# Newb - possible Hashi



## Prometheus (Jul 16, 2010)

Hello all!

I was living overseas in the UK from Sept '08 - Jan '10 to pursue an MBA. It was an intense course, piling 18 courses in 9 months, so needless to say a lot of stress! After I took my first set of exams in Jan '09 I came back home for a week for some R&R. For the past month I was feeling worn out - palpitations, insomnia, weight loss, anxiety, so I just wanted to see if everything was ok and asked my doc to do a full blood panel. Everything looked good, but my doc was highly concerned on my TSH. My readings were:

T4 total - 10.1 (norm 4.5 - 12.8)
TSH - <0.01 (below sensitivity limit of the analysis, norm 0.4 - 4.5)

I was already back in the UK by the time I received the results, and already had some run in's with the NHS, so I opted to wait until I came back to the US to follow up on it. I finally got around to it last week since I had a lot of other things on my plate. This time the results were:

T4 total - 4.4 (low, norm 4.5 - 12.8)
TSH - 4.63 (high, norm 0.4 - 4.5)
Thyroglobulin AB - 354 (high, norm <20)
Thyroid Peroxidase AB - >1000 (high, norm <35)

I have an ultrasound scheduled for Monday, with follow up blood work in 4 weeks to get a baseline since my earlier results are almost 1 1/2 yrs old. From what I read, I'm guessing this is Hashi. Right now I'm hypothyroid, and when I was hyperthyroid last year it might have been due to the antibodies destroying the thyroid and causing spikes ... which can explain why I keep bouncing back and forth in my weight, anxiety, etc...

Will update as I know more. How do they typically treat this - synthroid with blood work to monitor TSH levels?


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## Andros (Aug 26, 2009)

Prometheus said:


> Hello all!
> 
> I was living overseas in the UK from Sept '08 - Jan '10 to pursue an MBA. It was an intense course, piling 18 courses in 9 months, so needless to say a lot of stress! After I took my first set of exams in Jan '09 I came back home for a week for some R&R. For the past month I was feeling worn out - palpitations, insomnia, weight loss, anxiety, so I just wanted to see if everything was ok and asked my doc to do a full blood panel. Everything looked good, but my doc was highly concerned on my TSH. My readings were:
> 
> ...


The fabulous thryoid roller coaster ride! Welcome to the board and congrats on all your hard work pursuing your MBA.

Okay. Glad you are getting and ultra-sound; that is a good thing. With high thyroglobulin, I personally am suspicious of cancer. My preference would be that you get a radioactive uptake scan as ultra-sound can and does miss some "stuff!" However, the ultra-sound may be a good place to start.

Also, I recommend TSI (thyroid stimulating immunoglobulin) as this is the autoantibody which flips the switch to hyperthyroid. You should have absolutely no TSI; period. If you do, you have hyperthyroid.

Here are some references.......

http://graves.medshelf.org/Lab_Tests (scroll down for TSI)

http://www.hopkinsmedicine.org/endocrine/graves/TopicAnswer.asp?QuestionID=22

http://www.radiologyinfo.org/en/info.cfm?pg=us-thyroid

http://books.google.com/books?id=7u...v=onepage&q=thyroglobulin, high titer&f=false

I hope you touch on all the above with your doctor. Let us know how you are doing.

While high titers of TPO are suggestive of Hashimoto's, as far as I know,only FNA(fine needle aspiration) would be definitive if certain Hurthle cells indigenous to Hashimoto's are present. This gets complicated as there are also cancerous Hurthle cells.


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## Prometheus (Jul 16, 2010)

Thanks for the info, and the congrats!

I'm looking at my next lab form and it has Test, TSH, T3 uptake, T4 total, T4 free, Thyroglobulin AB, and Thyroid Peroxidase AB. I will touch base with the doc after the ultrasound to see if there is anything he wants to change in my next round of blood work.

Any idea on when I would get the ultrasound results? I wasn't sure if it was like an MRI where they have a tech run the test and send the results out to an MD to read. Would be great if I could get some more info that day.

As a side note for demographics: 31 y/o male, no family history


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## Andros (Aug 26, 2009)

Prometheus said:


> Thanks for the info, and the congrats!
> 
> I'm looking at my next lab form and it has Test, TSH, T3 uptake, T4 total, T4 free, Thyroglobulin AB, and Thyroid Peroxidase AB. I will touch base with the doc after the ultrasound to see if there is anything he wants to change in my next round of blood work.
> 
> ...


