# Can fever be a symptom of Hashimotos?



## Calla

Hello all,
I am new to this forum but it looks like there are some knowledgeable people here. I was diagnosed with Hashimoto's last summer after a strange episode of extended vertigo/nausea (probably viral) that had my doctor stumped. It was actually a naturopath that diagnosed me- my regular doc did a TSH, and said all was fine. The naturopath told me to get my thyroid antibodies checked, and lo and behold...

Here's my question- for the past week, I've had a low-grade fever (99-100) and general weakness/malaise. I don't have a cold or flu or anything else that seems to be the cause. Could it be the Hashimotos? Has anyone here experienced low grade fever that persists for a long time? I went to my primary care doc today and she ordered a few blood tests- CBC, a few others, and also the ANA test for Lupus. I won't have the results for a few days. I'm a little concerned- fevers aren't normal for me.

Thanks!


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## CA-Lynn

Fevers as I'm sure you know can be caused by any one of numerous things.

You say you were diagnosed with Hashimoto's. Does this mean that your NP ran the antibodies tests? [The reason I'm asking is that many people mistakenly believe that all hypothyroidism is Hashimoto's and it is not.]

Assuming the antibodies tests were run and you do indeed have Hashimoto's, then low grade fevers would not be unheard of. In fact, low grade fevers are quite common in practically ANY autoimmune disease.

I would make an earnest effort to be treated by an endocrinologist MD. You need specialized help.

It would help if you would list the tests that were run and the values for each of the tests.


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## Calla

Thanks for replying. Yes, I was initially diagnosed by the NP as having Hashimoto's, but the tests were done through my primary care org. I definitely know that all hypothyroid is not Hashimoto's- in fact, I'm not actually hypothyroid (or at least, I have not tested as hypo in the past year as per the lab ranges my doctor uses). Because my TSH was normal, my primary care doc did not think there was anything wrong with my thyroid, and only tested my antibodies when I insisted. I switched primary care docs after that and the new one agrees with the diagnosis of Hashimoto's and is more willing to run tests.

My TPO antibodies have been at 147, 116, and 109 (standard range <35)
My thyroglobulin has been 62.2, 29.3, and 70.3 (standard range <55) 
My TSH has been 3.86, 1.7, 1.55, and 2.26

All of these results were within the last year- about 3 months apart.

I did get a referral to an endocrinologist from my new doc, but she wasn't much help. She did an ultrasound of my thyroid and told me it looked "ragged" but since my TSH was normal, she said she would not recommend any treatment. I asked her what would warrant treatment, and she told me, "when your TSH reaches 6 or higher". That seems pretty drastic to me. Unfortunately my options for endocrinologists are very limited due to my health plan.

My naturopath has had me on 200mcg of Selenium since last summer. She wants to raise it to 400-600, but I am worried about potential side effects with going higher. It may be my only option, however.

What is odd to me is that the fever just showed up out of the blue. I'm not someone who usually runs a fever unless I have the flu or a really bad virus. I've had other symptoms that I suspect are thyroid-related: exhaustion, difficulty swallowing, etc. but not this. I have been web searching for the usual symptoms of Hashimoto's and I haven't seen fever listed as a common symptom. I've also been experiencing some joint pain in my hands for the past couple of weeks and had migraines before that. The joint pain is why they're also doing the tests for Lupus, but other than that and the fever, I don't seem to have many classic Lupus symptoms.

Calla


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## GD Women

Antibodies present does not mean thyroid. Other health issues have thyroid antibodies and they are also present in people with no thyroid problems. It takes both thyroid levels and antibodies to diagnose autoimmune thyroid. Ditto with symptoms and low grade fever.

I have had a low grade fever all my life until RAI in which now is all over the place from 97.6 to 100. I am Hyper/Graves'

("when your TSH reaches 6 or higher".) absolutely correct. I agree with your primary and endo. But then I'm not the doctor.

If you are Hashi then you are hypo. (but your levels don't relate to hypo)
You can't be Hashi without being hypo, but you can be hypo without being Hashi. Not all hypos are Hashi - but all Hashi's are hypos.


