# New to Hashimotos ?s



## Dollgirl (Jun 10, 2011)

Hello I had my 1st visit with a Endo yesterday. I was sent after a thyroid ultrasound showed nodules and my bloodwork came back high. He diagnosed me with Hashimotos and Pernicious Anemia. He did another U/S in his office which showed the largest nodule at 7mm, he said they werent big enough to worry about a needle biopsy yet. 
He started me on Levothyroxine 50 mcg daily. He said he didnt think the medicine would help that they only other option was to remove the Thyroid. He said the medicine may cause me to have a rapid heartbeat and insomnia.
My problem is I have days of fatigue where all I do is sleep, but I also have days of insomnia and rapid heart beat. I asked him if those days are going to be worse and he couldnt give me an answer. He didnt run any new blood work but put a order in for my TSH to be done in 6 weeks. I also have a appointment in 4 months to see him again.
All of my symptoms have worsened over 3 years, multiple Dr. visits where they kept saying as long as my panel was fine I was fine. They did discover the Pernicious Anemia, B12 has helped some with the memory loss but thats about it. The last visit to find out what was wrong they sent me to a therapist who keeps hinting at Bi-polar. I insisted on the anti-bodies test and a nurse practioner ordered the first U/S to see why I felt like something was in my throat and I choke on everything I try to eat. When they got the results back from that they sent me to the Endo.
My last labs
TSH 6.5 I dont have the ranges for this one
Free T4 index (T7) 2.9 range 1.4-3.8%
T3 uptake 27 range 22-35%
T4 Thyroxine total 10.6 range 4.5-12.0 mcg/dl
Thyroglobulin antibodies 248 range <20-IU/ml H
Thyroid Peroxidase antibodies >1000 range <35-IU/ml H

Im just afraid to take the meds due to the days of insomnia and racing heart already. If he said it could make my heart race is it going to make it worse than it already is? I dont really understand what my thyroid is doing but I am trying to read what I can on it.


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## Andros (Aug 26, 2009)

Dollgirl said:


> Hello I had my 1st visit with a Endo yesterday. I was sent after a thyroid ultrasound showed nodules and my bloodwork came back high. He diagnosed me with Hashimotos and Pernicious Anemia. He did another U/S in his office which showed the largest nodule at 7mm, he said they werent big enough to worry about a needle biopsy yet.
> He started me on Levothyroxine 50 mcg daily. He said he didnt think the medicine would help that they only other option was to remove the Thyroid. He said the medicine may cause me to have a rapid heartbeat and insomnia.
> My problem is I have days of fatigue where all I do is sleep, but I also have days of insomnia and rapid heart beat. I asked him if those days are going to be worse and he couldnt give me an answer. He didnt run any new blood work but put a order in for my TSH to be done in 6 weeks. I also have a appointment in 4 months to see him again.
> All of my symptoms have worsened over 3 years, multiple Dr. visits where they kept saying as long as my panel was fine I was fine. They did discover the Pernicious Anemia, B12 has helped some with the memory loss but thats about it. The last visit to find out what was wrong they sent me to a therapist who keeps hinting at Bi-polar. I insisted on the anti-bodies test and a nurse practioner ordered the first U/S to see why I felt like something was in my throat and I choke on everything I try to eat. When they got the results back from that they sent me to the Endo.
> ...


Well, your doctor certainly did some outmoded tests, I must say. Anyway, the TSH is high. AACE recommends the range for TSH to be 0.3 to 3.0

Please read this.......
understanding thyroid labs
http://www.amarillomed.com/howto/#Thyroid
http://pro2services.com/Lectures/Spring/Thyroid/ThyTests.htm

Your antibodies are very very high and that "combo" can suggest the possibility of cancer. Did they say whether that nodule was hot or cold? Solid or cystic? Calcified rim?

I don't know what to say about you taking the thyroxine replacement. I am not a doctor. If you are hyper, that could be a problem and just because the TSH is up there does not mean you are not hyper. Antibodies bind and block the receptor sites.

It would be interesting for you to get this test.

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

And here is some additional info.

Thyroglobulin Ab and cancer
http://qjmed.oxfordjournals.org/content/59/2/429.full.pdf

Another Thyroglobulin and cancer
http://www.mdlinx.com/endocrinology...963/?news_id=811&newsdt=092010&subspec_id=419


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## Dollgirl (Jun 10, 2011)

Thank you for the reply.
The 1st US report showed they werent sure if it was a 3 cm nodule or two 1.5cm nodules it said if it was 3cm I needed a FNB if not it could be watched. They wanted to do another US but my PCP said Id get one at the Endos anyway.
The Endo did his in the office and pointed out several nodules. He measured the largest on the left side and said it was 7mm. He said they werent big enough to worry with a biopsy.
He didnt say anything about hot or cold or solid or cystic. The first report doesnt state anything like that either.
I will try to get my PCP to order the TSI. Getting them to run the antibodies was very difficult I had to agree to start seeing the therapist. 
The thyroid cancer was a concern for the PCP since I have a family history of thyroid, breast, ovarian and colon, Cowdens syndrome. The 1st thing that brought me to the Dr. 3 yrs ago was neck pain and swollen nodes. This hasnt went away it just flares up at least once a week or more.


