Splinter Hemorrhages - are they serious?

[ChickenBoo]

I've noticed over the past week I have developed small blackish streaks under my fingernails - after a little searching I found they are splinter hemorrhages.

I have thyroid disease but also a whole host of other symptoms that have yet to be explained...

.. basically all the searches keep throwing up heart problems like endocarditis but I wondering if these splinter hemorrhages are anything to really worry about of it they're 'just one of those things'?

Thanks :)

[Red_Star]

My splinter haemorrages show up due to my hyperthyroid flare ups - Hashitoxicosis due to Hashimoto's thyroiditis (autoimmune hypothyroidism). From the list below, my reason is thyrotoxicosis (hyperthyroidism or overactive thyroid).

Causes of splinter haemorrhages:
  
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  
Drug reactions (especially tetracyclines)
Eczema  
Haemochromatosis
Haemodialysis and peritoneal dialysis
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  
Palmoplantar keratoderma
Peptic ulcer  
Pityriasis rubra pilaris
Psoriasis  
Pterygium  
Pulmonary disease  
Radial artery puncture
Raynaud's disease  
Renal disease  
Sarcoidosis  
Scurvy  
Septicaemia  
Severe illness  
Thyrotoxicosis (hyperthyroidism or overactive thyroid)
Minor and repeated trauma
Trichinosis  
Vasculitis

[minmtn]

Hi!  I hope your troubles a year ago are all fine now.  Wanted to let you know that Dr. Holick's very informative and interesting presentation, "Vitamin D and Prevention of Chronic Diseases" is now on YouTube.   Just put in Dr. Michael Holick and the title and you'll see it.   It is an update on his previous video and he presented it on behalf of grassrootshealth.com (a consortium of vitamin D scientists from top medical research institutes (Boston, Harvard, University of California Medical Schools).  The presentation is to a student group at UCal.  Best wishes!

[Mom2four85]

I'm having a hard time reading on my laptop (pc died) so I can't read all the responses.

I saw when doing some reading this week that splinter hemorrages (sp) can be caused by bacterial endocarditis if no one else has mentioned this; it may be worth researching and asking your doctor about.

[vicq]

I had the same problem with my heart either racing or flip floping, depending on the dossage of my thyroid dossage. Turns out I can't take the generic meds. Once I went on the Synthroid those out of control symptons went away.

[skydnsr]

I would suggest to go ahead and get the cardiology referral.  I was diagnosed with a bicuspid aortic valve and thoracic aortic aneurysm at age 49 but had had splinter hemorrhages on both thumbnails for a few years before that.

[ChickenBoo]

Hey Minmtn,
Not sure if you're still reading this thread but I just got my Vitamin D result back (the original blood test was deemed 'unusable', then I couldn't get a follow up appointment for ages, then they couldn't find the result... hence it's taken so long!!).

Anyway, the reference range is 20 - 110 nmol/L and my result was <10 so certainly looks like I am deficient!

I need to follow this up with the doctor but obviously I am going to need supplements!

[ChickenBoo]

Hey :)

Well I've looked up the reference ranges for our local lab and it's 20-110 nmol/L for 25-hydroxyvitamin D (and it looks to be the default one to test for) so I at least know the ranges I am looking at.

Yeah I found similar info on the Cherry Hems - I doubt I have any sort of malignancy to worry about (given the amount of blood tests I've had recently) so I am not going to worry about that (for now, ha ha!).

I don't believe we have Quest Labs here (I'll do some research on it though).

Well I had one doc about this time last year tell me all he could do for me was refer me to a psychiatrist - I knew I had a thyroid problem so saw a different doc, got the right tests done, turns out I was right.

My current doc is great but I've run through a lot of tests in a short space of time and I get the feeling she thinks I am just looking for answers where there might not be any (maybe she's right... but I don't think so). Even so she's ordered the vitamin D test (with a few other things). I think I'll see how that turns out and then perhaps request to see a cardiologist.

Although essentially in this country with private medical cover I could choose the cardiologist I wanted to see the GP still has the power to veto the choice, or not treat you with their recommendations if they decided they don't agree with the diagnosis/medication and ultimately they are the ones that issue the prescriptions (unless you want to pay huge private charges of course).

