# Referred to Endocrinologist for possible Hashimoto's



## RandomUserAZ (Nov 21, 2012)

Hello, everyone.

I stumbled upon this forum via Google and it looks like an active community where I can hopefully find some information and answers. I've not been diagnosed with Hashimoto's yet, but my bloodwork is certainly pointing in that direction.

During a recently carotid ultrasound, the doctor noted that I had an enlarged thyroid.

A followup thyroid ultrasound was done and they found multiple enlargements including some of over 1cm.

I was referred to en endocrinologist and had some thyroid blood work done in anticipation. These are the results:

T3 Uptake 25.8% (range = 23.4%-42.7%)
T4 (Thyroxine) - 6.5 (range = 4.5-12.5 ug/dL)
T7 Index - 1.7 (range = 1.2-4.3)
TSH, High Sensitivity - 3.23 (range = 0.45-4.5 mU/L)

These numbers are within range but have been gradually slipping over the past 10 years (T4 was 8.6 back in 2005)

Microsomal TPO-Ab - 644 (range = <35 IU/mL)

This would seem to point directly at Hashimoto's. Is there anything else that would cause this? What additional tests should expect the endocrinologist to ask for?

I will be seeing the Endocrinologist soon and wanted to learn a bit more about what questions I should be asking him. I have a feeling that I've had this issue for many many years and I wish that it had been detected much sooner.

From the age of 18, I weighed 145 and was unable to gain weight until I turned 28. From 28-40, I gained 5-10 pounds a year despite not changing my diet or exercise routine. I had put this down to 'getting older' and 'slower metabolism', but I'm wondering now if it was related to my thyroid.

Since peaking at 225, I have lost over 50 pounds and am currently in the best shape of my adult life. My metabolism is still low, however, and my weight will start to creep up if I slack off on my diet/exercise pattern even in the slightest. I'm currently 47, and will be turning 48 soon. I'm male, though I'm reading that Hashimoto's is much more common in women.

In reading through some of the threads here, some of the common symptoms jumped out at me.

I've always had a slight trouble swallowing, but it was never more than a minor occasional discomfort so I ignored it.

I've also suffered from depression/bipolar for much of my adult life and have been diagnosed with Asberger's. I wonder if this could be linked as well.

Another is 'ringing in the ears'. I've had this for quite some time.

The big one is the 'mental fog' and memory issues. My brain used to be sharp as a tack and worked exceeding well, but that has deteriorated significantly over the years and I have difficulty maintaining concentration. I also have major memory problems and was even hospitalized a few years back for memory loss (I lost an entire month). They did an MRI and Cat Scan, found no sign of stroke or other physical cause, and ended up discharging me with a diagnosis of Temporary Global Amnesia.

I've generally had good health for most of my life, so it is disconcerting to learn that something is seriously wrong with your body. Most of these symptoms I've attributed to the aging process, but now my brain is trying to link them all to my thyroid (along with every other symptom that pops up). It is difficult to control your imagination at times!

Mainly, I want information. I do listen to my doctors even when I don't always agree with them, but I like to be an active participant in my health care.

Any suggestions/comments welcome!


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## Octavia (Aug 1, 2011)

Welcome! Yes, you have found an active forum with many people who have been diagnosed with Hashimoto's. I am not one of them, so I'll refrain from comment about Hashi's, but I just wanted to say hello. I believe you'll gain some valuable insights here.

:hugs:


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## joplin1975 (Jul 21, 2011)

Hi there.

The TPO, in layman's terms, essentially means your thyroid is under attack, but it does not define the nature of the attack. You'll see high TPO in Hashi's, Grave's, and cancer. So, the logical thing to do would be to rule out cancer. If the nodules are over 1cm, they are candidates for biopsy (which is a quick process done with a very small needle). The FNA (fine needle aspiration) can rule out cancer and also definitively diagnose Hashi's.


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## CA-Lynn (Apr 29, 2010)

Welcome. Sorry we have to meet under these circumstances.

