# Update/Antibody questions



## lillia (Apr 24, 2012)

So after the rapid growth of my thyroid in April following lymph node enlargement in March I went to my university medical center and had the following tests:
TSH: 4.26 (0.5-4.5)
TPO ab: 3200 (<35)
(I believe I also had T4 and free tests done but all was normal by the ranges)

These results sent me to my PCM and after some pressuring i had follow up tests and an ultrasound, showing a symmetrical large thyroid (about 6cm i believe) and one nodule very close to 1cm on the isthmus as well as a lymph node posterior to the thyroid at about 2cm
the tests:
TSH 5.3 (0.3-5.5)
TPO ab >1000 (<35)
Thyroglobulin ab 420 (<10)

After these tests i began 25mcg synthroid in may and had an excisional biopsy of a cervical node to rule out lymphoma and an FNA in july for the posterior lymph node and nodule. The results showed the hurthle cells indicative to hashi's confirming the presumed diagnosis, and multiple reactive lymph nodes. So no worries of cancer but my endo did say that the cells from my thyroid looked like that had been inflamed for a long time.
Blood tests in july for TSH showed a decrease level of 3.3 for the same range and was increased to 50mcg

My dose has just been increased to 75mcg upon last week's blood test but I did not receive the numbers over the phone (I'm guessing there was little change since the last test in july)

My endo believes that I am now in the declining phase of my Hashimoto's and we may be trying to "catch-up" with the decreases function for a while. Last week I felt I was having a swing with anxiety and heart palpitations but subsided around the time of my test

Looking back I think I had been suffering from Hashi's for about 2 years with all of the brain fog and fatigue which was extremely debilitating for me but am starting to feel better and am more able to keep up with my classes.

Now I am wondering about the long-term effects of high antibodies. I am worried about damage to my body/organs from long term inflammation and possible fertility issues down the road? How can I distinguish joint pain from antibodies from the possibility of rheumatoid arthritis? (I have pain in my hands when I take notes, written or typed, and have stiffness in my leg joints) If there are any college students reading: I struggled in my classes before I was diagnosed and began treatment and as a pre-med student, I'm concerned about my future and my ability to get recommendations based on my previous performance which was not up to my ability. How can I recover and boost my reputation without blaming and leaning on the debilitating symptoms as an excuse?


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## Andros (Aug 26, 2009)

lillia said:


> So after the rapid growth of my thyroid in April following lymph node enlargement in March I went to my university medical center and had the following tests:
> TSH: 4.26 (0.5-4.5)
> TPO ab: 3200 (<35)
> (I believe I also had T4 and free tests done but all was normal by the ranges)
> ...


If I were in your position, I would see an ENT. With those high antibodies, it is my humble opinion that something is afoot.

cancer TPO and thyroglobulin
http://onlinelibrary.wiley.com/doi/10.1111/j.1699-0463.1994.tb04888.x/abstract
http://www.wikigenes.org/e/gene/e/7173.html

TPO Ab
http://www.nlm.nih.gov/medlineplus/ency/article/003556.htm

TPO Ab should be negative, 0
http://www.nlm.nih.gov/medlineplus/ency/article/003556.htm
(The normal thyroid has TPO but should not have antibodies to TPO)

Thyroglobulin Ab
A negative test is normal. A negative test means no antibodies to thyroglobulin are found in your blood.
http://www.nlm.nih.gov/medlineplus/ency/article/003557.htm
(The normal thyroid has Thyroglobulin in low titers but should not have Thyroglobulin Ab)


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## joplin1975 (Jul 21, 2011)

Agreed with Andros.

Remember, all that FNA told you was that the tissue that they were able to extract did not have cancerous cells. It does not mean you are in the clear.

Many, many doctors would insist that a nodule of that size be removed. Many posters here have gone into surgery thinking they were getting a benign nodule removed only to find out it was cancer that the FNA missed.