It all seems like a huge battle but it's one I am prepared for - I've been misdiagnosed for too long now, waiting for doctors to find out what's wrong with me - I just think at the end of the day it's my body and I know how I feel so I have as much chance as they do of working it out.

Thanks for your help so far - I will let you know how I get on!

[minmtn]

Well good for you for requesting a Vit D test!  You only need the one test to know if or how much of a deficiency you may have.  Just don't let someone tell you that a level of 30 is normal.  

If you know someone at the lab, ask if they can do the ionized calcium test--if your vit D level is below 50.  

I ended up with a flurry of those Cherry hemas (I call them blood moles).  Everything I have read says they are benign except a mention at the eMedicine website, "The gradual appearance of multiple cherry angiomas over many years is common and often is expected; however, the sudden appearance of multiple cutaneous lesions always should raise concerns that the lesions may accompany the development of an internal malignancy."  I haven't been diagnosed with any malignancy and my dad had those (fair skinned like me), so I take the position that mine are benign.

Do you have Quest labs where you live?  If so, there is a research study going on right now by the Vit D Council comparing Quest lab results to other labs because apparently there is something about their tests that gives a false positive -- their results indicate a range about 2/3 higher than the patient's actual range.  You can order a home "fingerprint" kit from www.vitamindcouncil.com for about $59.  I checked one of these against the big lab at a hospital and it was nearly identical, so I would trust it and use it again.

The docs here don't like patients bringing things to their attention either.  Some don't like you asking questions.  When I went to an internal medicine doc (one of the docs that missed my Vit D deficiency) and rattled off my 5 symptoms, she asked if I was just obsessive.  Another IM doc that missed the diagnosis frowned the entire time I described my symptoms and then asked if anyone had ever offered me an antidepressant.  I'v been tempted to call that one back and ask which antidepressant he might suggest for a missed diagnosis of Vit D deficiency.  Some of these docs should just give up and get a paper route.  The 5th doc listened for 5 minutes and asked if anyone had checked my Vit D.  He wins the prize, but he thought my calcium was fine and it was low, which I found out when I went to see Dr. Holick.

For all the talk about wasted health care dollars, the experts should look at the $ wasted when the docs are clueless and order tests that are unrelated to the condition.

Have a good week!  

[ChickenBoo]

Hello again :)

Thanks for the reply!

Actually, it was me that requested the vitamin D levels be tested - through the research I'd been doing between thyroid disease and vit. D deficiency - and funnily enough I had read a few cases of people that had secondary hypothyroidism because of it.

I *think* that may not be the case for me as I have autoimmune thyroid disease (Hashimoto's) but I still think it's very worth looking at. I wouldn't be surprised if I was deficient in vit. D - since I've been ill I hardly ever go outside and when I do I am covered up, sunglasses on etc.

Unfortunately I am in the UK and the doctors here are not at all receptive to any information we bring to them especially from the internet, I have been told I am obsessing when I bring in info I've found, honestly! - I figured I have to be 'obsessive' as the doctors aren't doing it on my behalf!

However, I do know someone at the local lab so perhaps I could ask them about which one they're going to test (and maybe see if they could cover both??). Worth a shot!

My calcium has been measured and it is normal but I have read many cases where the calcium is normal but the vit. D is deficient - your explanation covers that perfectly!

Tell me, do you have any knowledge of 'Campbell De Morgan' spots (otherwise known as Cherry Hemangioma)? I've noticed in the past year or so I have become covered in them. In themselves they are harmless and everyone gets them but I've noticed a real 'explosion' of them recently, literally new ones every day and I am wondering if they are something similar to the splinter hems? Interesting to know!

[minmtn]

It seems you have very good medical care if you doctor is even thinking of doing a Vit D test.  Just make sure she orders the correct test (see below).  Mayve you could tell your PCP that you have a friend in Texas that referred you to Dr. Holick's research.  Perhaps she would read his New England Journal of Medicine articles, or just call him if she has any questions.  My level was 16 when tested.  I also had migraines and many of the symptoms you describe.  I experienced medical personnel being unable to get BP readings or even a pulse because it was so faint.  Your PCP can do the EKG to check for WPW.  It's pretty rare, but if you haven't had a EKG, it would also give them a picture of what's going on with your heart.  

Vit D deficiency can result in secondary thyroid conditions!  (see below)  Replete the Vit D and the thyroid condition may simply go away.  