As far as the bipolar and Asberger's - there is a corelation to thyroid disease that I am aware of. Thyroid is a very common disease, so it tends to pop up a lot. Just coincidental.


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## Andros (Aug 26, 2009)

RandomUserAZ said:


> Hello, everyone.
> 
> I stumbled upon this forum via Google and it looks like an active community where I can hopefully find some information and answers. I've not been diagnosed with Hashimoto's yet, but my bloodwork is certainly pointing in that direction.
> 
> ...












It sounds to me like it would be in your best interest to have FNA (fine needle aspiration) of that thyroid nodule.

TPO Ab is "suggestive" of many things.

TPO Ab
Mild to moderately 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. Significantly increased concentrations most frequently indicate thyroid autoimmune diseases such as Hashimoto thyroiditis and Graves disease.
http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test

What is definitive for Hashimoto's is this..................

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

I don't have any credible info linking Asperger's to thyroid but I do on bi-polar which may be of interest to you..........

bipolar/thyroid disease
http://www.psycheducation.org/thyroid/introduction.htm


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## RandomUserAZ (Nov 21, 2012)

Thanks for the warm welcome! Looks like I found the right place to share/learn.

I think the most difficult thing for me is going to be learning patience. I am not a very patient person by nature (major understatement), and have been champing at the bit during the 4-week wait for my first endocrinologist appointment. I want answers now!

Since I doubt that a quick fix is possible/practical, I foresee a continual future of testing and waiting 6-8 weeks while my imagination goes overboard with every perceived symptom or side effect.


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## surge (Aug 15, 2012)

Welcome! I was nodding furiously reading your post. I thought I was just getting older (and boy did it suck) when encountering the string of symptoms associated with undiagnosed thyroid disease-- the memory issues, the weight gain. A lot of people here also have the ear ringing. It's intermittent for me (they're ringing right now!).

B/c your TPO is fairly high, it does point to Hashis, but everyone is right to point out that it will be very important to rule out cancer. I suspect this will be the first thing your endo talks to you about since you are male and have nodules, some of them large.

For a first appointment with an endo, I'd be curious to talk about how s/he sees your case, what s/he suspects is going on, and his/her treatment plan for you. Hopefully, you have an endo who listens and asks a lot of questions and is easy to work with.

You'll get used to the blood work, medication tweak, wait 5 weeks pattern pretty quickly. I think you'll be surprised. But waiting for this first appointment might be the hardest. I'd use the time to write up a history, to collect recent lab work from the past year (always nice to have on hand at the appointment, so you can refer right to it if need be). Start a list of questions that you can add to and edit down over the next several days, so you feel like, when the time comes, you have questions in front of you. Nothing worse than leaving the doc feeling like there's something you didn't get to/forgot to ask...

When's your appointment?


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## StormFinch (Nov 16, 2012)

Lol well by the time all is said and done, you will have either definitely learned patience or run screaming.  Hurry up and wait will be normal operating status for now at least.

Welcome!


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## RandomUserAZ (Nov 21, 2012)

Just came back from my first appointment. The doctor was very easy to talk with and asked a lot of questions and answered the ones I had as well. I think I will get along with him very well (which is always a good thing).

According to the ultrasound, the largest nodule is 1.7cm on the left side with a 1.5cm module on right. However, he was unable to feel the nodules physically (he mentioned that the thyroid was 'soft and squishy' whatever that means).

So the diagnosis is Hashimoto's Disease. And while he did mention the possibility of cancer, he said the incidence rate was 1-2% and recommended that I wait on the biopsy for now. From what he said, even if it is cancerous, there is little difference in discovering it now or in 6 months. He seemed to not want to do an invasive procedure that does not help 98-99% of patients (too conservative of an approach?).

I am to go back in April for a followup ultrasound and see if there is additional growth whereupon he can decide then what he wants to do.