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## chopper

I almost always run hot, around 99.2 - 99.9. I am almost NEVER "normal". I too have Hashis.

You'll get some ups and downs with Hashi's. One minute you're hot, next your colder....it usually correlates with the antibody attacks in my opinion. It's the nature of the disease unfortunately.


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## Andros

Calla said:


> Thanks for replying. Yes, I was initially diagnosed by the NP as having Hashimoto's, but the tests were done through my primary care org. I definitely know that all hypothyroid is not Hashimoto's- in fact, I'm not actually hypothyroid (or at least, I have not tested as hypo in the past year as per the lab ranges my doctor uses). Because my TSH was normal, my primary care doc did not think there was anything wrong with my thyroid, and only tested my antibodies when I insisted. I switched primary care docs after that and the new one agrees with the diagnosis of Hashimoto's and is more willing to run tests.
> 
> My TPO antibodies have been at 147, 116, and 109 (standard range <35)
> My thyroglobulin has been 62.2, 29.3, and 70.3 (standard range <55)
> My TSH has been 3.86, 1.7, 1.55, and 2.26
> 
> All of these results were within the last year- about 3 months apart.
> 
> I did get a referral to an endocrinologist from my new doc, but she wasn't much help. She did an ultrasound of my thyroid and told me it looked "ragged" but since my TSH was normal, she said she would not recommend any treatment. I asked her what would warrant treatment, and she told me, "when your TSH reaches 6 or higher". That seems pretty drastic to me. Unfortunately my options for endocrinologists are very limited due to my health plan.
> 
> My naturopath has had me on 200mcg of Selenium since last summer. She wants to raise it to 400-600, but I am worried about potential side effects with going higher. It may be my only option, however.
> 
> What is odd to me is that the fever just showed up out of the blue. I'm not someone who usually runs a fever unless I have the flu or a really bad virus. I've had other symptoms that I suspect are thyroid-related: exhaustion, difficulty swallowing, etc. but not this. I have been web searching for the usual symptoms of Hashimoto's and I haven't seen fever listed as a common symptom. I've also been experiencing some joint pain in my hands for the past couple of weeks and had migraines before that. The joint pain is why they're also doing the tests for Lupus, but other than that and the fever, I don't seem to have many classic Lupus symptoms.
> 
> Calla


Calla................I have read both your posts. I recommend a radioactive uptake scan to be "sure" you do not have cancer. "Sometimes" high titers of thyroglobulin can indicate cancer.

What does the test result mean?

Small amounts of thyroglobulin are normal in those with normal thyroid function. If thyroglobulin concentrations are initially elevated in a person with thyroid cancer, then it is likely that thyroglobulin can be used as a tumor marker. Thyroglobulin levels should be undetectable or very low after the surgical removal of the thyroid (thyroidectomy) and/or after subsequent radioactive iodine treatments. If levels are still detectable, there may be normal or cancerous thyroid tissue remaining in the person's body, indicating the need for additional treatment. 
Based on the results of a thyroglobulin test, a doctor may follow up with a radioactive iodine scan and/or radioactive iodine treatments to identify and/or destroy any remaining normal thyroid tissue or thyroid cancer. Thyroglobulin levels are then checked again in a few weeks or months to verify that the therapy has worked.

Also, Anti-DNA, C3 and C4 are specific tests for Lupus. ANA is not specific.

You can look all this up here.............
http://www.labtestsonline.org/understanding/analytes/thyroglobulin/test.html

Welcome to the board. We will help you best we can.


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## Calla

Andros, thanks for your concern and for the welcome. None of my providers has mentioned that they suspect cancer, including the endo. Of course, now I'm wondering!

