# Ultrasound confirms Hashi, now what?



## dizzyrors (Feb 25, 2013)

I'm so irritated with these doctors. I finally get someone to ultrasound my throat. They called with my results and stated that the ultrasound confirmed Hashi, but my thyroid looked fine. There were no abnormalities. I asked them to explain that because it did not make sense. They could not. I restated my question asking how can they visually confirm Hashi, which involves the thyroid gland, but yet my thyroid gland looked normal. Once again they could not explain and just wanted to me to tell them to send a referal. Now, granted I was talking to a medical assistant (I suppose), but why couldn't they give me more info?
Anyway, has anyone else ever encountered something like this? My options are limited on finding an understanding endo. Been to 3 already. One said nothing was wrong. One said I was only hypo even though my antibodies were >1000 and another said I was not hypo, only Hashi. I was hoping that the ultrasound would help with a diagnosis, but now I am not sure. By the way, my last blood work showed my TSH at 4.16 and my free T4 was 1.0 with a range of 0.8-1.8. I also had them do a PTH test and that came up 39 with a range of 10-65. Not sure what that last thing means. Should it be lower or higher?


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## joplin1975 (Jul 21, 2011)

I'm guessing -- and this is ONLY a guess -- that you do not have any discrete nodules, but rather have a "lumpy" or "grape-like" thyroid that is indicative of Hashi's.

First thing I'd do is request a copy of the ultrasound report.

Is you doctor not willing to do a trial run on levo?


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## jenny v (May 6, 2012)

I would second what joplin says and get a copy of your ultrasound report.

I have Hashi's and my last ultrasound report indicated that while I have no major nodules within my thyroid, it's covered with multiple fine hypoechoic nodules, which basically means it's got the typical Hashi's grape-like texture. The report also used words like "diffusely abnormal" to describe that texture. Definitely get a copy of the report and see what words they use to describe your thyroid as looking "fine".


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## Octavia (Aug 1, 2011)

I'll third what joplin says.

And even if what they're saying makes no sense, maybe it will still be the path to getting you on some thyroid medication. I do believe you would benefit from some levothyroxine.


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## Andros (Aug 26, 2009)

dizzyrors said:


> I'm so irritated with these doctors. I finally get someone to ultrasound my throat. They called with my results and stated that the ultrasound confirmed Hashi, but my thyroid looked fine. There were no abnormalities. I asked them to explain that because it did not make sense. They could not. I restated my question asking how can they visually confirm Hashi, which involves the thyroid gland, but yet my thyroid gland looked normal. Once again they could not explain and just wanted to me to tell them to send a referal. Now, granted I was talking to a medical assistant (I suppose), but why couldn't they give me more info?
> Anyway, has anyone else ever encountered something like this? My options are limited on finding an understanding endo. Been to 3 already. One said nothing was wrong. One said I was only hypo even though my antibodies were >1000 and another said I was not hypo, only Hashi. I was hoping that the ultrasound would help with a diagnosis, but now I am not sure. By the way, my last blood work showed my TSH at 4.16 and my free T4 was 1.0 with a range of 0.8-1.8. I also had them do a PTH test and that came up 39 with a range of 10-65. Not sure what that last thing means. Should it be lower or higher?


Trust your instincts. That is a ridiculous statement. Usually, the Hashimoto's thyroid gland has a grape-like appearance meaning of course, many nodules. That is not definitive, however. It is only suggestive. And according to your report received; your gland looks normal. Unbelievable. And scary!

Here is info.

Histologic diagnosis of Hashimoto's
http://emedicine.medscape.com/article/120937-diagnosis

Hashimoto's Hurthle cells
http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)71549-2

http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/

What antibodies' are high? TPO? Did they run Thyroglobulin and Thryoglobulin Ab?