(When you click on the link, "ECTS Presentation" be sure to wait for the video to load/buffer (maybe 3-5 minutes).  Then if your screen goes black, tap any key on your keyboard.)

Here are some notes I made from the (live stream) video of Dr. Michael Holick's presentation to the European Calcified Tissues Symposium (viewed from his website www.vitamindhealth.org:

"Why is Vitamin D Deficiency often misdiagnosed?  Because most doctors look at a chem scan and if the calcium is normal they are not thinking about Vitamin D Deficiency.  This is something most of them did not learn in school.  It is relatively new information.

But as soon as the Vitamin D level goes down, and ionized calcium goes down (due to decreased efficiency of intestinal calcium absorption) calcium sensors in the parathyroid glands pick it up and increase PTH and you wind up with secondary hypoparathyroidism.  So typically in a Vitamin D deficient state, serum calcium levels are normal or elevated.  

How do you know what your Vitamin D status is? You want to measure it.  What you want to measure is  25-hyroxyvitamin D.  (Even though the active form is 1,25 dihydroxyvitamin D, it tells you nothing about Vitamin D status!  It’s often normal or even elevated in Vitamin D deficient state.) The reason?  Because it circulates at 1,000 x less concentration and as you become Vitamin D deficient and PTH renal levels go up, you increase renal production of 1,25d.  It is a barometer of Vitamin D status.  

Test 25-hydroxyvitamin D, not 1,25 (OH)2D!"

There is a slide in Dr. Holick's presentation about the misdiagnosis of subjects that were seen at the Mayo Clinic Emergency Department for bone and muscle pain and who were misdiagnosed with various conditions.   They were then tested at Mayo and 50% were found to have UNDETECTABLE 25-Hydroxyvitamin D.  They were diagnosed with Osteomalacia.  

In another slide, testing is reported from a study of women on bisphosphonates.  Testing 1,554 women on Rx bisphosphonates for osteoporosis from 61 North American sites including US, Hawaii, Alaska and Canada.  A single blood draw was performed and the result was that 50% of the group were found to be Vitamin D deficient.  

I have another friend here that actually had a heart attack before her Vit D level was found to be 6.  Dr. Holick has won the Linus Pauling award twice.  After I returned to Texas with a requisition for the testing he wanted me to do, he asked me to call or email him to discuss the results.  I was surprised that when I emailed his office, he actually replied to the email with instructions.  I feel certain he would be happy to answer any questions another physician might have about helping patients with Vit D deficiency.  

[ChickenBoo]

Well it's funny you should say that, as I am having my vitamin D (and a few other things) tested next week! I've been looking into all sorts of things recently to try and get to the bottom of the many weird symptoms I have, including numbness and pain on the right side of my body, bad migraines, dizziness and a spaced out head (the thyroid meds actually make that symptom worse which is really odd as it's meant to do the opposite!).

I initially thought it was all down to my thyroid problem - on the meds a LOT of things have improved but I am still very fatigued and brain fogged even though I have been optimally treated on the thyroid meds. I've looked into adrenal problems and food intolerances etc so far but haven't had any success in working out what is the missing piece of the puzzle.

I've also noticed that when I am on the thyroid meds my heart does a lot of weird things - often feels like it is racing when it actually isn't.

Something that keeps leading me back to the heart is that when I am on the thyroid meds my blood pressure actually lowers (90/60 at times), I find it drops when I stand and my pulse increases a little, kind of like POTS.

On 3 occasions, 3 different doctors have had trouble getting a blood pressure reading from me - the actual reading has been on the low side and the pulse in the 80s so doesn't look abnormal but they've told me the actually 'sounds' have been on the weak side so hard to read - but never explained why.

When I tried beta blockers for headaches last year they made all my symptoms worse and I had palpitations all day long - this was before my underactive thyroid was diagnosed though so perhaps it was that.  

I'm actually in the UK so we don't always get to choose the doctors we see, although thankfully I do have insurance and have been thinking of asking to be referred to a cardiologist - I just don't want my GP to think I am crazy as she's been very good as getting me into see different doctors over the past year. I just have to have a good reason to go for it!