I'm a little concerned about having a radioactive uptake scan because I *think* that some of my thyroid-related symptoms may have been triggered by two iodine contrast CT scans- abdomen and chest- that I had last year when they were trying to diagnose the cause of my crazy vertigo/gastro symptoms. Then, last fall, my NP also gave me a supplement with iodine in it, and I felt much, much worse after a day or two on it. After about a week, I was so weak and depressed I was starting to feel like I had no reason to live (not a normal feeling for me!) Once I went off of it, I felt like myself again. I've also had numerous chest x-rays and a head CT in the past year. I feel like I will start glowing in the dark soon! I don't want to miss anything, but I also am very wary of putting more iodine/radiation in my body.

With the Lupus- I know that the ANA is not specific, but unfortunately it was all my primary doc would do at this point given my symptoms. I always have to press for tests, but if the symptoms continue, I think I'll be able to ask her to do more specific ones.

GDWoman- could you explain what you meant about thyroid antibodies being present with other health issues (not thyroid)? I haven't heard that before, so I'm curious. The endo I saw did say that she saw that my thyroid was "under attack" (the raggedness) but given that I have so many other weird symptoms that don't relate specifically to Hashimoto's, I am trying to figure out what else might be going on. Hashimoto's is the one diagnosis I have been given, and oddly enough, it's almost "nice" to have something I can focus on.

In the past year I've had: an episode of extreme vertigo with chest pain and heart palpatations (EKG was normal), followed closely with severe gastro pain in my upper abdomen with lack of appetite (a Barium test showed some inflammation but nothing else), and then rapid weight loss of about 10 pounds(significant, since I weighed only 120 to start- though I've since gained most of it back); ongoing headaches and dizziness (referred to a neurologist and had an MRI, he diagnosed migraines); fatigue; frequent colds and infections; difficulty swallowing/sense of fullness around my throat; a new diagnosis of mild/moderate asthma; and a couple of random episodes of dehydration with a racing heartbeat. And now joint pain and the fever. Honestly, I feel like my body has just gone haywire lately. The endo I saw told me that maybe I was just going into perimenopause (I'm 41), but all these symptoms seem a bit extreme for that.


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## Andros

Calla said:


> Andros, thanks for your concern and for the welcome. None of my providers has mentioned that they suspect cancer, including the endo. Of course, now I'm wondering!
> 
> I'm a little concerned about having a radioactive uptake scan because I *think* that some of my thyroid-related symptoms may have been triggered by two iodine contrast CT scans- abdomen and chest- that I had last year when they were trying to diagnose the cause of my crazy vertigo/gastro symptoms. Then, last fall, my NP also gave me a supplement with iodine in it, and I felt much, much worse after a day or two on it. After about a week, I was so weak and depressed I was starting to feel like I had no reason to live (not a normal feeling for me!) Once I went off of it, I felt like myself again. I've also had numerous chest x-rays and a head CT in the past year. I feel like I will start glowing in the dark soon! I don't want to miss anything, but I also am very wary of putting more iodine/radiation in my body.
> 
> With the Lupus- I know that the ANA is not specific, but unfortunately it was all my primary doc would do at this point given my symptoms. I always have to press for tests, but if the symptoms continue, I think I'll be able to ask her to do more specific ones.
> 
> GDWoman- could you explain what you meant about thyroid antibodies being present with other health issues (not thyroid)? I haven't heard that before, so I'm curious. The endo I saw did say that she saw that my thyroid was "under attack" (the raggedness) but given that I have so many other weird symptoms that don't relate specifically to Hashimoto's, I am trying to figure out what else might be going on. Hashimoto's is the one diagnosis I have been given, and oddly enough, it's almost "nice" to have something I can focus on.
> 
> In the past year I've had: an episode of extreme vertigo with chest pain and heart palpatations (EKG was normal), followed closely with severe gastro pain in my upper abdomen with lack of appetite (a Barium test showed some inflammation but nothing else), and then rapid weight loss of about 10 pounds(significant, since I weighed only 120 to start- though I've since gained most of it back); ongoing headaches and dizziness (referred to a neurologist and had an MRI, he diagnosed migraines); fatigue; frequent colds and infections; difficulty swallowing/sense of fullness around my throat; a new diagnosis of mild/moderate asthma; and a couple of random episodes of dehydration with a racing heartbeat. And now joint pain and the fever. Honestly, I feel like my body has just gone haywire lately. The endo I saw told me that maybe I was just going into perimenopause (I'm 41), but all these symptoms seem a bit extreme for that.