I have no idea on how long you would have to wait for sonogram results. Everyone beats to a different drummer as they say!

Anyone in your family with arthritis, lupus, diabetes....................anything like that? If so, that is autoimmune and sets the genetic stage for anything autoimmune.

I found your board name interesting in that if only you could grow back a new thyroid which by the way does regenerate if any tissue is left behind.


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## Prometheus (Jul 16, 2010)

Andros said:


> I have no idea on how long you would have to wait for sonogram results. Everyone beats to a different drummer as they say!
> 
> Anyone in your family with arthritis, lupus, diabetes....................anything like that? If so, that is autoimmune and sets the genetic stage for anything autoimmune.
> 
> I found your board name interesting in that if only you could grow back a new thyroid which by the way does regenerate if any tissue is left behind.


Nope, CVD is the main thing - have it on both sides of the family. Even though a lot of my older relatives are overweight, no one has Type2 diabetes.

I chose the name as a play on the AB's attacking the thyroid and making it grow, plus I work (or in the midst of finding work) in strategy & insights.


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## Andros (Aug 26, 2009)

Prometheus said:


> Nope, CVD is the main thing - have it on both sides of the family. Even though a lot of my older relatives are overweight, no one has Type2 diabetes.
> 
> I chose the name as a play on the AB's attacking the thyroid and making it grow, plus I work (or in the midst of finding work) in strategy & insights.


Whoa on the CVD. Untreated thyroid disease can also wreak havoc on the heart so I am glad you are under good care.

explode I did get a chuckle out of that.


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## Prometheus (Jul 16, 2010)

K - got my results today. No sign of nodules or cancer, but my thyroid is enlarged so indicative of hashi. Doc wants to wait for follow-up blood work in 5 weeks to see what the numbers are then and to take it from there. Office visit is set for 8/30, so I think I'll do the blood work on 8/25. This way I'll know the results and can have some informed follow-up questions.


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## Andros (Aug 26, 2009)

Prometheus said:


> K - got my results today. No sign of nodules or cancer, but my thyroid is enlarged so indicative of hashi. Doc wants to wait for follow-up blood work in 5 weeks to see what the numbers are then and to take it from there. Office visit is set for 8/30, so I think I'll do the blood work on 8/25. This way I'll know the results and can have some informed follow-up questions.


I am so glad that the ultrasound was good. What a relief. You will have to keep us posted on what happens next.

How are you feeling?


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## Prometheus (Jul 16, 2010)

I've gained about 8lbs in the past few weeks, think its mostly fluid retention though. I was doing well with exercising (4-5 miles every other day) but I've lost my motivation and haven't done anything in a week or so. I can usually get back down to regular weight within a week if I really watch what I eat and get exercising, so going to get myself out for a run later in the evening when it cools down.

I have a bunch of other symptoms (hard time concentrating/sleeping, feeling achey and tired, etc..) but I'm not overly concerned. Big thing is know what the cause is and am taking the right steps forward.


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## Andros (Aug 26, 2009)

Prometheus said:


> I've gained about 8lbs in the past few weeks, think its mostly fluid retention though. I was doing well with exercising (4-5 miles every other day) but I've lost my motivation and haven't done anything in a week or so. I can usually get back down to regular weight within a week if I really watch what I eat and get exercising, so going to get myself out for a run later in the evening when it cools down.
> 
> I have a bunch of other symptoms (hard time concentrating/sleeping, feeling achey and tired, etc..) but I'm not overly concerned. Big thing is know what the cause is and am taking the right steps forward.


There is a tendency for water retention (myxedema) w/thyroid disease. And that could be the cause of the weight gain. You don't want to get cardio/pulmonary edema so keep an eye on this.

Glad you are keeping your body in motion. There is nothing like it. If nothing else, you trigger the endorphins and you feel so much better.


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## Prometheus (Jul 16, 2010)

Feeling much better today. Less aches and more energy. I'm curious on how the blood work changes - I'd assuming the numbers are different during an attack then compared to when you're feeling fine?

I also read about doing a 24-hour saliva test for adrenal fatigue - anyone here have that done? Not sure if its worth doing, but I might mention it to my doc if I can find more info backing it up.


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## Andros (Aug 26, 2009)

Prometheus said:


> Feeling much better today. Less aches and more energy. I'm curious on how the blood work changes - I'd assuming the numbers are different during an attack then compared to when you're feeling fine?
> 
> I also read about doing a 24-hour saliva test for adrenal fatigue - anyone here have that done? Not sure if its worth doing, but I might mention it to my doc if I can find more info backing it up.