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## lillia (Apr 24, 2012)

my ENT removed the lymph node with all negative results and the FNA by my Endo was negative as well. I have no other nodules and will have a follow up US next April. the ENT said removing the thyroid was not possible at this time because of such a high degree of inflammation. sorry if there was any confusion


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## Andros (Aug 26, 2009)

lillia said:


> my ENT removed the lymph node with all negative results and the FNA by my Endo was negative as well. I have no other nodules and will have a follow up US next April. the ENT said removing the thyroid was not possible at this time because of such a high degree of inflammation. sorry if there was any confusion


Aw; you just wanted to see if we knew our stuff!!! ROLF!!

That is very very good news. Wonder if ENT meant vascularity as well as inflammation.

So, once this is brought under control, do you think you will have your thyroid ablated?


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## lillia (Apr 24, 2012)

Andros said:


> So, once this is brought under control, do you think you will have your thyroid ablated?


I am unsure, before I was experiencing relief from my symptoms I was sure I would get it out. however now that I feel more consistent and much more focused/less tired, I am mostly concerned about what the antibodies are doing to my body. I have heard long term inflammation can age organs and cause other problems like increasing cancer risks. my thyroid seems to be decreasing since starting treatment but at the same time I do not want the inflammation for 20 years at my young age. do some people have quick decline of thyroid function? the antibodies go away after the thyroid stops working right?


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## joplin1975 (Jul 21, 2011)

My thyroid was removed because of cancer. That said, pathology revealed Hashi's as well. I sound like a broken record, but...

I spent most of my 20s in lots and lots of pain -- mostly joint and muscle -- and now that the gland is gone, so is my pain. I'm lucky that I'm only 37 and didn't "lose" too much time, but I can help but think of all the good times I would have had had I been more conscientious or self-aware about the abnormality of the pain. I was in a wedding earlier this summer and spent the night dancing my tail off in a pair of heels. It was the first time my feet had swollen in a LONG time...I had forgotten how miserable it was and couldn't believe I lived like that for so long!

Which is a long-winded way of saying that you may very well have antibodies still present, but they should "calm down" if the thyroid is removed.


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## lainey (Aug 26, 2010)

> I am mostly concerned about what the antibodies are doing to my body.


Autoimmune diseases, in general are organ/antibody specific. Thyroid antibodies generally attack the thyroid, not other organs, rheumatoid factor antibodies attack the joints, islet cell antibodies attack the pancreas, etc.

Generally antibodies wax and wane and for the most part, "burn" themselves and the organ involved out. In the case of thyroid antibodies, you do not treat them per se, but the resulting thyroid disfunction they cause (it works that way for diabetes too). Removing the thyroid will not necessarily cause the antibodies to disappear, but they may become less active without an organ to "act" upon. However, thyroid surgery is generally not considered palliative for Hashimoto's, and is reserved for those who have overly enlarged thyroid, suspicious nodules or other structures or competing sets of thyroid stimulating and thyroid peroxidase antibodies that make treatment with replacement medication difficult.


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## sjmjuly (Mar 23, 2012)

When I was diagnosed last March, my TPO was 439. Today it's down to 237. Not sure why other than maybe my thyroid is finally burning out. I am on medication and that has helped alot and I am feeling much better. I don't have the hyper swings as much as I used to either. I do know that when my thyroid was under attack and I wasn't medicated, I felt like death. Things have settled quite a bit. Now I am just trying to get the medication dose correct. I think I am almost there.


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## CA-Lynn (Apr 29, 2010)

Lillia,

As someone who has RA and several other autoimmune arthritic diseases I would encourage you to see a rheumatologist for testing and rule out. Lots of people here on this board, without an autoimmune arthritis, will mention that they have joint pain....not uncommon in autommune thryoid disease.

As a premed student you should know that autoimmune forms of arthritis cause joint destruction and aggressive treatment is imperative. *You cannot repair the damage. *But you can prevent it with the right drugs. For this reason I would invest in a visit to the rheumatologist. Rule related diseases out.

And no, your PCP is not equipped to understand all the symptoms of the 100's of diseases that a rheumatologist is trained in.

As far as getting back on track with your studies..... You're just going to have to work your butt off even more. I was towards the end of my doctoral studies when I was diagnosed with one disease after another. My GPA went down and I made the mistake of whining to a professor who told me to just get with the program and push hard. [Which was the right advice.]

Good luck to you.


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