Splinter Hemorrhage: Can check up wait?

[acherron]

Hi there.  A few days ago, I noticed tiny little brown lines near the base of one of my fingernails, and out of boredom I googled it, and discovered that it was a splinter hemorrhage.  I wasn't really too concerned, since my nails are very long and I don't pay attention to possible damage to them and I tend to get over pain pretty quickly, so it was conceivable that I snagged the nail on something or some other explanation.  But then I noticed two other nails on my right hand also had the same thing, and I started to look into the other explanations for this.

Endocarditis is what came up. I don't have a history of heart disease, though my family has had quite a few cases.  However, those cases were my aunt and grandfather, when they were older. I'm 23. I don't believe I have any other symptoms of this.  The only other symptom I might possibly have is the tiredness and slight malaise, but that's kind of a constant state for me. However, I read that a possible cause of infection is dental work or bacteria from the mouth getting into the bloodstream, and I had some extensive dental work a few months ago and a tooth which is still causing me problems. (My dentist planned to save that tooth for last, but his prices caused us to have to cease seeing him)

I have an appointment with a new primary doctor (mine is moving out of the area soon) in a little under two months.   Due to some family issues, now isn't a great time to try to manage this situation, unfortunately. Should I call my doctor and ask to be seen earlier, or can I wait?

[Red_Star]

I have splinter haemorrages due to too much thyroid hormone. In my case that is due to hyperthyroid flare ups due to Hashimoto's thyroiditis (most common cause of hypothyroidism), once due to a two month very bad Hashitoxicosis flare due to TRAb/TSI antibody seen with Graves disease (splinter haemorrages were bright red during this time), and overmedicating on thyroxine.

My hyperthyroid flare ups can be so mild that the only sign of a bit too much thyroid hormone in the blood is splinter haemorrages and usually my face turns red after having a shower as well.  I'm always tired so that symptom doesn't count. LOL

The following list of causes is from "A text atlas of nail disorders" third edition, along with a few additional causes from fpnotebook and gpnotebook.

Reasons for splinter haemorrhages include:

Amyloidosis  
Antiphospholipid syndrome
Arterial emboli  
Arthritis (notably rheumatoid arthritis and rheumatic fever)
Behçet's syndrome
Blood dyscrasias (severe anaemia, high-altitude purpura)
Buerger's disease  
Cirrhosis  
Collagen vascular disease
Cryoglobulinaemia (with purpura)
Darier's disease  
Dermatomyositis
Drug reactions (especially tetracyclines)
Eczema  
Haemochromatosis
Haemodialysis and peritoneal dialysis
Haematological malignancy
Heart disease (notably uncomplicated mitral stenosis and subacute bacterial endocarditis)  
High-altitude living
Histiocytosis X  
Hypertension  
Hypoparathyroidism
Idiopathic (probably traumatic) - up to 20% of normal population
Indwelling brachial artery cannula
Malignant neoplasia
Occupational hazards
Onychomatricoma  
Onychomycosis  
Oral contraceptives
Palmoplantar keratoderma
Peptic ulcer  
Pityriasis rubra pilaris
Polyarteritis nodosa
Psoriasis
Pregnancy
Pterygium  
Pulmonary disease  
Radial artery puncture
Raynaud's phenomenon  
Renal disease  
Sarcoidosis  
Scurvy
Septicaemia  
Severe illness
Systemic lupus erythematosus (SLE)
Scleroderma
Thyrotoxicosis
Minor and repeated trauma
Trichinosis  
Vasculitis  

[acherron]

It can be caused by thyroid conditions as well?  That would actually make a lot of sense for me.  Both parents and several relatives have thyroid trouble and I've had some bloodwork come back with low levels, but I reacted poorly to even very low doses of synthoid, so I'm not being treated for it at the moment.

Anyway, thank you for the information!  I did call my doctor and move the appointment to an earlier time just to get everything cleared up. After typing out my question, I realized that I'm worried enough about this that putting off addressing it is a really ridiculous idea.

[Smiley2000]

Hi there,

I had Infective Endocarditis (SBE) in 2007 and 2008 I had my 1st OHS to repair mitral valve.  SBE is a very serious disease and I can assure you that splinter hemms under the nails are the last symptom.  With SBE you have severe night sweats, high fevers and mine was only treated and diagnosed 3 months after I had some flue-like symptoms.

It is good that you are going for a complete medical check-up, but normally the splinters are from nail damage and non-specific to any serious illness.

All the best and please do keep us informed on your progress and results.

[acherron]

I have had night sweats off and on, and I've had a touch of what I assume is allergies for a while, but it is mild enough that I haven't even bothered to touch OTC medications for it besides Aleve for the sinus headaches I wake up with at times.  

The only thing that makes me question the nail damage possibility is that they are on three different nails all dispersed separately from each other.

Thanks for the help, and when I see my doctor on the 8th of November I will make sure to update you all on the answers I receive!

[Red_Star]

I too had reactions to thyroxine myself. I had very bad adrenal issues, sensitivity to T4 (hyperthyroid for the first week), followed by a month of worsening hypothyroid symptoms.

Causes of not reacting well to thyroxine include:

* Reaction to the fillers and binders.

* Sensitive to T4 - initial T4 dose produces hyperthyroid symptoms (smaller starting doses are required with smaller and slower increases).

* Hypoadrenalism (poor adrenal function) - other terms include adrenal fatigue, adrenal insufficiency, adrenal dysfunction, hypoadrenia.

* Very low ferritin (iron storage) can cause negative reaction like palpitations, nervousness, and anxiety when starting thyroid hormone replacement.

* Natural production of thyroid hormone slows down in response to medication and hypothyroid symptoms worsens. It takes about 4 to 6 weeks for thyroxine to build up in the blood.

[Red_Star]

My symptoms of untreated adrenal insufficiency resulted in extreme drugged like sleep for 15/16 hours a day for a month. When in bed I could barely move and was able to slur out a few words at best.  Also, worsening of numbness and extreme dizziness were other symptoms.  

"The reaction varies with degrees of adrenal insufficiency. Symptoms may include: a sudden feeling of exhaustion, nausea, headache, inability to concentrate, trembling, muscle weakness, loss of peripheral circulation leading to numbness, lack of muscle control, giddiness, slurred speech, and cognitive impairment."