Beyond POTS: What a Complete Evaluation Actually Screens For

If you have been diagnosed with POTS, or you strongly suspect you have it, there is a good chance something else is going on alongside it. A thorough evaluation looks well beyond the stand test itself, and I want to walk through what that actually includes, and why.

Hypermobility: what I can do same-day, and what I cannot

Screening starts with a video-guided joint assessment during your visit. If that screen is positive, I can diagnose Hypermobility Spectrum Disorder, HSD, directly, and we can start treatment that same day.

Hypermobile Ehlers-Danlos Syndrome, hEDS, is different. A definitive hEDS diagnosis requires an in-person skin and joint exam that cannot be done over video. If your presentation looks more specifically like hEDS, I will refer you to rheumatology or genetics for that piece of the workup, but your treatment does not sit and wait for that appointment. We keep moving on everything within my scope while that referral is in progress.

The baseline workup

Every evaluation starts with labs to rule out other explanations for your symptoms: electrolytes, a complete blood count, thyroid function, and an ECG. This isn't optional or an afterthought, ruling out thyroid disease, anemia, and other mimics is part of reaching an accurate diagnosis in the first place.

Autoimmune screening

POTS patients have measurably higher rates of autoimmune conditions than the general population, including Hashimoto's thyroiditis, Sjögren syndrome, lupus, celiac disease, and antiphospholipid syndrome. Depending on your presentation, I consider autoimmune markers like ANA and Sjögren antibodies as part of your workup. This is a piece that's often overlooked in POTS evaluations, but it's genuinely important, since an underlying autoimmune condition can change the treatment picture significantly.

Iron studies

Low ferritin is common in POTS patients and is easy to miss if it isn't specifically checked. Iron studies are part of a thorough workup, and correcting a deficiency, when present, is often one of the more straightforward wins in a treatment plan. Low ferritin is important to check as it indicates low iron stores (not exactly low iron), and can cause symptoms such as tachycardia, fatigue, and exercise intolerance which exacerbates POTS or could be an underlying driver of symptoms.

Cardiac monitoring

When indicated, I coordinate ambulatory cardiac rhythm monitoring, a wearable patch mailed directly to your home, to rule out arrhythmia as a cause of palpitations. This isn't needed for every patient, but it's an important piece to consider when the clinical picture calls for it.

Mast cell activation: asked about, not assumed

The relationship between POTS and Mast Cell Activation Syndrome is genuinely contested in the current literature. Reported overlap varies enormously across studies depending on which diagnostic criteria are used, and current reviews describe the evidence for a direct causative link as limited.

Because of that, I don't run MCAS lab testing as a default part of every POTS evaluation. I do ask about MCAS-relevant symptoms, flushing, unexplained allergic-type reactions, GI symptoms, food or medication sensitivities, as part of the standard history at every visit, since it costs nothing to ask. If that history points toward MCAS, I order an appropriate initial lab evaluation and build evidence toward a diagnosis from there, managing you based on that evidence while coordinating referral to allergy/immunology once it points clearly that direction.

What this looks like in practice

None of this requires a separate appointment or a long wait to get started. It happens within the same evaluation you are already having for POTS. If something comes up positive, we talk through what it means, what the next steps look like, and what I can start addressing immediately versus what needs a specialist's input down the line.

You should not have to choose between getting your POTS addressed and getting the rest of the picture addressed too. My goal is to look at all of it, together, from the start.

You can learn more about a POTS evaluation here, or book a visit to get started.

For a full overview, see this guide: POTS and Dysautonomia: A Complete Guide to Diagnosis and Treatment