28F. I’m trying to understand whether the combination of my blood results and symptoms could point toward a systemic connective tissue/autoimmune disease, and which findings are actually clinically meaningful.
I already have autoimmune thyroid disease (Hashimoto’s), but because of additional symptoms and abnormal autoimmune serology I am currently being evaluated for a possible systemic autoimmune/connective tissue disorder.
Autoimmune / rheumatological blood results
Most of these results are from October 2026:
ANA by IIF: 1:1280 (reference <1:80)
DFS70: strongly positive (+++)
CENP-B: positive (+)
SS-B/La: positive (+)
SSA/Ro: negative
Ro52: negative
Scl-70: negative
dsDNA: negative
Sm: negative
nRNP/Sm: negative
nucleosomes: negative
histone antibodies: negative
Jo-1: negative
PM-Scl100: negative
anti-MPO: negative
anti-PR3: negative
ribosomal P: negative
AMA-M2: negative
PCNA: negative
rheumatoid factor: <6.6 kIU/L / negative
anti-CCP: 1.90 u/mL / negative
C3: 1.0 g/L (normal)
C4: 0.10 g/L (right at the lower end of the reference range)
IgG: 14.9 g/L
IgA: 1.4 g/L
IgM: 1.50 g/L
haptoglobin: 0.78 g/L
ACE: 39 u/L - serum immunoelectrophoresis: no evidence of monoclonal gammopathy
ANA internal screening assay: 0.5 IU/mL despite the strongly positive ANA IIF
Tissue transglutaminase antibodies were negative:
tTG-IgG: 0.4 AU/mL
tTG-IgA: 2.0 AU/mL
What confuses me particularly is that DFS70 is strongly positive, but it is not isolated, since CENP-B and SS-B/La are also positive.
I am also unsure how to interpret the discrepancy between the ANA IIF of 1:1280 and the negative/normal internal ANA screening assay.
Thyroid
I have had Hashimoto’s thyroiditis for many years.
My thyroid function has fluctuated considerably.
Current/recent values include:
TSH: 0.15 mIU/L on 08/10
TSH: 0.33 on 30/09
TSH: 0.24 on 28/08
free T4: 2.27 ng/dL – high on 08/10
free T4: 2.05 ng/dL – high on 30/09
free T3: 3.91 pg/mL – normal on 08/10
free T3: 3.1 – normal on 30/09
TPO antibodies: >400 IU/mL – strongly elevated
current TRAb/TRAK: 0.8 u/L (within this laboratory’s reference range)
At other points my TSH has been very high; an older laboratory result shows a TSH of 34.1.
I take levothyroxine, and there have been significant problems getting the dose/thyroid function stable.
Blood count
On 08/10:
WBC: 4.18/nL
RBC: 4.01/pL
hemoglobin: 12.4 g/dL
hematocrit: 35.2% – slightly low
platelets: 207/nL
neutrophils: 48.3%
lymphocytes: 36.4%
monocytes: 10.8%
eosinophils: 3.8%
basophils: 0.5%
MCV: 87.8 fL
MCH: 30.9 pg
MCHC: 35.2 g/dL
RDW: 11.5% – slightly below the laboratory reference range
There has been some fluctuation.
On 30/09:
WBC: 3.5/nL – low
hemoglobin: 11.8 g/dL
hematocrit: 0.36
platelets: 182/nL
neutrophils: 45.8%
lymphocytes: 36.0%
monocytes: 11.9% – elevated
On 28/08:
WBC: 4.7/nL
hemoglobin: 12.4 g/dL
platelets: 208/nL
neutrophils: 49.9%
lymphocytes: 35.3%
monocytes: 10.3% – slightly elevated
So there was at least one episode of mild leukopenia, with repeatedly relatively elevated monocyte percentages.
Inflammation
Despite my symptoms, systemic inflammatory markers have been very low:
ESR/BSE: 2 mm/h
CRP: 0.20 mg/L
Iron / vitamins / trace elements
ferritin: 29 ng/mL (recent values around 28–29)
serum iron: 1070 µg/L, within reference range
vitamin B12: 369 pg/mL
folate: 134.27 nmol/L
vitamin D (25-OH): 37.9 ng/mL
zinc: 9.9 µmol/L, low-normal
selenium: 145 µg/L – above the laboratory reference range of 50–120
I have a history of chronic iron deficiency.
Kidney / liver / metabolic results
creatinine: 0.85 mg/dL
eGFR: 94 mL/min on 08/10 (previously 89)
sodium: 143 mmol/L
calcium: 2.46 mmol/L
alkaline phosphatase: 54 u/L - AST/GOT: 17 u/L - ALT/GPT: 20 u/L - GGT: 8 u/L - glucose: 90 mg/dL
HbA1c: 5.3%
uric acid: 5.3 mg/dL
total protein: 73.0 g/L
Serum protein electrophoresis showed a slightly elevated gamma fraction:
gamma fraction: 19.6% (reference 11.1–18.8%)
Other fractions were within or close to their reference ranges.
Other endocrine results
PTH: 45.7 pg/mL
ACTH: 14.5 pg/mL
cortisol: 11.2 µg/dL
aldosterone: 48.5 pg/mL
renin: 27.4 pg/mL
aldosterone/renin ratio: 1.8
IGF-1: 300 ng/mL
These were within the laboratory reference ranges. But I may need to add that during a period of immense trauma and stress I had a cortisol level of over 100 two years ago.
Symptoms
Over the last months I have developed a combination of symptoms including:
Raynaud’s phenomenon
very severe diffuse scalp hair shedding
visible reduction in hair density
thinning/loss of eyebrows and possibly eyelashes
scalp burning/tenderness/pain
severe joint and bone pain
significant leg pain and tenderness
occasional difficulty walking because of the leg symptoms
Baker’s cyst in July
pronounced fatigue/exhaustion
headaches
concentration problems/brain fog
feeling unusually cold
occasionally slightly low body temperature
recurrent inflammatory/skin symptoms, including scaly skin lesions
a recent oral ulcer
episodes of inflammatory symptoms in other areas of the body
I do not have a classic malar/butterfly rash, and I have not noticed obvious persistent joint swelling (only occasionally).
The timing of the symptoms, including the hair loss, overlaps with the emergence/investigation of the systemic autoimmune findings, so I am unsure whether this is simply severe telogen effluvium from the thyroid disease or whether a systemic autoimmune process could also be contributing.
Taken together, how would you interpret the combination of ANA 1:1280, CENP-B positivity, SS-B/La positivity, strong DFS70 positivity, Raynaud’s phenomenon and my systemic symptoms? Could this fit an undifferentiated connective tissue disease or an early form of a more specific condition such as limited systemic sclerosis?
Could the other abnormalities — including the episode of mild leukopenia, slightly low hematocrit, low-normal C4 and mildly elevated gamma fraction — support a systemic autoimmune explanation even though CRP and ESR are normal? How much of the overall picture could instead reasonably be explained by unstable Hashimoto’s/thyroid hormone levels?
Based on this overall picture, what further evaluation would you consider most useful ?
Edit: country of residence: germany, race: white, height & weight: 158, 50kg, diagnosed medical conditions: Hashimoto, Raynaud’s phenomenon, migraine, prescriptions or supplements and dosages: levothyroxine 135 µg, Omega 3, iron, zinc, hair vitamines, minoxidil foam 5 Percent, Clarelux foam, duration of complaint, the issue you've been having: 3 Month