If you have antibodies and autoantibodies indigenous to the thyroid, they can and do wax and wane.

This does not necessarily reflect in the numbers (thyroid panel) for there seems to be a lag time or a miscommunication of sorts.

I am sure we have some posters that have done the 24-hour saliva test. Hopefully they will share their experiences.


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## Prometheus (Jul 16, 2010)

K, just some updates:

- Heard back from my Doc today since he was away on paternity leave. Basically stated what I already knew; that the ultrasound shows a mildly enlarged thyroid and blood work indicates the immune system attacking the thyroid, so indicative of Hashimotos. He said he wanted to keep an eye on it with blood work every 6 months and to monitor the attacks, but I would go in and out of being fine and having symptoms. He wants to hold off on supplemental thyroid, but I'll wait to see what the lab results say in 2 weeks. Follow up appt is for the end of the month.

- Physically I'm feeling MUCH better. No more lethargy or fogginess. I did have palpitations about 2 weeks ago: BP 136/82, HR 86. I also gained about 8-10 lbs in about a month. As of today I'm almost back down to my weight of a month ago, and vitals yesterday were BP 110/78, HR 64. I'm going to keep an eye on this for anytime I start to feel 'off'.

- I was talking to a friend who I found out is also hypothyroid, and they said I could have had this for a while without knowing it, just that the symptoms are now starting to show. As long as I can remember my hands and feet always get cold in the winter yet the rest of me is hot (usually shovel in a t-shirt b/c I generate so much body heat), but not sure how telling that is. However, I did have a severe case of mono my freshman year of college and have had a hard time losing the weight I gained from it (put up 25 lbs) even though that was 12 yrs ago. I did some research and it ends up there is a link between mono/epstein-barr and autoimmune/thyroid disorders. Not going to jump the gun on this, but I have a feeling that could have kicked this all off.

I will update again once I get my blood work in ~2 weeks.


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## Prometheus (Jul 16, 2010)

Doc's office just called with my results, but the girl on the phone had a hard time reading them to me. I dont think she was expecting me to ask questions, just relaying the Docs message to me. The lab should have mailed a copy to me as well, but here is what I gathered:

**norms are based on what I found online, not from the lab**
Positive for Antibodies
TSH "normal"
T3 uptake - 36 (10 - 26) High
T4 free - 2.1 (0.7 - 2.0) High
T4 total - 3.1 (5.4 - 11.5) Low

Once I get my copy in I'll post up the exact results.

Apparently the message the doctor had the receptionist relay was 'You have hashimotos, theres nothing we can do, but we'll monitor it'.

I have an appointment to see him at on the 30th and would like to be prepared going on. Right now I'm researching what the results mean. How are most other hashi patients treated? I'm not looking forward to medication, but I'd rather not just live with it and see what happens every 6 months.


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## Andros (Aug 26, 2009)

Prometheus said:


> Doc's office just called with my results, but the girl on the phone had a hard time reading them to me. I dont think she was expecting me to ask questions, just relaying the Docs message to me. The lab should have mailed a copy to me as well, but here is what I gathered:
> 
> **norms are based on what I found online, not from the lab**
> Positive for Antibodies
> ...


Good grief. There is plenty they can do. Wonder why they did not run the FREE T3.

Please read this about the T3 Uptake. It is seen in hyperthyroid. http://www.drstandley.com/labvalues_thyroid.shtml#T3

And, your FT4 reflects that as well. My personal opinion is that you should insist on a radioactive uptake scan (RAIU) to see what is "really" going on. We always want to rule out cancer. Hyper and cancer are often bedfellows.


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## Prometheus (Jul 16, 2010)

Andros said:


> Good grief. There is plenty they can do. Wonder why they did not run the FREE T3.
> 
> Please read this about the T3 Uptake. It is seen in hyperthyroid. http://www.drstandley.com/labvalues_thyroid.shtml#T3
> 
> And, your FT4 reflects that as well. My personal opinion is that you should insist on a radioactive uptake scan (RAIU) to see what is "really" going on. We always want to rule out cancer. Hyper and cancer are often bedfellows.


Thanks Andros. I think part of the issue is that my original GP retired, and this guy is fairly green (only a few yrs under his belt) and a DO, which tend to be more holistic in their approach.

