# Hashi or not?



## Rach33 (Jun 24, 2014)

When I first started taking Armour thyroid I felt fine the first week on 30mg then I felt an immediate crash where all my symptoms came flooding back. After being on the med for 6 weeks...
My labs were:
TSH: 0.55 (0.36-3.74)
FT3: 2.9 (2.18-3.98)
FT4: 0.9 (0.76-1.46)

He increased my med to 60mg. I felt great! All my hypo symptoms were either gone or greatly reduced until the 4th week when everything came flooding back again. I had my labs drawn...
My labs were:
TSH: 0.06 (0.36-3.98)
FT3: 3.0 (2.18-3.98)
FT4: 0.9 (0.76-1.46)

He asked me how I was feeling and I told him all my symptoms. He concluded he was positive it was hashimotos because of my symptoms and my labs hadn't changed even though my med was doubled. He said it looked like we had the labs drawn right when my thyroid was at a very low point. I did bring up that both of my antibody tests drawn 6 weeks prior were negative, he told me Hashi can go undetected by labs. He increased my dose to 90mg, I'm going on day 6 and I still am very tired and freezing. My basal temp this morning was 96.9 and heart rate is 68. He is going to order an ultrasound, not sure why because he hasn't felt my thyroid so not sure what he's looking for. All I know is that I can't stand anything close to my neck because it bothers me. The doctor I had seen prior to him (in the same office) said I had a swollen lymph node suspecting I would get a cold soon (this was 7 weeks ago) but that never happened now I question if it was in my thyroid instead.

Anyways, is the doctor right, are these things constant with Hashi or not?


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## bigfoot (May 13, 2011)

There are some that feel (for example, the Stop the Thyroid Madness book) that increases of desiccated meds (Armour, Nature-Throid, West-Throid, etc.) should be at a quicker pace with Hashi's patients. Supposedly it has something to do with antibodies flaring up if you take too long between dose increases. The usual approach is doing a dose increase, waiting 6-8 weeks, running more labs, and checking to see if another increase is needed. There is another school of thought that feels that a minority of Hashi's patients will have a bad reaction to drugs like Armour, because it somehow aggravates the antibodies even further.

On the plus side, this doctor seems to be pretty well informed. The fact that he has continued to increase your dosage, is listening to your signs & symptoms, runs FT3 & FT4 labs, and understands that antibodies will fluctuate is proof of this. Many of us here have struggled for years to get a doctor who even agrees with part of all of that.

Typically Hashi's is diagnosed by running labs for TPO Antibodies (aka TPO Ab) and Thryoglobulin Antibodies (aka TG Ab). The gold standard is a FNA biopsy of the thyroid, but I think many docs and insurance companies (and patients) shy away from that unless they really feel it's necessary. Another lab they might run is for Thyroid Stimulating Immunoglobulin (aka TSI, *not* the same as TSH) otherwise lumped into a group of tests called Thyroid Receptor Antibodies (aka TRAb). This would check for the presence of Graves' Disease, if applicable. Another good tool to get a baseline is doing a thyroid ultrasound.

It will be interesting to see what they think about that supposed swollen lymph node. Who knows, could be a lymph node, could be thyroid, could be something else. Hard to say without them looking into it further.


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## Rach33 (Jun 24, 2014)

These are the antibody results and TSI done 7 weeks ago:
TPOab: 0.09 (0.0-4.0) 
TgAb: 1.0 (0.0-9.0) 
TSI: 93 (<123)

If the swelling is still in my lymph node will they still do an FNA at the same visit or reschedule? I'm so in the dark on all this, last ultrasounds I've had were for pregnancy so I have no clue what to expect when it comes to this. LOL! Thank you for responding!


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## visc (Feb 22, 2014)

You might just have thyroditis from being sick. Those antibody numbers don't suggest Hashi's...

Or low iodine??

Others will chime in soon on this.

Good luck!


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## bigfoot (May 13, 2011)

Getting the TSI results properly interpreted can be tough. It seems to be part art, part science. I know around the forum it is felt that *any* TSI present is cause for concern. I lean this direction, and like you, I've had a TSI result in the mid-90s. But no doc has jumped at it yet. Some lab companies state that anything under a certain reference value (<123, for example) can be ignored. Others state that folks can have Hashi's antibodies, as well as the TSI. There doesn't seem to be a real overall consensus from what I've seen. It will be interesting to see what your doc says about it.

The thyroid ultrasound itself is a breeze, maybe a 10-15 minute procedure. Seems to take more time getting checked in. But, I haven't had an FNA yet, so I can't really comment much. But I do know if, for example, it's done in an outpatient setting in a hospital or clinic, a doc may be nearby to conduct the FNA if needed.


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