# Newly diagnosed with Hashis...a couple questions



## Lachrymosa (Jul 25, 2012)

Hello all, I was recently diagnosed with Hashis after months of feeling terrible and visits to multiple doctors / ERs. I have high TPoAB but my symptoms and labwork point to hyperthyroidism, which come and go. Of late my hyper symptoms have been much more tolerable...a few months ago I was having really bad panic episodes, heart racing, insomnia...I felt all the time like I was dying. My symptoms now are slight palpitations, weight loss (have lost 20 lbs in the last 4.5 months, but I'm actually thrilled about that), hand tremors, and some nights I wake out of a sound sleep with high pulse and a feeling like I can't breathe...but overall my symptoms are less severe than they were. Have not been on any meds...only recent change is going gluten free after finding out about the possible link between gluten intolerance and thyroid disease (my sister is a diagnosed celiac and my daughter is suspected to be as well...waiting on test results).

Yesterday I had a sonogram and they found a large nodule on the right side of my thyroid. The endo prescribed me 2.5 Mg of methimazole daily to try and reduce hyper symptoms and to see if it reduces or changes the nodule. She said that nodules in patients with hyper symptoms are rarely cancerous. I'm supposed to have more bloodwork done in a month and another sonogram in 6 months.

I'm really nervous that she's not concerned about checking the nodule for cancer. Am I worrying needlessly? I'm dreading having to wait 6 months since I will spend the entire time being paranoid.

Also, is it really all that bad to let oneself go untreated with my mild symptoms? She told me I need to wean my daughter off nursing to take the methimazole (after reading me the riot act for still nursing her at 14 months...which was offensive and frankly none of her business). She said if I opt not to take the med my only other treatment option is surgery...?! Frankly I find my current bouts of hyper symptoms tolerable.

Any insight is much appreciated!


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## lainey (Aug 26, 2010)

> Yesterday I had a sonogram and they found a large nodule on the right side of my thyroid.


How large? Anything over 1 cm should be biopsied.


> She said that nodules in patients with hyper symptoms are rarely cancerous.


 Not true, and the only way to tell is with a biopsy.



> The endo prescribed me 2.5 Mg of methimazole daily to try and reduce hyper symptoms and to see if it reduces or changes the nodule.


It is not my experience that medication for hyperthyroidism will impact a nodule. If the nodule is hyper functioning, surgery is the solution. The way to tell this is with a radioactive uptake scan. Given that you are still nursing, that test may not be possible--but, it would not only classify the nodule, but also rule out thyroiditis. Did the doctor even suggest this?



> I was recently diagnosed with Hashis....I have high TPoAB but my symptoms and labwork point to hyperthyroidism, which come and go.


Have the thryoid stimulating antibodies been run (TSI)? If your blood work is hyper, chances are that you have them. This would be nice to find out, as it impacts your treatment and prognosis.



> She told me I need to wean my daughter off nursing to take the methimazole (after reading me the riot act for still nursing her at 14 months...which was offensive and frankly none of her business).


I believe pregnant women can use PTU instead of methimazole--I would check with the pediatrician or your obstetrician as to which is better. As for reading you the riot act for nursing, that is just rude and offensive. I nursed 3 children each into the second half of their second year, and it was probably the best good-health gift I could ever have given them.


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## joplin1975 (Jul 21, 2011)

Agreed, if it large enough, biopsy.


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## Andros (Aug 26, 2009)

Lachrymosa said:


> Hello all, I was recently diagnosed with Hashis after months of feeling terrible and visits to multiple doctors / ERs. I have high TPoAB but my symptoms and labwork point to hyperthyroidism, which come and go. Of late my hyper symptoms have been much more tolerable...a few months ago I was having really bad panic episodes, heart racing, insomnia...I felt all the time like I was dying. My symptoms now are slight palpitations, weight loss (have lost 20 lbs in the last 4.5 months, but I'm actually thrilled about that), hand tremors, and some nights I wake out of a sound sleep with high pulse and a feeling like I can't breathe...but overall my symptoms are less severe than they were. Have not been on any meds...only recent change is going gluten free after finding out about the possible link between gluten intolerance and thyroid disease (my sister is a diagnosed celiac and my daughter is suspected to be as well...waiting on test results).
> 
> Yesterday I had a sonogram and they found a large nodule on the right side of my thyroid. The endo prescribed me 2.5 Mg of methimazole daily to try and reduce hyper symptoms and to see if it reduces or changes the nodule. She said that nodules in patients with hyper symptoms are rarely cancerous. I'm supposed to have more bloodwork done in a month and another sonogram in 6 months.
> 
> ...


This is not at all true about the cancer. We don't know which comes first; the cart or the horse. Cancer could be causing the hyper or hyper could cause the cancer.

Also, you need Thyroglobulin Ab lab test.

Here is info and I know you don't feel well but I am going to urge you to demand FNA of that nodule. And maybe even RAIU as ultra-sound can miss a lot of stuff.

Here is info...............

Thyroid cancer in patients with hyperthyroidism.
http://www.ncbi.nlm.nih.gov/pubmed/12876418

cancer TPO and thyroglobulin
http://onlinelibrary.wiley.com/doi/10.1111/j.1699-0463.1994.tb0488.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)

Also, radioactive uptake scan (RAIU); sonograms have limitations.

Ultra-sound limitations http://www.radiologyinfo.org/en/info.cfm?pg=us-thyroid

It would be good to get tests before you start Methimazole.


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## Lachrymosa (Jul 25, 2012)

I really appreciate the replies!

The endo didn't say how large the nodule is, but she did say it was large enough to biopsy. The reason she decided not to biopsy was because she said being that I'm having hyper symptoms it's "unlikely to be cancerous". She pointed out to me that the bloodflow was extremely good around the nodule...but not what that meant. The left side of my thyroid is inflamed, due to the Hashimotos thyroiditis she said.

She did not even suggest RAI (even before she knew I was still nursing)...she immediately decided on the methimazole. She put me on such a low dosage because my symptoms are milder and increasingly so, and she does not want me going too hypo.

I have not had a TSI test run. If I tested positive for that would that mean I have Grave's as well as Hashi's? She didn't seem concerned about that possibility the first time I saw her...she just said I have the kind of Hashi's that "yo-yos" between hypo and hyper. Hyper symptoms are the only ones that bother me though.

I've done some research on methimazole and nursing and from what I'm finding its entirely compatible with nursing. Studies have shown no detrimental effects on thyroid function, brain development, or any other side effects at doses up to 20 Mg. I'm not sure why she was so adamant I wean my daughter. I agree on extended nursing being the best thing I can do for my daughter healthwise. In her 14 months she has not been sick a single time...no ear infections, colds, diarrhea, fever, not even a sniffle. And her half-sister is always bringing home bugs from school. Plus I'm very aware of the long term health benefit of extended breastfeeding and am adamant about not weaning yet...so I would probably not opt for the RAI unless deemed absolutely essential.

I guess I'm going to have to insist on the biopsy and TSI/thyroglobulin ab tests. I can tell my endo will not be pleased I'm questioning her...and I'm a very nonconfrontational personality so I'm not looking forward to that.


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## joplin1975 (Jul 21, 2011)

Lachrymosa said:


> I really appreciate the replies!
> 
> The endo didn't say how large the nodule is, but she did say it was large enough to biopsy. The reason she decided not to biopsy was because she said being that I'm having hyper symptoms it's "unlikely to be cancerous".


Yeah that's just inaccurate...push for that biopsy and if she won't do it, try to get a consult with an ENT.


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