Here is where I'm confused:
- T3uptake indicates hyperthyroid
- T4 free indicates hyperthyroid
- T4 total indicates hypothyroid

- Blood work 6 weeks ago I had my results were: TSH = 4.63 (0.4 - 4.5), T4 = 4.4 (4.5 - 12.8)
- Blood work 18 months ago TSH was <0.01 (0.4 - 4.5) so hyperthyroid

I'm wondering if this is thyrotoxicosis / hashitoxicosis ? I'll ask about the RAIU, but since I dont have any nodules and my thyroid is only slightly enlarged, I would think that would rule it out right?


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## GD Women (Mar 5, 2007)

Can't you list you levels with real numbers with Labs reference range in real numbers? Low, high, normal, etc. does not give any information for us to go by and are not trust worthy. To me they indicate hiden and perhaps false meanings.

Thanks!


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## Prometheus (Jul 16, 2010)

GD Women said:


> Can't you list you levels with real numbers with Labs reference range in real numbers? Low, high, normal, etc. does not give any information for us to go by and are not trust worthy. To me they indicate hiden and perhaps false meanings.
> 
> Thanks!


I did list reference numbers, scan up higher and you'll see them, as well as in my earlier posts that I referenced. What I posted today was what the receptionist relayed to me, and the ranges I was able to find on Quests website which is where I had the blood work. Once I get my copy of the results I'll post that.

I'll edit the post the add them in - but hidden and false meanings? Not sure what you mean by that
*missed a range in my first post so added that as well*


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## Andros (Aug 26, 2009)

Prometheus said:


> Thanks Andros. I think part of the issue is that my original GP retired, and this guy is fairly green (only a few yrs under his belt) and a DO, which tend to be more holistic in their approach.
> 
> Here is where I'm confused:
> - T3uptake indicates hyperthyroid
> ...


This site is copy protected so I am going to ask you to go here

http://www.drstandley.com/labvalues_thyroid.shtml#T3

and read about the low T4 in hyper. It is not unusual to see low T4 in hyper.

There is a reason your thyroid is enlarged. It is usually a mass of some sort.

Have you had the TSI run? Thyroid Stimulating Hormone is responsible for hyperthyroid. You should have none at all. If you do, you are hyperthyroid.

http://www.hopkinsmedicine.org/endocrine/graves/TopicAnswer.asp?QuestionID=22


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## Andros (Aug 26, 2009)

Prometheus said:


> I did list reference numbers, scan up higher and you'll see them, as well as in my earlier posts that I referenced. What I posted today was what the receptionist relayed to me, and the ranges I was able to find on Quests website which is where I had the blood work. Once I get my copy of the results I'll post that.
> 
> I'll edit the post the add them in - but hidden and false meanings? Not sure what you mean by that
> *missed a range in my first post so added that as well*


What GD means is that if something is in normal range, that does not mean it is good. One very good example is regarding antibodies. There are some that the healthy person should not have at all but yet they are in normal range. This is very confusing; even to some doctors.


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## Prometheus (Jul 16, 2010)

Just got the copy of the results, looks like the receptionist was confused reading the report to me since the numbers didn't match up. The only thing consistent are the high presence of Ab in the past two tests. To make it easier here are all the lab results:

*01/29/09*
*TSH* <0.01 (0.40-4.50)
*TT4* 10.1 (4.5-12.8)
*Test tot* 619 (241-827)

*07/08/10*
*TSH* 4.63 (0.40-4.50)
*TT4* 4.4 (4.5-12.8)
*TgAb* 354 (<20)
*TPO Ab* >1000 (<35)
no testosterone taken

*07/19/10*
Ultrasound
(L) lobe 5.6 cm in length x 2 cm in depth x 1.6 cm in width
(R) lobe 7 cm in length x 2.1 cm in depth x 2.1 cm in width
No evidence of cystic or solid thyroid nodule.
Mildly enlarged heterogeneous thyroid gland. Can be seen in Hashimoto's thyroiditis but appearance is nonspecific

*08/17/10*
*TSH* 3.15 (0.40-4.50)
*TT4* 5.7 (4.5-12.8)
*FT4 index* 2.1 (1.4-3.8)
*FT4* 1.0 (0.8 - 1.8)
*T3U* 36% (22-35%)
*TgAb* 293 (<20)
*TPO Ab* >1000 (<35)
*Test tot* 238 (241-827)

Ultrasound is being faxed over since I wanted to see exactly what it said *added*. Going to try to read up on test results since I am a bit confused on the rise and fall of some of the numbers. I want to be as informed as I can be for my doc appointment next week.


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