Thanks for your suggestion - I will check out that website :)

[minmtn]

Have you ever had a EKG (ECG)?  If not, I would definitely ask my doc to do one.  Any primary doc can do it.  I didn't know until I was 30 that I had WPW Heart Syndrome, a congenital heart anomaly.  It is an extra electrical pathway that should not be in the heart and it shows up with a very distinctive pattern on EKG.  No one in my family that I know of has had this condition.

Still, everything I have read indicates splinter hem with systemic infection.

One other thought, have you had your Vitamin D level checked?  I never knew this was even done until I had about 5 frustrating symptoms:  chronic infection (UTI), numbness/tingling in my feet, cramping in my feet, dental deterioration for unknown reason and heart pressure/pain.  After 5 doctors missed it, I went to a new doc and he listened for about 5 minutes, then asked if anyone had checked my Vit D level.  He ordered the test and I was severely deficient.  The old lowest level was 30 and now it is 50, but most docs are not familiar with the dangers of low Vit D because it is a newly recognized health hazard.  It causes many, many dangerous health conditions including heart problems.  You can watch a very interesting video from this website www.vitamindhealth.org.  Dr. Holick made this presentation to the European Calcified Tissue Symposium (ECTS) to a convention of medical professionals.  If you go to the website, on the left side of the page, look for External Links and click on ECTS Presentation.  It will take about 3-4 minutes to load (buffer).  Then it will begin.  It takes about 30 minutes to watch and if your computer screen goes black, just tap any key.  The recommendation is for everyone to take at least 2,000 iu Vit D/day.

There is a transcript on Dr. Holick's website from a live chat of medical people with just about any question and answer you could ever want to know about.

I had to take a prescription Vit D (50,000 iu/week) for 8 weeks, then I started the 2000 iu/day.  You also have to be getting plenty of calcium citrate (not carbonate) through diet and/or supplements.  I take 600 mg cal citrate and get about the same amount in fortified milk, orange juice (it has to say it has calcium added), yogurt, some veggies.  Also, you may want to go to the Vit D Council website.  www.vitamindcouncil.com.  

And if you think you might have Raynaud's, just search on the name and see if anything looks familiar.  Again, after my WPW ablation, I rarely have Raynaud's episodes when my fingers "die".  I've had a couple of bad episodes while taking antibiotics and when I finished the meds, the Raynaud's stopped.

If you have insurance where you can pick and go to a doctor w/o a PCP referral, it might be good to go to a cardiologist.  Also, I sent a specific message to one of the "Expert Docs" (urologist) listed on this website under the service where I paid a small fee ($20 or something) and I received a specific answer back by email.  It was well worth it!  

Hope you find the answers you need!

[ChickenBoo]

Thanks for the reply,
That's interesting, my first two appeared in identical places on my thumbs. Weird!

Well I guess I could possibly have 'mild' Raynaud's as my fingernails often go blue and cold - I'd been putting it down to my thyroid problem but who knows.

Also since being on the thyroid meds I have experienced weird things going on with my heart such as very low drops in my blood pressure (I've always been prone to lowish BP anyway) with a racing or elevated heart rate.

I've been wondering for a while if I perhaps have a heart problem as well as a thyroid problem but haven't acted on it yet as I've been having loads of other tests for various weird things going on in my body.

Thanks for the reply - it's given me something to think about for sure!

Cindy

[minmtn]

I'll be interested to see the answer to this question.  I, too, have had splinter hemorrhages.  The first time, it was both thumbnails, nearly identical markings.  At the time I was having cardiac symptoms.  I knew I had WPW Heart Syndrome, but didn't realize that the symptoms I was having might be related to that -- in fact, when I asked, my local doc said she doubted it.  I was sick as a dog when the "splinters" appeared and now I think I had some sort of systemic infection.  I was having fever, nausea, severe sore throat, very painful stiff neck, weakness, fatigue.  This happened again right after pelvic surgery nearly a year later. (Different fingernails). I had the WPW ablated in 2008 after I was referred to an electrophysiologist who told me that my cardiac symptoms (weird rhythms, chest pressure/pain, erratic BP including very low BP and high pulse) were WPW-related.  Then the PCP told me that the splinter hems were caused by Raynaud's, not WPW!  I haven't had them again since the WPW ablation.  So. . .are they caused by systemic infection?  Will Raynaud's EVER cause splinter hemorrhages?  Take care--