ANA and TPO (for example) are "suggestive" of a myriad of things. Meaning that more specific tests should be done.

Most of us w/thyroid disease are allergic to iodine. For me, it is life-threatening.

Don't blame you for not wanting more of the same but it may be necessary.

We are here to help you in anyway we can and no matter what, we will support "your" decisions. It is your body, your life.

It sounds like you have been through an awful lot. I really am sorry for this. Many of us know what this is like; sad to say but true.


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## GD Women

Calla said:


> GDWoman- could you explain what you meant about thyroid antibodies being present with other health issues (not thyroid)? I haven't heard that before, so I'm curious.


Some people without thyroid disease may have TPO antibodies

http://www.mayoclinic.com/health/thyroid-disease/an00806

However, about 5-10% of healthy people test positive for TPO antibodies, so the presence of these antibodies doesn't always indicate that you have an autoimmune disorder. http://www.endocrineweb.com/conditions/thyroid/graves-disease/graves-disease-diagnosis

Given the high prevalence of thyroid antibodies among healthy middle-aged women, long-term follow-up is warranted to ascertain whether the presence of antibodies is associated with subsequent excess risk of disease, in particular, CHD http://www.annalsofepidemiology.org/article/1047-2797(94)00110-F/abstract

One or more thyroid antibody tests may also be ordered if a person with a known non-thyroid-related autoimmune condition, such as systemic lupus erythematosus, rheumatoid arthritis, or pernicious anemia, develops symptoms that suggest thyroid involvement. This involvement may occur at any time during the course of the other condition(s). 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

A certain percentage of patients who are healthy may be positive for one or more thyroid antibodies. The prevalence of these antibodies tends to be higher in women and tends to increase with age. If a person with no apparent thyroid dysfunction has a thyroid antibody, her doctor will track her health over time. While most may never experience thyroid dysfunction, a few may develop it in the future.http://www.labtestsonline.org/understanding/analytes/thyroid_antibodies/test.html

Thyroid antibodies may remain positive for years, and do not provide an indication of whether the person has normal or abnormal thyroid function. Patients with positive levels of thyroid antibodies may never develop thyroid disease during their lifetime

http://www.mythyroid.com/bloodtests.html

Other autoimmune disorders, however, may have a positive TPOAb test, including lupus, rheumatoid arthritis, Sjogren's syndrome, or pernicious anemia.

http://www.medicinenet.com/thyroid_peroxidase_test/index.htm

"The physician should not treat the disease but the patient who is suffering from it." Maimonides


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## CA-Lynn

Boy, just when you think you have it all understood, a new study comes along and turns your brain upside down! :tongue0015:


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## loumath

I am newly diagnosed with Hashimoto's. My endo doctor. educated at Mayo, says the new range is (0.2-2.5) for normal. Labs and doctors don't use this new range or aren't aware of it or it is newly found information. I read in Mary Shomon's book that the ranges they have been using for years, were gathered from men's blood test results, which they have discovered is not accurate for women.


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## Andros

loumath said:


> I am newly diagnosed with Hashimoto's. My endo doctor. educated at Mayo, says the new range is (0.2-2.5) for normal. Labs and doctors don't use this new range or aren't aware of it or it is newly found information. I read in Mary Shomon's book that the ranges they have been using for years, were gathered from men's blood test results, which they have discovered is not accurate for women.


Not only does gender make a difference but so does ethnicity. I am glad Mayo is following suit on the new recommended guidlines by many credible sources.


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## Calla

GD Women- thanks for the info and links. I am still puzzled as to what's going on with me, but it gives me some things to think about. I do think that my thyroid is affected- the endo confirmed that with the ultrasound, so I don't think I'm in that category of "normal but with antibodies". But whether my current symptoms are being caused by thyroid or something else is still a question.

