# Possible Hashitoxicosis?



## MsMarsha (Dec 15, 2012)

I recently posted this issue on the General forum. Seems like its on the wrong forum since my poor Mom gotten maybe a diagnosis. She is in such a bad state right now she stays in the bed because she is so sick.

Prev. Post:

Hey all! I would like some of thoughts on My Mom's results. She diagnose with Hyperthyroid 6 months ago. Her thyroid has gotten worst with low energy, real red in the face, high blood pressure, swelling in the neck glands and thyroid and swallow issues. So she decided to get some tests done. Waiting to hear from her Endo Doctor. Here is her results:

Uptake and Scan:
4 Hours: 12%
24 Hours: 35%

Aug Labs:

TSH: 3.78
T4, Free: 1.2
T3, Total: 84
TSI: <89
Baseline: <140
HDL: 39 (says its low)
Trigs: 151 (says its high)
ALT: 35 (says its high)
Hemoglobin A1C: 5.9 (says its high increase for diabetes)
Absolute Lymphocytes: 4055 (says its high)

Any thoughts about her numbers? I am really scared for her don't want her to go through what I did with my thyroid cancer. Have such horrible headaches now from the hormone replacement. Hope she doesn't have to go through this.

Thanks,
Marsha
<end of prev. post>

Her nurse did call and say its possible Hashitoxicosis. She has no antibodies with this. But the TPO wasnt tested. She does have huge issues with gluten but its not that Hasselbeck's lady disease forgot the name sorry. She does have IBS and prev. had chrohn's for 20 years but went away after having her gallbladder removed in 2010 and when into the IBS. Love to see your input on your experience that I can show her. Any links to articles would be appreciated, i cant seems to find much.

Thank you!


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## StormFinch (Nov 16, 2012)

As I mentioned on your other thread, we could really use the ranges on these tests since each lab has their own. If you don't have them, can you get a copy from her doctor?


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## MsMarsha (Dec 15, 2012)

Sorry about that, Storm! Such an Airhead lol.

Here you Go!

TSH: 3.78 (just gave a pregnancy range from 0.26 -2.91. At 61 she isnt!) Had a note: A serum TSH level greater than 350 micro-international units/mL can interfere with the TSI bioassay and potentially give false positive results. 
T4, Free: 1.2 (0.8 - 1.8 ng/DL)
T3, Total: 84 (76-181 ng/dL)
TSI: <89 (note: TSI results greater than or equal to (>=) 140% of the Reference Control are considered positive.
Baseline: <140
HDL: 39 ( > or = 46 mg/dL)
Trigs: 151 (<150 mg/dL)
ALT: 35 ( 6- 29 U/L)
Hemoglobin A1C: 5.9 (<5.7 % of total Hgb)
Absolute Lymphocytes: 4055 (850-3900 cells/uL)

I dont have the uptake results yet. She just got a call possible Hashitoxicosis. The Doc still going over her labs, uptake and Ultrasound she had months ago. She requested the report from the hosp. I should be able to post about that Monday or Tuesday.


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## StormFinch (Nov 16, 2012)

Alright, if you go by the newer suggested TSH ranges that it seems almost no one follows except those of us that actually have thyroid conditions, your mother's TSH is high while her Free T4 is near the top of the range.

I'd rather see a Free T3 than a total, but since it's what we have to work with, it's low in the range and I'm betting her Free would be as well.

As I mentioned before, her RAIU uptake at 24 hours is going to be either right at or slightly over the range.

She has a positive TSI, and individuals without an autoimmune disease will not have any. Although TPO and TG antibodies should be run as well to confirm, and of course I could be wrong, but in my opinion Hashitoxicosis is probably the proper diagnosis.

Here is a decent article on Hashitoxicosis by Elaine Moore. Mrs. Moore is a medical technologist with 30 years of lab experience and her own history of thyroid autoimmune disease. http://suite101.com/a/hashitoxicosis-update-a121050

Simply put, if it were my mother I would be suggesting to her as well as her doctors that thyroidectomy would be the best solution. Whether my own experience could have been classified as Hashitoxicosis or was actually the combination of Graves and Hashi's that I was diagnosed with I don't really know, but I can tell you that it was absolutely impossible to get my numbers stable at any given time. Whether I was in a hypo or hyper phase medications did little to nothing. It wasn't until I had my thyroid removed that I finally found relief.


