# ultrasound to diagnose hashi's?



## sochs (Feb 1, 2010)

Hi. I'm a 30 year old white male. 7 years ago, I began having hypertension, panic attacks, and slow weight gain with the inability to lose weight. Thyroid tests back then showed:

TSH: 1.5 (.5-5)
FT4: 1 (.8-1.8)
Iodine uptake: 9 (10-20)
Antimicrisomal antibodies: 35 (<20)
Thyroid Ultrasound: thyroid slightly enlarged

I've had TSH and FT4 checked a million times since, with similiar results as the first time. The only blood test to ever offer anything definitive was the first anitbody test mentioned above. As I understand it, Hashi patients generally have antibodies in the triple digits at least, not just a mere "35".

I've also had several CBC tests done. For a couple of years, my white blood cells were low (hematologist found nothing, exhausting all tests inluding a bone marrow biopsy). Since, all CBC's, metabolic tests, you name it.....have been normal.

Over the past 7 years, I have been on and off different doses of Synthroid (I've also tried Armour). It seems like the benefits sometimes outweigh the disadvantages. For instance, it seems like I have more exercise endurance while on Synthroid. However, my appetite increases while on the medicine and I have a difficulty losing weight regardless of whether I'm on it or not.
When I'm not on the medicine, I feel "sick" more, am less motivated, legs get tired with exercise, and throat hurts in front of neck quite often. In all honesty, I think I feel the best when on a low dose (25mcg) in terms of energy, endurance, etc. However, I want to make certain that I should be on it at all, so....here are my questions.

One month ago, while during a thyroid ultrasound (performed by my endo), my dr. said "You definitely have Hashimoto's". He described that the gland was slightly enlarged, thinning in places, and irregularly shaped. However, because my lab values remain unchanged, should I take Synthroid? When I pose this question to my endo, he says it's up to me. My antibody levels were only high the one time back in 2003. I've had the TT4, TT3, FT3 tests done as well. All are smack dab in the middle of the reference ranges. Can a firm diagnosis be made with only the ultrasound as the definitive test?

Any advice?

Thanks so much!


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## Andros (Aug 26, 2009)

sochs said:


> Hi. I'm a 30 year old white male. 7 years ago, I began having hypertension, panic attacks, and slow weight gain with the inability to lose weight. Thyroid tests back then showed:
> 
> TSH: 1.5 (.5-5)
> FT4: 1 (.8-1.8)
> ...


Hi there and welcome to the board. I have been taught that the only definitive diagnosis for Hashimoto's is FNA (fine needle aspiration) whereupon "if" certain Hurthle Cells indigenous to Hashimoto's are present, then yes.............that "confirms" the diagnosis.

This is very complicated stuff but I recommend that you at least scan. I certainly do not pretend to understand all of this stuff. Start here........

http://www.thyroidmanager.org/Chapter8/8-frame.htm

But, the entire chapter is worth having a look see.

They "say" that about TPO but I am not sure I buy that because of this information............

What does the test result mean?

Mild to moderately elevated levels of thyroid antibodies may be found in a variety of thyroid and autoimmune disorders, such as thyroid cancer, Type 1 diabetes, rheumatoid arthritis, pernicious anemia, and autoimmune collagen vascular diseases. Significantly increased concentrations most frequently indicate thyroid autoimmune diseases such as Hashimoto's thyroiditis and Graves' disease.

http://www.labtestsonline.org/understanding/analytes/thyroid_antibodies/test.html

So....................my take on that tells me that more in-depth testing needs to be done to either rule in or rule out some of the other disorders where TPO may be present.

Clearly you have thyroid disease as evidenced by the enlarged and unhealthy looking thyroid.

And finally,the thyroxine titration process can be painful. A doc should not leave you suspended in a place where you do not feel well. The goal is to get euthyroid and this necessitates getting labs every 8 weeks and having the thyroxine titrated either up or down as the case may be until you feel terrific.

And might I add that your doctor might be so clinically proficient (it does happen) that he can tell at a glance. There are some really good docs out there with lots of experience.


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## sochs (Feb 1, 2010)

Thanks for the quick, comprehensive response, Andros! The article that you referred me too was an absolutley fascinating read.

I have a couple of additional questions for you:

1. Given the certainty of mythyroid disease due to the ultrasound diagnosis, is it, in your opinion, possibly more beneficial for me to replace some of my natural thyroid hormone with Synthroid? Or, does it make more sense to not take meds given the normal lab values? I constantly struggle with the fact that I'm on Synthroid and my FT4 and TSH are completely normal, although I generally feel much better on the Synthroid. Also, is it possible that a "normal" TSH is person-specific?

2. I notice that you take Armour/Cytomel. Why don't you take Synthroid/Cytomel?

3. Is there any validity to the "Wilson's Syndrom" movement, or should I rule that completely out given the abnormalities seen in my ultrasound?

Thanks again


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## Andros (Aug 26, 2009)

sochs said:


> Thanks for the quick, comprehensive response, Andros! The article that you referred me too was an absolutley fascinating read.
> 
> I have a couple of additional questions for you:
> 
> ...


I think that you should take Synthroid because those numbers could move a bit. TSH could be a little lower and FT4 a little higher. Most of us feel best w/ TSH @ 1 or less. And somewhere along the line a Free T3 test would be good for that is your active hormone.

My immunologist and I have found that by keeping the TSH suppressed that we also suppress the autoantibodies. For that reason, the patient then feels better. Autoantibodies can wreak total havoc on how you feel. So, you may wish to consider what I just told you.

I take Armour and Cytomel because I am about to run out of Armour as they have taken it off the market (FDA) and it is supposed to come back but no one knows when. I thrived on Armour as I don't convert T4 to T3 and I was on 3 & 3/4 grain per day (225 mg..) So, my immunologist and I figured I could wimp along on 1 2 grain tab (120 mgs.) and 5 mcg. of Cytomel and we were right. I am wimping along. I have enough Armour if used this way to last 4 months. Sigh. I am scared. I was very very sick on Synthroid and Levoxyl and not responding favorably at all.

For now, all dessicated porcine products are unavailable except maybe through a compound pharmacy or ordering ERFA through Canada. And then there is the concern are you getting porcine, bovine or what? A mixture? Some sites say "other thyroid" as needed if porcine is unavailable. Aaaaaaaaaargh. Not for me! Ha, ha!!

Bookmark Thyroid Manager. You will come to love that site. I rely heavily upon that site.

Now the illustrious Dr. Wilson!! You bettcha'! W/o T3, I would be dead; are you kidding??? As stated above, I do not convert. I am cold from my core on out. Always have sub zero temp even w/ T3 "because" you can only take so much T3 unless you want to stroke out.

The only time I am warm is when I work out at the gym and I go twice a day for that reason.

Sure, I think the guy was before his time. I listen to everything and make it a habit to think outside the box.

http://www.thyroid.org/professionals/publications/statements/99_11_16_wilsons.html

I gave this link because they are so wrong, so wrong, so wrong. Lord have mercy....................way wrong. It is a very very negative and in my humble opinion, a narrow minded opinion.

T3 is the active hormone; it is life sustaining. If you keep on giving someone T4 and they continue to be unwell and in failing health and you find out that the Free T3 is low in that patient, why I ask you, would you deprive that patient the hormone he/she so badly needs to have quality of life.

Better get off my soap box now.................:anim_63:

Lastly; of course TSH is person specific!! The ranges are only guidlines which are the result of a small cohort from a very small segment of the population and these cohorts by the way are usually ethnically biased as well. Harumph!

Another soap box.


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