# New and Unsure



## LivingPower (Dec 21, 2015)

Hi all. I am new here. I spent more than a year with hypothyroid symptoms that would sometimes be debilitating (particularly the fatigue and muscle fatigue after exercise and physical activity, such as raking). I have such a high tolerance for pain, discomfort, and the like and a busy life as a single mother, that I took a long time to get down to figuring out what was the problem. Shortly after I started investigating the cause of these symptoms (thyroid was ruled out because of normal TSH), a large nodule was found on the left lobe of my thyroid. I am in the midst of the journey to determine whether the nodule is malignant. I have had two FNA biopsies, one of which showed follicular neoplasm. I am now waiting for surgery to have the left lobe removed and biopsied.

Despite this, I haven't let go of the possibility of Hashimoto's. My FNA biopsy results showed chronic thyroiditis. What does that mean? There were not comments that would indicate cause or Hashimoto's, but anytime I try to research Chronic thyroiditis, the only thing that comes up is Hashmoto's. My mother's side of the family has Celiac disease and thyroid issues and I had done my research and taken myself off gluten shortly before my FNA. After three months gluten-free, I began to feel better than I had in a long time

Yet, I wanted to know for sure, so I had my endo schedule blood tests (he basically humored me) and started eating gluten to see if there would be any antibodies. After two weeks back on gluten (I felt fine reintroducing it), I had the test, but the levels are all fine. At the time I asked for the blood tests, I did not know the pathology from the FNA had said chronic thyroiditis and my endo didn't tell me, even though he knew this was a concern of mine. The only reason I found out about that result from the FNA was because I got copies of all my test results and read through them myself. My endo's focus is on the priority of determining if cancer is present and I get that, it obviously must take priority, but this is also a concern. And since I have been passed off to ENT, my endo can still address this issue.

My question is what else could chronic thyroiditis be if not Hashimoto's? I didn't go back off gluten after my blood tests and I am starting to feel hypo again, so will go back off, but want to know what is going on. Autoimmune is not something to take lightly.

Any thoughts would be appreciated.


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## LivingPower (Dec 21, 2015)

Thanks for the reply joplin. First off, these were the results of the blood work I had done about a month ago:

TSH 2.50 (0.35-5.00 mlU/L)

T4 Free 14 (12-22 pmol/L)

T3 Free 5.1 (2.6-5.7 pmol/L)

TPO <10 (<35 klU/L)

For reference, my TSH was 2.58 back in March, at a time I was feeling relatively good. I have never had my blood work done when at a low. But my T4 seems relatively low (although still within normal range) and my T3 is relatively high (again in normal range), but this was a time when I felt relatively good. I can almost guarantee if I had my blood drawn right now, it would be a different story because I have crashed over the last few days and I am certain I'm hypo right now. Today is a day of complete exhaustion and the last few days have been highly fatigued days.

I don't necessarily trust antibody tests because I know they can be off. If the immune system is too damaged, it simply can't produce the antibodies. In the case of Hashimoto's, you can have good thyroid levels one week and low the next and even high the next. It fluctuates. I have read about endo's who take this all into account, but mine is not one of those. When I saw that my pathology came back stating chronic thyroiditis and realized that even though I had expressed concern about it and he didn't bother to tell me, I called him on it. While he apologized for not telling me, he still essentially brushed it off and doesn't think it's Hashimoto's because my antibodies were fine, and if it was, then the pathology report would specify Hashimoto's, as opposed to just saying chronic thyroiditis. But is there anything else, realistically, that chronic thyroiditis can be? He can't or won't give me a clear answer as to what it means.

As for having my entire thyroid removed, I'm not a big advocate for having body parts removed when there is a problem with them (apart from cancer when it is necessary). I am not sick because of my thyroid. My thyroid is not the cause. It's supposed to be there. If it's not functioning properly, the goal is to determine why. The root cause, in the case of Hashimoto's, is often a reaction to gluten, and there is almost always a dietary/environmental link to autoimmune disorders. And as I said, I felt much better when off gluten. But a definitive diagnosis would be very good to have. I just want to know, if it's not Hashimoto's, which is what my endo is telling me, then what else could it be? Are there other options? I am thinking there aren't, but want to be sure. Also, should I be searching out a new endo who will take my concerns more seriously?


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## Andros (Aug 26, 2009)

Histologic diagnosis of Hashimoto's
http://emedicine.medscape.com/article/120937-diagnosis
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Hashimoto's Hurthle cells
http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)71549-2
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http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/
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http://www.mayoclinic.com/health/hurthle-cell-cancer/DS00660
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Cancer Hurthle Cells
http://www.thyroidmanager.org/Chapter21/ch01s12.html
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Hashimoto's Hurthle cells
http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)71549-2
(Copy and paste into your browser)

http://www.mayoclinic.com/health/hurthle-cell-cancer/DS00660
(Copy and paste into your browser)

There is no definitive lab test for Hashimoto's. Only biopsy. Info furnished and a big welcome to you!

I agree with Joplin1975; if you only get half out, you may have to go back and get the other half out plus keeping half makes it nigh impossible to titrate replacement meds ideally.

Antibodies do wax and wane; indeed they do!


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