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## Andros (Aug 26, 2009)

Dollgirl said:


> Thank you for the reply.
> The 1st US report showed they werent sure if it was a 3 cm nodule or two 1.5cm nodules it said if it was 3cm I needed a FNB if not it could be watched. They wanted to do another US but my PCP said Id get one at the Endos anyway.
> The Endo did his in the office and pointed out several nodules. He measured the largest on the left side and said it was 7mm. He said they werent big enough to worry with a biopsy.
> He didnt say anything about hot or cold or solid or cystic. The first report doesnt state anything like that either.
> ...


And, I forgot to welcome you. I can get intense. LOL!










I hope you can get the TSI and I would at this point recommend RAIU (radioactive uptake scan) rather than another sonogram which does have it's limitations.

I was going to ask if you have swollen lymph nodes in the neck/clavicle area. That chinches it for me; please insist on RAIU and FNA of the lymph nodes if the thyroid nodules are not big enough.

Aaaaaaaaaaaaaaaaargh. But I would rather know and be informed and I hope you agree because I don't beat around the bush when it comes to the possibility of cancer.

http://www.cumc.columbia.edu/dept/thyroid/papillary.html (this is one variation only but the swollen lymphs make me think this one)

http://www.thyca.org/thyroglobulin.htm

Thyroid cancer symptoms
http://www.cityofhope.org/patient_care/treatments/thyroid-cancer/Pages/symptoms.aspx

I hope not but do not despair. They really have a handle on this thyroid cancer stuff.


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## Dollgirl (Jun 10, 2011)

Thank you for the welcome.
I agree Id rather know whether it was or wasnt. Thanks you for the articles. I will try to get the PCP to order the tests. Ive learned the more I insist the more they look at me like Im just crazy which is very frustrating. I will try the meds but if they make my heart race worse Im stopping them and will just let the Endo know I want the whole thing out. Im not due to see him again until Oct. but I will call him if that happens.


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## bigfoot (May 13, 2011)

Dollgirl said:


> Ive learned the more I insist the more they look at me like Im just crazy which is very frustrating.


Ain't that the truth! Your health is exactly that, _your_ health.

My understanding is that the antibodies and wacky T3 / T4 levels are what cause the signs & symptoms, not your TSH level. Since your antibodies are so high it makes sense that you are suffering right now.

I hope you get some answers and feel better soon! hugs3


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## Dollgirl (Jun 10, 2011)

Thank you I do too


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## lavender (Jul 13, 2010)

When I read your symptoms, you sound hyperthyroid, even though your TSH is high. I say this because of the heart palpitations and the suspicion of bipolar. I felt and acted bipolar when I was hyperthyroid, and having my thyroid out relieved my mood swings without psych meds! (which were suggested by a friend who is a psychiatriac nurse practitioner.)

If you are hyperthyroid, synthroid is only going to make things worse. TSI will show if there is hyperthyroid activity, but I suspect you are swinging between hyper and hypo. Between the swinging and the possibility of cancer, having your thyroid removed may be the best thing. I suspect it's hard to make a decision without all the information.

RAIU is really the best test get a clear picture of nodules. That combined with FNA can really help you see what is going on, the likelihood of cancer. When running thyroid labs, the best tests for thyroid function are TSH, Free T3 and Free T4, but sometimes it's hard to find a doctor who will run them consistently.


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## Andros (Aug 26, 2009)

Dollgirl said:


> Thank you for the welcome.
> I agree Id rather know whether it was or wasnt. Thanks you for the articles. I will try to get the PCP to order the tests. Ive learned the more I insist the more they look at me like Im just crazy which is very frustrating. I will try the meds but if they make my heart race worse Im stopping them and will just let the Endo know I want the whole thing out. Im not due to see him again until Oct. but I will call him if that happens.


Please keep in touch with us here. I do want to know how you do w/ the thyroxine replacement and futher testing.


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## Dollgirl (Jun 10, 2011)

Thank you for the hugs I feel I need them today. I feel jittery, weak, shakey had to stop working on a sculpture I kept fidgeting and messing up.


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## Andros (Aug 26, 2009)

Dollgirl said:


> Thank you for the hugs I feel I need them today. I feel jittery, weak, shakey had to stop working on a sculpture I kept fidgeting and messing up.


Tch! As you know, a couple of us suspect hyper.

I hope you can get the TSI (thyroid stimulating immunoglobulin) test and the RAIU as well.

You are doing what most of us have done; flipping back and forth with the ultimate net result of full-blown hyper.

Just to be on the safe side,I am going to give you symptoms of a thyroid storm.

Familiarize yourself.

Thyroid Storm
http://www.clivir.com/lessons/show/thyroid-storm-symptoms-causes-and-treatment.html


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