Loumath- I've read some of Mary Shomon's book too- my provider still uses the "old" ranges (up to 5.5 is normal as far as they are concerned). I think the recommendations to use the lower range have been around for a few years now, but many are slow to change.


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## GD Women

loumath said:


> I am newly diagnosed with Hashimoto's. My endo doctor. educated at Mayo, says the new range is (0.2-2.5) for normal. Labs and doctors don't use this new range or aren't aware of it or it is newly found information. I read in Mary Shomon's book that the ranges they have been using for years, were gathered from men's blood test results, which they have discovered is not accurate for women.


Don't get mixed up between a diagnose level and a target level once a person is diagnosed. If Labs believed this I am sure they would abide by the new levels. And I would think this is a doctor's call anyway. The doctor knows the patient, patient health and the type of thyroid issue, there is more than just one.

There are different thyroid scenarios with different diagnose and treatment scenarios. It's not all cut and dry of being hypo or hyper.

Hypos have a different metabolism than hypers so hypos will feel better at a different level than hypers. One shoe does not fit all, likewise levels. Where one feels good another may not. Where hypers feel best hypos may not. There is not a gold level. That is why there are Lab ranges with a wide scale.

The American Association of Clinical Endocrinologists (ACEE) considers 0.45-4.5 mIU/L, with the ranges down to 0.1 and up to 10 mIU/L requiring monitoring but not necessarily treatment. There is always the risk of overtreatment and hyperthyroidism. Some studies have suggested that subclinical hypothyroidism does not need to be treated

AACC's Expert - November 2009
Note: not all high TSH levels are abnormal. There can be inactivating polymorphisms of the TSH receptor requiring a higher TSH to maintain euthyroidism. Judgments regarding any treatment or follow-up interval should relate to patient-specific factors.
http://www.aacc.org/publications/cln/2009/november/Pages/Inside1109.aspx

This statement was developed by an AACE Rapid Response Team comprised of:
The consensus report acknowledges that the continued controversy on conventional practices is mainly due to the paucity of evidence-based data and, therefore, recommends large, randomized prospective studies to determine outcome of treatment. The report maintains that the upper limit of TSH should remain at 4.5 mIU/L, rather than 3.0-3.5 as some other organizations have suggested. The authors recommended neither routine testing for nor routine treatment of subclinical disease, a position at variance with what several medical organizations including AACE and ATA had previously published. It is clear from several published studies that subclinical hypothyroidism can result in clinical symptoms, hyperlipidemia and cardiac dysfunction The paper states that since available data do not convincingly show clear-cut benefit from early thyroxine therapy, routine T4 treatment for patients with TSH between 4.5 and 10 mIU/L is not warranted.
http://www.aace.com/pub/positionstatements/subclinical.php

Scientific Review and Guidelines for Diagnosis and Management - JAMA. 2004
Conclusions Data supporting associations of subclinical thyroid disease with symptoms or adverse clinical outcomes or benefits of treatment are few. The consequences of subclinical thyroid disease (serum TSH 0.1-0.45 mIU/L or 4.5-10.0 mIU/L) are minimal and we recommend against routine treatment of patients with TSH levels in these ranges. There is insufficient evidence to support population-based screening. Aggressive case finding is appropriate in pregnant women, women older than 60 years, and others at high risk for thyroid dysfunction. 
http://jama.ama-assn.org/cgi/content/full/291/2/228

serum TSH below 0.1 mU/L are considered low and values 
above 6.5 mU/L are considered elevated.
http://www.ahrq.gov/clinic/3rduspstf/thyroid/thyrrs.htm

GPAC: Guidelines and Protocols Advisory Committee - January 1, 2010
subclinical hypothyroidism TSH greater than 10mU/L;
http://www.bcguidelines.ca/gpac/guideline_thyroid.html

The Journal of Clinical Endocrinology & Metabolism
http://www.aacc.org/members/nacb/Pages/default.aspx

American Thyroid Association Guidelines
www.thyroid.org/.../GuidelinesdetectionThyDysfunc_2000.pdf


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## GD Women

loumath said:


> I am newly diagnosed with Hashimoto's. My endo doctor. educated at Mayo, says the new range is (0.2-2.5) for normal. Labs and doctors don't use this new range or aren't aware of it or it is newly found information. I read in Mary Shomon's book that the ranges they have been using for years, were gathered from men's blood test results, which they have discovered is not accurate for women.


