Help for HHT and bleeding fingers

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DEAR DR. ROACH: Would you please say something about hereditary hemorrhagic telangiectasia? My fingers bleed constantly. One doctor told me just to keep a bandage over it. Others said they could not treat me. — H.L.M.

ANSWER: Hereditary hemorrhagic telangiectasia, also called Osler-Weber-Rendu syndrome, is an uncommon but not rare syndrome of abnormal blood vessels. The “hereditary” part tells us that this is a genetic disease, but at least three different genes are involved, and the variations between one person and another with this condition are very wide.

“Hemorrhagic” means bleeding — the type of bleeding you have from the fingers is common, but so are nosebleeds and bleeding internally from the GI tract. A “telangiectasia” is an abnormality of blood vessels in which arteries in the skin connect directly to veins. These can bleed much more easily than normal skin.

HHT is a condition that many doctors are unfamiliar with, and because treatment of this condition requires special expertise, it may be worthwhile to travel to an expert on the condition, someone who can help your local doctor treat you.

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One very helpful resource is the HHT foundation, at www.HHT.org. It has a list of the treatment centers in the U.S., Canada and internationally.

DEAR DR. ROACH: I have been taking thyroid medication for 15 years. Ten months ago, I had a normal TSH level. Last week it was slightly low. During this period I developed trigger finger on the middle digit of both hands. I went to an orthopedic surgeon, who asked if I am hypothyroid, and at the time I said no.

My question is twofold: Does the drop in my TSH signify hypothyroid? And is it possible to develop trigger finger due to hypothyroidism? My doctor said he’d never heard of it. I wondered if I should change my dosage of thyroid to see if this helps my hands, but my doctor said no. I am a potter, and my hands need to be strong to work on the wheel. — J.R.

ANSWER: Trigger finger is a condition where the tendon to the finger gets stuck in its sheath, sometimes painfully. It usually is treated by an orthopedic surgeon with an injection, although it sometimes needs surgery. Hypothyroidism does make this condition more likely, but there isn’t a consensus on why it happens. Untreated hypothyroidism can cause swelling in soft tissues, and this may be the problem. A study recently showed that the antibody present in Hashimoto’s thyroiditis, the most common cause of hypothyroidism, is strongly correlated with trigger finger.

You are being treated for hypothyroidism, so the correct answer to the surgeon was “Yes, and I am on replacement therapy.” However, a low TSH blood test means that the thyroid replacement is greater than needed. TSH is the hormone made in your pituitary gland that tells your thyroid gland in your neck how much hormone to make. A high TSH means there’s low thyroid in the blood, so the thyroid should make more. Because your TSH was slightly low, if your doctor were to make any change, it would be to slightly decrease the dose of replacement hormone.

However, it’s the orthopedic surgeon who can help your hands the most.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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