# Hashi's confirmed. Now what?



## jojo307 (Apr 3, 2012)

Hello all, I am 24 and I have been Hypothyroid and on 25mcg Synthroid for 4 years. In February I noticed swelling in my neck and went to my doctor, who referred me to an endocrinologist. 
Lab results from February:
TSH: 3.780 Range: 0.550 - 4.780
Ultrasound shows enlarged thyroid, no nodules.

The Endo increased my dosage to 50mcg because I am always tired and TSH was on high side of normal. He asked me to come back in April to see how I was doing. 
Labs:
THYROID PEROXIDASE AB: GT 1300.0 Range: 15 - 60
TSH: 2.635 Range: 0.550 - 4.780
Free T4: 1.17 Range: 0.89-1.76

When I went back to talk to him, he said because of the high antibodies, I have Hashimoto's Thyroiditis (and he barely mentioned it, like it didn't matter).

He said I don't need another ultrasound in August, like we originally planned and he just wants me to come in in 6 months to check the levels again.

I don't really know what Hashimoto's is, and just wondered for those of you who have it, what comes next? What can I expect?

Thanks!


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## Andros (Aug 26, 2009)

jojo307 said:


> Hello all, I am 24 and I have been Hypothyroid and on 25mcg Synthroid for 4 years. In February I noticed swelling in my neck and went to my doctor, who referred me to an endocrinologist.
> Lab results from February:
> TSH: 3.780 Range: 0.550 - 4.780
> Ultrasound shows enlarged thyroid, no nodules.
> ...


Whoa! Not sure I like the diagnosis as the thyroid usually presents with a grape-like very nodular appearance as well has high TPO both of which are only "suggestive."

Ultra-sounds are tricky and prone to error.

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

Can you request Thryoglobulin and Thyroglobulin Ab?

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/e...cle/003557.htm
(The normal thyroid has Thyroglobulin in low titers but should not have Thyroglobulin Ab)

Thyroglobulin Ab http://www.nlm.nih.gov/medlineplus/ency/article/003557.htm

Info on Hashimoto's.

Hashimoto's is diagnosed by FNA. If certain Hurthle Cells indigenous to Hashi's are present, then you have Hashi's.

Histologic diagnosis of Hashimoto's
http://emedicine.medscape.com/article/120937-diagnosis

Hashimoto's Hurthle cells
http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)71549-2

Now tell me; what is your gut feeling? What is your body saying to you? This is really where it is at, you know? Who would know your body better than you?


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## laff66 (Mar 9, 2012)

I've been wondering about the ab tests as well. I have hashis also, but my doc never runs the tg ab test. I've read all the suggested info regarding what the test indicates, but with my already high tpo, does the tg test change anything?


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## Andros (Aug 26, 2009)

laff66 said:


> I've been wondering about the ab tests as well. I have hashis also, but my doc never runs the tg ab test. I've read all the suggested info regarding what the test indicates, but with my already high tpo, does the tg test change anything?


It certainly would if the Thyroglobulin Ab is high. That's double the concern.


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## laff66 (Mar 9, 2012)

Ok thanks. So I will definitely ask for that next time. What do we do if it's high though?


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## Andros (Aug 26, 2009)

laff66 said:


> Ok thanks. So I will definitely ask for that next time. What do we do if it's high though?


The first thing would to be to query your doctor about it. See what the input is.

None of us here are doctors although there is a lot of personal experience amongst our posters.


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## laff66 (Mar 9, 2012)

the problem is that he didn't run that test in the first place so he must not think its too important. I always like to have an answer ready when they give me the, "why do you feel you need that" statement. There is so much good info on this board that has given me the ammunition to use for other tests. Its really something to see when they ask why I want a certain test, I give them the info I've learned from all you guys, and they say, "hmmm, okay we can do that." Pretty impressive!
I've looked everywhere, but all I can find is that my 800 result on the TPO test indicates Hashi's, and a positive on the tg ab test also indicates Hashi's, so I really can't figure out what to ask for. More ammo to push for an ultrasound maybe?


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## Andros (Aug 26, 2009)

laff66 said:


> the problem is that he didn't run that test in the first place so he must not think its too important. I always like to have an answer ready when they give me the, "why do you feel you need that" statement. There is so much good info on this board that has given me the ammunition to use for other tests. Its really something to see when they ask why I want a certain test, I give them the info I've learned from all you guys, and they say, "hmmm, okay we can do that." Pretty impressive!
> I've looked everywhere, but all I can find is that my 800 result on the TPO test indicates Hashi's, and a positive on the tg ab test also indicates Hashi's, so I really can't figure out what to ask for. More ammo to push for an ultrasound maybe?


If you will go to the links I provided, you will find your answers there. That would be post # 2 in this thread. Knowledge is power!


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## laff66 (Mar 9, 2012)

as always, thanks Andros for your input! You are incredibly patient. I wasn't trying to badger you, I just couldn't find anything that explained why the Tg test would be indicated if I've already been diagnosed with Hashi's with high TPO. I read through all the links provided, and they all basically say if its high, then you have hashi's, which I already have been told I have.

For the benefit of anyone else who might run across this thread with a search, i found the following info on the anti Tg antibody test. I don't think its geared to non-medical professionals, but there are a few interesting pieces of info. this part actually deals with the two antibody tests together:

Diagnosis of Autoimmune Thyroid Disease:
Measurements of anti-thyroid peroxidase (anti-TPO) autoantibodies have higher sensitivity and equal specificity to anti-thyroglobulin (anti-Tg) autoantibody measurements in the diagnosis of autoimmune thyroid disease. Anti-Tg autoantibody levels should, therefore, only be measured if anti-TPO autoantibody measurements are negative, but clinical suspicion of autoimmune thyroid disease is high.

heres a link to the page:

http://www.mayomedicallaboratories.com/interpretive-guide/index.html?alpha=T&unit_code=84382


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