You are reading from a long time thyroid advocate who has a very strong agenda. Who searches for doctors and articles that agree with her theories? She is not a doctor!

Current guidelines June 10, 2008
At present, the typical statistical reference range used in U.S. laboratories is between 0.5 mIU/L and 5.0 mIU/L, according to Hossein Gharib, MD, professor of medicine at, the Mayo Clinic College of Medicine
http://www.endocrinetoday.com/view.aspx?rid=28716

Health Fair study showed that, with serum sensitive TSH levels between 5 and 10 mIU/L, Mayo Clin Proc, April 2001
http://www.mayoclinicproceedings.com/content/76/4/413.full.pdf

A reference range is a set of values used by a health professional to interpret a set of medical test results. The range is usually defined as the set of values 95% of the normal population falls within. Reference range will vary, depending on the age, sex and race of a population, and even the machines the laboratory uses to do the tests. Also remember that by definition 5% of the normal population will fall outside the reference range.

1.	National Health and Nutrition Examination Survey III Thyroid 2007
TSH REFERENCE LIMITS ARE calculated from the 95% confidence intervals of cohorts of individuals without evidence of thyroid dysfunction or positive thyroid peroxidase antibodies (TPOAb) and/or thyroglobulin antibodies
http://jcem.endojournals.org/cgi/content/full/92/11/4236

Establishing Reference Intervals for Clinical Laboratory Test Results: Is There a Better Way?: June 2008
The study was carried out using the data from Laboratory Corporation of America, one of the largest providers of laboratory testing in the United States
129,443 men and women adult patients (18 years or older). second set of TSH results (n = 151,235) from adult patients (18 years or older) originated from December 2008 was collected. (have to be a member to get results)
http://www.medscape.com/viewarticle/716949_2

Diagnostic accuracy of basal TSH determinations based on the intravenous TRH stimulation test: An evaluation of 2570 tests and comparison with the literature - BioMed Central Ltd. 2007
A series of 2570 women attending a specialized endocrine unit were evaluated. Results - Basal TSH values were within the normal range (0.3 to 3.5 mIU/l) in 91,5% of cases, diminished in 3,8% and elevated in 4.7%. Based on the response to TRH, 82.4% were considered euthyroid, 3.3% were latent hyperthyroid, and 14.3% were latent hypothyroid. Combining the data on basal and stimulated TSH levels, latent hypothyroidism was found in the following proportions for different TSH levels: 5.4% for TSH < 2.0 mIU/l, 30.2% for TSH between 2.0 and 3.0 mIU/l, 65,5% for TSH between 3.0 and 3.50 mIU/l, 87.5% for TSH between 3.5 and 4.0 mIU/l, and 88.2% for TSH between 4 and 5 mIU/l. The use of an upper normal range for TSH of 2.5 mIU/l, as recommended in the literature, misclassified 7.7% of euthyroid cases.
Elevated levels of TSH are the hallmark of decreased thyroid function. In order to correctly identify these patients it is imperative to have a clear definition of the upper reference range for basal TSH. Patients whose TSH lies in the upper reference range might appear to have minimal thyroid deficiency. Although this might appear to be an easy task, the definition of the upper reference range for TSH has been matter of controversial debate [1-5]. Reported reference values for the upper range of basal TSH vary between 2.12 and 5.95 mIU/l [6-21] (Table 1). In the majority of studies, the reference range for TSH has been defined by statistical analysis (95% confidence interval) of log transformed data.
http://www.biomedcentral.com/1472-6823/7/5


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