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## dizzyrors (Feb 25, 2013)

@Andros - the antibody test was the TPO test. No, not a Thyroglubulin or Thyroglobulin Ab. I have to insist on every test. Seems like everyone I see thinks my problems can be solved with either weight loss, exercise or better sleep. Would love it if it were that simple.
@Joplin - I intend on getting a copy of the report. Just haven't gotten around to requesting it yet. I did have one doc put me on 25mg levo. I never felt better but my TSH went down to 2.07 and he would not increase the dosage. This is the doc that diagnosed me as hypo, but not Hashi. The only he would prescribe me in addition to the 25mg levo was adipex at 37.5mg. Was on the adipex for a month and lost a meager 5lbs and never got the energy he promised that pill would create. My 3rd doc took me off the levo b/c they said that since my numbers were in a normal range they did not feel that an increase would help my symptoms and my symptoms were related to my sleep and suggested a sleep study. Told them I had already had a sleep study with nothing abnormal showing up and they just said that they really thought it was my sleep and I should have another one day at their facility.
I just feel like I am chasing ghost while swimming upstream. Not sure where to go from here. Not a lot of endo doc options local. I could try some others out of town (my 3rd doc was at UF/Shands in Gainesville), but I don't really have the time to run all over central florida looking for the one doc that can help me. Maybe I'll just suffer through another year until my numbers get out of range enough that these nincompoops recognize that I need treatment.


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## Andros (Aug 26, 2009)

dizzyrors said:


> @Andros - the antibody test was the TPO test. No, not a Thyroglubulin or Thyroglobulin Ab. I have to insist on every test. Seems like everyone I see thinks my problems can be solved with either weight loss, exercise or better sleep. Would love it if it were that simple.
> @Joplin - I intend on getting a copy of the report. Just haven't gotten around to requesting it yet. I did have one doc put me on 25mg levo. I never felt better but my TSH went down to 2.07 and he would not increase the dosage. This is the doc that diagnosed me as hypo, but not Hashi. The only he would prescribe me in addition to the 25mg levo was adipex at 37.5mg. Was on the adipex for a month and lost a meager 5lbs and never got the energy he promised that pill would create. My 3rd doc took me off the levo b/c they said that since my numbers were in a normal range they did not feel that an increase would help my symptoms and my symptoms were related to my sleep and suggested a sleep study. Told them I had already had a sleep study with nothing abnormal showing up and they just said that they really thought it was my sleep and I should have another one day at their facility.
> I just feel like I am chasing ghost while swimming upstream. Not sure where to go from here. Not a lot of endo doc options local. I could try some others out of town (my 3rd doc was at UF/Shands in Gainesville), but I don't really have the time to run all over central florida looking for the one doc that can help me. Maybe I'll just suffer through another year until my numbers get out of range enough that these nincompoops recognize that I need treatment.


This is very discouraging to say the least. Why don't you try to find a Naturopathic doctor who has a good rating and recommendations?


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## Phoenix016 (Apr 29, 2013)

dizzyrors said:


> I'm so irritated with these doctors. I finally get someone to ultrasound my throat. They called with my results and stated that the ultrasound confirmed Hashi, but my thyroid looked fine. There were no abnormalities. I asked them to explain that because it did not make sense. They could not. I restated my question asking how can they visually confirm Hashi, which involves the thyroid gland, but yet my thyroid gland looked normal. Once again they could not explain and just wanted to me to tell them to send a referal. Now, granted I was talking to a medical assistant (I suppose), but why couldn't they give me more info?
> Anyway, has anyone else ever encountered something like this? My options are limited on finding an understanding endo. Been to 3 already. One said nothing was wrong. One said I was only hypo even though my antibodies were >1000 and another said I was not hypo, only Hashi. I was hoping that the ultrasound would help with a diagnosis, but now I am not sure. By the way, my last blood work showed my TSH at 4.16 and my free T4 was 1.0 with a range of 0.8-1.8. I also had them do a PTH test and that came up 39 with a range of 10-65. Not sure what that last thing means. Should it be lower or higher?


Perhaps what they meant by your thyroid being normal is that it looks normal for Hashimoto's. When I was first diagnosed it was because my thyroid visibly appeared large (due to the inflammation caused by my body attacking my thyroid). They did a scan and it confirmed what they thought - an enlarged thyroid. Plus I had very high TPO antibodies (over 6,000 to start and it kept going up).

I think the thing with Hashimoto's, which is tricky in the beginning, is that your thyroid is still functioning somewhat. I think that is why, when I was put on medications, it was a roller coaster when it came to the TSH (very low, very high).


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