He started me on a low dose of Levothyroxine (50mcg daily). I will have bloodwork done in January to see if they need to adjust the dosage, and then again in March before my next appointment in April.

I wish I had more definitive answers, but his logic seems sound. I just have to try and keep my imagination in check every time a 'symptom' shows up. Doubly so since I am going to be watching out for any possible side effects of the Levothyroxine. What should I expect from taking that, btw, or is the dosage so small that I won't really notice much?


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## Andros (Aug 26, 2009)

RandomUserAZ said:


> Just came back from my first appointment. The doctor was very easy to talk with and asked a lot of questions and answered the ones I had as well. I think I will get along with him very well (which is always a good thing).
> 
> According to the ultrasound, the largest nodule is 1.7cm on the left side with a 1.5cm module on right. However, he was unable to feel the nodules physically (he mentioned that the thyroid was 'soft and squishy' whatever that means).
> 
> ...


To be honest w/you, I am at a loss as to how the doc can diagnose Hashimoto's when..........................

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

And you might find these STATS interesting.............
http://seer.cancer.gov/statfacts/html/thyro.html


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## smelliebellie (Oct 14, 2012)

I personally never had an FNA done. I was diagnosed by TPO antibodies alone.


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## surge (Aug 15, 2012)

All my docs always say indicative of hashimoto's...even my thyroid pathology said, 'structural changes consistent with hashimoto's', but, as is smelliebellie's case, it was the antibodies that we were working off of.

I think your doc is pretty standard-- as far as waiting to see for 6 months. Did he discuss the slightly higher risk factor for cancer b/c you're male?

Looking back on my particular cycle, the only thing I wished I'd done differently is ask for name brand from the get-go. My friend advised me to do this and I did, but there was a mix up at the pharmacy and by the time I noticed it was generic, well...I was feeling better and didn't want to mess with it. But when things went haywire later, it did mean I had to suffer through 6 weeks of name brand before my endo would even consider that it wasn't a 'filler' issue. Who knows, maybe if I'd started on levoxyl, she'd have switched me to synthroid, just to test, so maybe the name brand wouldn't have made a difference, but I did want to bring it up, since your just starting and maybe other people will weigh in, too...


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## RandomUserAZ (Nov 21, 2012)

How significant a difference in price is the name brand? I have an HSA with a high deductible, so I pay most things out of pocket.

I do get the PPO discount on prescriptions, but I know a lot of name brand drugs can be expensive. The generic pills only cost me $.15 each.


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## joplin1975 (Jul 21, 2011)

I think brand name synthroid is about $11 more per month (over the generic, that is) under my PPO.


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## surge (Aug 15, 2012)

Levoxyl is also name brand and it's typically in between generic and synthroid.


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## RandomUserAZ (Nov 21, 2012)

I had a question about my upcoming blood tests.

According to the order, they only are doing two tests:

TSH, High Sensitivity
T4 Free, Non-dialysis

Would it beneficial to get T3 Free done as well, or others?

I've never had the T3 Free done that I know of, just the T3 uptake. I'm curious to see where in the range my T3 Free is (though it would have been nice to know that before I started on the medication).

Do I have to get the doctor's approval to get additional tests done or can I ask for them when I go in?


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## joplin1975 (Jul 21, 2011)

Yes, I think you should get the free t3. With my lab and insurance policy, I need the doctor to order it.


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## webster2 (May 19, 2011)

I think it is a more expensive test so that requires the doctor ordering it. So...you may have to pester your doctor to order it!


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## Andros (Aug 26, 2009)

RandomUserAZ said:


> I had a question about my upcoming blood tests.
> 
> According to the order, they only are doing two tests:
> 
> ...


Free T3 is very important in my humble opinion. When did you have the T3 uptake? Sometimes it is significant bearing in mind that this is the protein that stores the Triiodothyronine for cellular uptake.

T3 Uptake test
http://www.drstandley.com/labvalues_thyroid.shtml (high, hyper---low, hypo)


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