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## StormFinch (Nov 16, 2012)

I forgot to mention, the reason you're having trouble finding a whole lot of info on Hashitoxitocosis is that in the past quite a few doctors either didn't recognize the process or didn't understand it. Hopefully that's starting to change. Here's another article I just ran across from someone that's been through it. http://voices.yahoo.com/hashitoxicosis-signs-symptoms-hashimotos-thyroiditis-6159572.html?cat=5


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## MsMarsha (Dec 15, 2012)

Thank you, Storm. The articles were very helpful. She glad to read them. Hoping she get this diagnosis if its that. Her Doc is in the Texas Medical Center (by M.D. Anderson)They seem to be educated on the thyroid issues that I could tell. This disease would explains the bad migraines she been having the past six months. This recent visit the Doc didn't run her Free T3. She gone to this Doc every 3 months and labs were runned. The Free T3 three months ago was 2.8. She going to see if they run the TPO and TG that wasn't runned.

I think you are right getting her thyroid removed. She can't live like this. She such an active person before I feel she has changed alot and nothing she does helps. Last night she was so cold all day and very sleepy. Then about 8ish at night till about 2 in the morning her thyroid was so hot and the migraines started. She felt she going insane. She been taking Aleve or something for her fever. Her temp is runs around 99 - 102. She been taking B complex liquid to try to give her some kind of energy to sit up and take care of herself.

Thank you again.


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## MsMarsha (Dec 15, 2012)

Stormfinch,

Here is my Mom's Uptake Finding and Impression. Please let me know what you think. I do know she will be having a biopsy per the Radiologist next week or the following week waiting on the results from her Ultrasound first. They didn't want to run her TPO Antibodies yet. Hopefully they run those soon!!!

FINDINGS:

The 4-hour and the 24-hour I 123 thyroid uptake are 12.2 and 35.5% respectively. The 4-hour uptake is within normal limits (normal 3-15%) and the 24-hour uptake is slightly above the normal range of 10-30%.
The thyroid scan reveals both lobes to be normal in size with equal but *heterogenous distribution of radioactivity in both lobes. A small focal ill-defined photopenic defect is seen within the right upper outer lobe, best appreciated on the RAO projection.* No hot nodules are seen.

IMPRESSION:

1.* Right upper outer lobe small focal ill-defined photopenic defect is concerning for a cold nodule.* FNA is recommended to rule out malignancy.
2. Slight increased 24-hour uptake consistent with mild hyperthyroidism, 
3. Heterogenous appearance of both thyroid lobes could represent underlying Hashimoto's thyroiditis.

Could you let me know from your experience what the bold areas this could mean.

Thanks.


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## MsMarsha (Dec 15, 2012)

I forgot to mention the nodule is 7mm. Could it be difficult to biopsy? The tech took like 20 or 30 pics of the nodule from different angles and gland.


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## StormFinch (Nov 16, 2012)

No, 7 mm is close enough to 1 cm that I don't think they should have a real problem biopsying it. I've heard of them doing FNAs on nodules as small as 5 mm.

Heterogeneous means not uniform and photopenic means cold. Basically they're saying that your mother's thyroid did not uptake the radioactive iodine evenly, which is typical of one that has been under autoimmune attack, and that she has a single ill defined cold nodule located on the right lobe, best viewed on the right anterior oblique (RAO) radiographic projection. Although a single nodule is worrisome, as is one that has an ill defined border, (although ill defined could very well mean something different here, since typically that is a characteristic done via ultrasound) keep in mind that 85% of all cold nodules are benign, the older we are the more chance we have of developing a nodule, and they are found even in people with healthy thyroids. It definitely needs to be biopsied, but no sense in worrying unless they confirm that there's something to worry about. It's small and if it comes back as anything other than benign then it would be a good excuse just to have her thyroid removed completely so she can get some relief.


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## MsMarsha (Dec 15, 2012)

Thank you so much! This will be very helpful for her. Hoping this info calm her down. I think her being so stress is stressing out her thyroid. Her ENDO and ENT are awesome ladies I am sure she is in good hands.


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## zohaa (Oct 8, 2014)

I felt my thyroid destruction would eventually turn to cancer.

Good info


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