I have heard that the AIs cluster that way.

I'm not on any steroids at all, so that can't be a cause. My doc doesn't believe the mtx dose is playing a role in this. What's interesting is that it has held at a stable state in the year I've been diagnosed (or probably at least since March), while I would say that the November beforee, in the midst of the flare that led to diagnosis, my blood pressure was the usual 120/80. Don't know about heart rate, though.

[ScreaminMeanie]

That does seem a bit bizarre. I was dx'ed with HBP about 2 years before I started having obvious WG symptoms (lesions, joint pain). I have often wondered if the HBP was the start of my flare. I had always had low BP before, typically around 100/60. All of a sudden, it was 150/100. Now I take BP meds and keep it at about 115/70.

[Sangye]

ScreaminMeanie, it makes me wonder if your Wegs is due to toxicity. One cause of hypertension is liver stuff--toxicity, congestion, etc.... The blood has to filter through the liver and if there is congestion there it raises the blood pressure. I'm not just talking about overt liver disease, but subclinical changes that can cause disease.

Jan, mtx is toxic to the liver (whether or not it reaches a medical degree). It may be that the mtx is irritating your liver just enough to cause hypertension. Toxicity can cause elevated pulse rate, too.

[ScreaminMeanie]

I wrote a long, boring reply and then the intarwebz ate it! Probably just as well. ;)

I go back and forth between wondering if I'm a toxicity case or an infection case. I can see evidence for both. Both flares I've had were shortly after intense exposure to herbicides (but not the only two times I've had such exposure). I'm also allergic to a lot of chemicals - which cause sinus infections. One of my theories is that when I'm having a lot of sinus infections, I'm taking a lot of antibiotics, which could theoretically keep the WG at bay. The fact that I haven't had a sinus infection in over 3 years lends some support to the infection theory. Also, the fact that when I stopped taking Bactrim about six weeks ago, I immediately felt worse AND my inflammatory markers went up. When I started taking it again after two weeks, I immediately felt better. Haven't had blood work done since then (going next week for that), so it'll be interesting to see if the markers have gone back down again.

[Sangye]

Toxicity can make you susceptible to infection by chronically lowering your immunity. Multiple chemical sensitivities are usually a result of toxicity as well. There's not much you can do about any of it with the limitations we have. It does make the case for avoiding chemicals in your environment, though.

[vdub]

Interesting that this thread should come along today. Yesterday I had apts with both rheumy and endo. Rhemy is not sure I have WG, but can't explain me in any other way except sarcadosis which seems to be the catch all explaination if they can't think of anything else. He's sticking with WG, but is puzzled.

Endo is concerned I may have more tumors; thyroid, medulla, brain. I'm undergoing additional tests now. One thyroid has a 1" tumor that can be seen, but has not be biopsied. I have continuing headaches almost 24/7. Tylenol/codeine T3 keeps them in check to some extent.

Both the rheumy and endo have ordered up records and images from up to 2 years ago....

In the meantime, I am really, really getting tired of drugs, injections, ct scans, mri's, etc. etc. I wish I could have just 6 months off where I felt reasonably well and didn't have to see any docs. Not going to happen, tho....

[elephant]

Screamin, I too have a problem when I get off Bactrim. The Bactrim does keep me infection and mini flare free, but lately it had caused some abdominal issues.. I have significantly lowered my Bactrim and guess what????? I know have a Sinus infection/virus? I am seeing how thinkings pan out.
Yes, I like to have a 6 month break too!

[vdub]

I go off the mtx today in prep for a knee surgery. The last time I went off mtx, I was sleeping 12/16 hrs per day and had severe joint paint within 3 days. So went right back on. I hope this time is different.

[Sangye]

I hope your docs find answers, vdub. I know the feeling of relentless tests and dr visits. It's rare when I can go a week without one.

When is your surgery and what are they doing? I hope you do okay.

[ScreaminMeanie]

Definitely sending you good wishes for your time off mtx and the surgery. Keep us posted.

[vdub]

It's a semi-minor surgery unless it develops an infection of something. I have a torn meniscus in my right knee, so they are going to do an arthroscopy and try to repair it. It's an in and out day thing. I'm hoping for a speedy recovery with minimal steroids. I'm also taking advantage of the no-mtx time period to get a shingles shot.

If I didn't want to be active and hike national park trails and such, then there would be absolutely no reason to do the surgery since I generally manage ok. However, I do hope to return to a semi-normal life that I had hoped for in retirement and I don't like sitting around much.

Endo told me yesterday to lose 20 lbs.... Can you imagine the audacity of that girl?! Sheeezeee! Her steroids caused the weight! Oh well, she's a great doc -- I'll do as she asks... It will probably help my knees anyway. I might even go for 30 lbs, but then I have to buy new clothes again.... Dang, can't win....

[elephant]

Good luck with surgery!