# Dr. Google says I have Hashimoto's - my provider says I don't. Help!



## Alyssa726 (Mar 10, 2017)

Hey y'all,

My nurse practitioner says I don't have hashimoto's, but as per my googling, I do! She is concerned about my "low" T4, and wants to try a low does of synthetic thyroid and then retest, but I think I should see an endocrinologist. I was concerned about the thyroglobulin antibody and they thyroid peroxidase.

Ultrasound shows two non calcified nodules, one is 0.7 x 0.9 x 0.9 and the other is 0.5 x 0.6 x 0.7.

What do you think?

*T4, Free (Direct) - 0.77 (0.82 -1.77) - LOW*

T4 - 4.9 (4.5 - 12.0)

TSH - 3.42 (0.45 - 4.50)

T3 Uptake - 26% (24 - 29)

Free Thyroxine Index - 1.3% (1.2 - 4.9)

T3 - 98 (71 - 180)

*Thyroglobulin Antibody - 5.9 (0.0 - 0.9) - HIGH*

*Thyroid Peroxidase (TPO) Ab - 92 (0 - 34) - HIGH*

Thanks for your input!


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## joplin1975 (Jul 21, 2011)

You do look like you have the beginnings of a thyroid disorder.

Your TPO is elevated and certainly points to Hashi's, but a lot of people have TPO in the hundreds...sometimes thousands. A lot of doctors, unfortunately, dismiss any irregularities in your blood work unless they are VERY abnormal.

The best way to control Hashi's is to "catch it" early on and get the patient started on a low dose of thyroid meds. It will likely simmer those antibodies down and improve your symptoms.

You should have a baseline thyroid ultrasound, but assuming there's not anything wrong with that, your NP should be able to treat this effectively.


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## Alyssa726 (Mar 10, 2017)

Thanks for responding! You think a thyroid Rx is the way to go? I was considering trying vitamins, herbs, acupuncture, etc. I feel like garbage and my periods have been crazy, and I don't want to add side effects from medication on top of that.

Baseline ultrasound shows two non calcified nodules, one is 0.7 x 0.9 x 0.9 and the other is 0.5 x 0.6 x 0.7.

Thanks agin!


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## joplin1975 (Jul 21, 2011)

I will be supportive of any approach you'd like to take...but I can say after posting for five years on these boards, I have yet to see anyone report any degree of long term success with "natural" or "alternative" or "lifestyle change"-type "treatment."

I will also tell you with complete honesty that any endo will laugh you outta the room if you suggest that, so if you are thinking that, don't waste your time with an endo.

The most successful approach, supported by years of clinical research, is a low dose of thyroid meds.


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## Alyssa726 (Mar 10, 2017)

Thanks again! I appreciate and respect your knowledge and experience.

I am hesitant about treatment because I don't understand what is wrong with me. I felt like she was saying, "I don't know, you're probably fine, let's put you on this medication..." I'm not getting answers to my questions.

Is it the low T4 or the antibodies or both that are raising a red flag? Will the thyroid meds make me feel less garbage-y?


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## joplin1975 (Jul 21, 2011)

Both raise red flags and both indicate the beginning of autoimmune disease.

And yes, thyroid meds should make you feel better. It can be a process adjusting to the meds, so it won't be immediate, but long term? Yes.


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## Alyssa726 (Mar 10, 2017)

cool, thanks so much joplin1975! I think I will try the low-dose synthroid. You talked me into it 

Sorry to keep bugging you- I just put my test results in my signature and I see that my ferratin was very low in January (18 [15-150]), but when we re-tested in March, they didn't even look at that. Does that add a red flag to the situation?

I have been taking Vit D and B12, which is explains that change. I have no idea why the TSH is so different January to March...


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## joplin1975 (Jul 21, 2011)

T4 is a "storage" molecule. When your body need thyroid hormone for basic metabolic functions, T4 is coverted into T3. T3 is the "active" version of the hormone.

Ferritin helps your body convert T4 into T3. So, you should work on improving that number so your body can most effectively use the T4 (both the T4 produced by your body and from the Levo).


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## creepingdeath (Apr 6, 2014)

Does the ultrasound report say anything else?

Like multi nodular or micro nodular?

People can have slightly high antibodies without thyroid disease.

If you have advanced Hashi's it will show the texture of your thyroid in the report.

A biopsy would confirm it also.


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## Alyssa726 (Mar 10, 2017)

Thanks for responding, creeping death.

It says "findings consistent with multinodular thyroid goiter. Non specific appearance of the 2 smaller subcentimeter solid and noncalcified nodules in the thyroid lobes. these nodules may represent thyroid adenomas or benign hypoplastic nodules Thyroid malignancy, while felt less likely, difficult to exclude fully. Consider correlation with T3, T4, and TSH. Follow-up ultrasound in 6 months may be helpful to assess stability of thyroid nodules."


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## creepingdeath (Apr 6, 2014)

You got Hashi's alright.

When your nodules become 1 cm or more then they'll do a biopsy for cancer.

I have Hashi's with no nodules .

But my thyroid swelled up very large and I was being strangled along with extreme disabling symptoms.

My antibodies are always in the thousands. Even after being on hormone for years.

Desiccated thyroid is the hormone that works for me. I feel 1000 % better on it but it's not perfect .

I still occasionally get symptoms.

I got nothing but real bad reactions on synthetic's.......


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## Alyssa726 (Mar 10, 2017)

creepingdeath said:


> Desiccated thyroid is the hormone that works for me. I feel 1000 % better on it but it's not perfect .


Happy to hear you feel so much better!


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## Alyssa726 (Mar 10, 2017)

What SHOULD these numbers be? I know the lab ranges are BS... I am a 33 year old woman, average height/ weight and fairly active, if any of that matters.



Alyssa726 said:


> *T4, Free (Direct) - 0.77 (0.82 -1.77) - LOW*
> 
> T4 - 4.9 (4.5 - 12.0)
> 
> ...


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## joplin1975 (Jul 21, 2011)

TSH -- should be as close to 1.0 as possible

Free t4 -- should be between 1.295 and 1.5325

You'll need your FREE t3 tested. Looks like you have the total t3 which isn't especially helpful. I don't really pay much attention to the other labs you posted although some posters are interested in the uptake value. I'll have to rely on them to respond.

You shouldn't have any TgAB.

Your TPO should be very, very low.


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## Alyssa726 (Mar 10, 2017)

Thanks again Joplin1975! I'll ask for Free T3 next time. I feel like I should pay you a copay 

I just made a spreadsheet of my last 5 labs, which starts in 2013; so interesting to see how these numbers change.


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## jenny v (May 6, 2012)

That's a smart idea, keeping a spreadsheet. I wish I had done that when I felt really good (and really bad), so I'd have a good idea of what levels worked best for me.


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