Do I have a second autoimmune disease?

[starlyric]

In 2015: Graves disease presents 8 months postpartum. Treated with RAI.
• Thyroglobulin Antibody was high, 5 IU/ml, (Normal < or = 1)
• Thyroid Stimulating Immunoglobulin was high, 281 (normal <140)

March 2018: 37 year old female, 3 months postpartum

• ANA screen Positive, 1:160, Nucleolar pattern
• Sed Rate by Modified Westergren normal: 2mm/h (< or = 20)

• Iron 16 low (40-190) (History of iron deficiency anemia, this result in spite of taking 28mg daily heme iron. GP has ordered me to double my dosage to 56mg daily)
• Ferritin 4 low (10-154)
• B12 850 normal (history of deficiency, already taking supplements)
• Vit D .25-OH, Total, IA: 46, normal (history of deficiency, already taking supplements)

• TSH .02 low (endocrinologist has adjusted levothyroxine dosage accordingly)
• T3 and T4 normal  

• Urinalysis, some abnormal results: (GP suggests possible contamination?)
• Leukocyte Esterase 1+ (Normal is negative)
• WBC 10-20 high (Normal < or = 5)
• Squamous Epithelial Cells 10-20 high (Normal is < or = 5)
• Bacteria: few, high (Normal is none seen)
• Hyaline Cast 0-5 high (Normal is none seen)
• All other urinalysis results normal

Symptoms: fatigue, headaches, neck/shoulder/back pain, leg muscles sore especially hip adductors, acid reflux, hemorrhoids with occasional bleeding, history of frequent constipation, frequent gas/bloating, adult acne, small raised red spot on leg, nipples turn purple when exposed to cold, more floaters in vision, hair loss, can't lose weight in spite of exercising and dieting, possible postpartum depression/anxiety

Questions:
1. Is Graves disease associated with nucleolar ANA pattern?
2. What additional diagnostic tests are needed, if any?
3. How many diseases are associated with nucleolar pattern?
4. What are some good books that might help me?
5. Should I switch to a liquid iron supplement?
6. Are the urinalysis results relevant?

[Red_Star]

A nucleolar pattern also lists Systemic lupus erythematosus and Rheumatoid Arthritis as well.

I found one study on 93 children with autoimmune thyroid disease; 7 of those children had Graves disease.  66 children had a positive ANA; 4 with Graves disease. Unfortunately the study does not list an ANA pattern for these 4 children.  20 of 93 children (21%) had another autoimmune disease. 3 of the 7 children (43%) with Graves disease had another autoimmune disease.

"The ANA pattern was homogeneous in 61/66 (92.4%), coarse/fine speckled in 4/66 (6%), and nucleolar in 2/66 (3%)."*

*Journal of Immunology Research Volume 2014 (2014),
Clinical Study - High Prevalence of Antinuclear Antibodies in Children with Thyroid Autoimmunity

[Red_Star]

You have classic hypothyroid symptoms.  It is possible you may have another autoimmune disease but I would not be surprised if all your symptoms vanish with  optimal thyroid hormone levels. You may want to go over to the thyroid forum to ask for more advice from other members.

I have read a nucleolar pattern is associated with diffuse systemic sclerosis/scleroderma
or polymyositis.

Excerpt from Hypothyroid Mom - Top 5 Reasons Doctors Fail To Diagnose Hypothyroidism...

"Thyroid Tests "Normal" But You Don't Feel Well?

If you're undiagnosed, or a thyroid patient taking thyroid hormone replacement medications, being in the "normal" range does not mean you feel well, or that your treatment is optimized. What levels are considered "optimal*" by many integrative physicians?

~ TSH - Typically less than 2.0
~ Free T4 - Top half of the reference range
~ Free T3 - Top half - top 25th percentile of reference range
~ Reverse T3 - Lower end of normal range
~ Thyroid Peroxidase Antibodies (TPO) - Within reference range
~ Vitamin D - Above 50
~ Ferritin - Above 60 (Above 80 if experience hair loss)

* we are all different, one size doesn't fit all, so these are guidelines. Your optimal levels may vary."

[starlyric]

Thanks for your response! With TSH at .02 I am technically hyperthyroid, but you're right, it still may account for many of my symptoms, and hopefully many of them will resolve once I am euthyroid again.

What really concerns me is the ANA nucleolar pattern. There are no books about this at my local library or bookstore, which leaves me scouring the internet and trying to parse international medical journal articles from the 90s that turn out not to answer my questions. If I could just find out what kind of ANA pattern Grave's disease antibodies have that would be a huge help.