# Need help! Understanding labs and treatment for Hashi's



## sc7 (Jun 4, 2015)

Hello everyone. I am so grateful to have found this forum - you all seem so knowledgable and supportive. I am hoping you can help shed some light on my husband's Hashimoto's. We really need your help!

Background: He became sick very suddenly in July 2012 (panic attacks, hyper-stress reactions, major stomach issues, and heart palpitations), but it wasn't until June 2013 that we got the Hashimoto's diagnosis. He has been gluten-free since then and that has helped (but not healed) him quite a bit. In the beginning, he was determined to find a natural way to heal this illness and was very resistant to taking meds because he didn't like the idea of taking a pill for life. I think he is slowly warming to the idea - mostly because he has felt badly for so long and has tried just about every other option.

Treatment: Currently, he is seeing a functional doctor who has him on a course of immunotherapy. This doctor believes that he can reverse the Hashimoto's and get his hormones to a level that he gets symptom relief. He has apparently had some success with other patients and this was to be my husband's last attempt to reverse the disease naturally before getting on meds. The immunotherapy is typically three rounds (once every two months) and he has finished his second round, with the third scheduled for July 1 and labs on August 1. The he will re-evaluate. So far he hasn't had any symptom relief, although his labs are improving somewhat. The doctor is willing to put him on meds at any time if he chooses. His main symptoms are - fatigue, difficulty dealing with stress, and stomach issues. He also currently takes vitamin d, a b-complex and magnesium.

Questions: I am hoping that you all can help me in a few ways: one - *can you tell me what you think of his labs and pattern*? Both in terms of what you think could be going on and as a way to help me understand what these labs mean in terms of how my husband must feel. (It has been helpful for me, his wife, to read things like "when my T4 is super low, I feel like xyz" - he can tell me how he feels, but somehow it helps me understand to tie it to labs). Also, what are your *thoughts in terms of treatment* - would you recommend *medicine* based on his labs? Would you recommend something like Naturethroid with both the t-3 and t-4? Any *tests* you recommend he have? I already have on a list that he should have his ferritin levels and TSI checked as well as a new ultrasound (last one was in 2013). He also needs his insulin tested because he was labelled "insulin resistant" and pre-diabetes with the last doctor but this one has tested that.

I know you aren't doctors and we will listen to medical advice officially, but I have read many threads here and believe you may be able to help us think through these labs and his path since you all have experienced it yourselves.

October 2013

TSH: 6.25 (reference interval .27 - 4.20)

Free T3: 3.7 (reference interval 2.0 - 4.4)

Free T4: 1.37 (reference interval .93 - 1.7)

TPO: 234 (reference interval 0-34)

February 2014

TSH: 7.61 (reference interval .27 - 4.20)

Free T3: 3.7 (reference interval 2.0 - 4.4)

Free T4: 1.36 (reference interval .93 - 1.7)

TPO: 220 (reference interval 0-34)

(New doctor)

January 2015

TSH: 7.64 (reference interval .4 - 5.5)

Free T3 (convert): 360 (reference interval 230 - 420)

Free T4: 1.23 (reference interval .8 - 1.8)

TPO: 275 (reference interval 0-34)

TGAB: 96 (reference interval 0-4)

May 2015 (after two rounds of immunotherapy)

TSH: 5.5 (reference interval .4 - 5.5)

Free T3 (convert): 321 (reference interval 230 - 420)

Free T4: .88 (reference interval .8 - 1.8)

TPO: 227.5 (reference interval 0-34)

TGAB: 4 (reference interval 0-4)

Thank you!


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## Lovlkn (Dec 20, 2009)

Has your husband had an ultrasound on his thyroid?


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## sc7 (Jun 4, 2015)

He had one around August 2013 and it was normal at the time. His doctor doesn't think he needs another one but I'm not so sure...


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## joplin1975 (Jul 21, 2011)

Just so I understand better: What, exactly, does the immunotherapy consist of?

His TSH might be improving...but I don't see any notable changes in his other labs.


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## Lovlkn (Dec 20, 2009)

sc7 said:


> He had one around August 2013 and it was normal at the time. His doctor doesn't think he needs another one but I'm not so sure...


Because he has TGAB I believe it would be a good idea to have another ultrasound.

I would agree that his thyroid labs have not improved.

I have to imagine immunotherapy is expensive - can you provide more information to exactly what your husband is being treated with.


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## sc7 (Jun 4, 2015)

The immunotherapy is hard to explain, in part because I barely understand it. Basically it is explained to me to be the same that people with allergies have - and that now cancer patients are getting at times - that is intended to balance the immune system so it stops attacking the thyroid (or whatever the therapy is aimed to fight). It uses natural materials like bacteria and somehow turn off the immune attack. I'm sure I am not describing this well. Here is a link that may help: http://www.specialtynaturalmedicine.com/our-services/allergy-shot-treatments/

I think it can be expensive but our doctor has enough people doing it that he was able to lower the cost. He handles pricing and insurance different than most doctors, so it isn't covered by insurance but is on $50 per time.

Lovlkn, could you tell me more about the TGAB and ultrasound connection?

Does anyone have any thoughts about his numbers - are they (T3 and T4) super low? Would you think he would benefit from Naturethoid and/or Low Dose Naltrexone?


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## joplin1975 (Jul 21, 2011)

TgAB is an antibody that attacks Tg. Elevated levels of Tg are associated with thyroid cancer. Because males tend to develop more aggressive variants of thyroid cancer, it would be a really good idea to have an ultrasound.

His current free t4 level is super low, but his free t3 level is just at mid-point, which is unusual. I would definitely get his TSI tested.

Because of the relative higher free t3, I would hesitate to jump to a desiccated medication right away. It's possible that he has antibodies skewing the results, but...I had very similar results when I was first treated and *any* thyroid medication would throw me into a hyper state (or, if you ask my husband, make me act like a meth addict). My own thoughts on hyper vs hypo is that as crummy as hypo is, it's a LOT better than hyper. If I were in his shoes, I would be thinking about a t4 medication only, first...but only after that ultrasound.


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## sc7 (Jun 4, 2015)

joplin1975 said:


> TgAB is an antibody that attacks Tg. Elevated levels of Tg are associated with thyroid cancer. Because males tend to develop more aggressive variants of thyroid cancer, it would be a really good idea to have an ultrasound.
> 
> His current free t4 level is super low, but his free t3 level is just at mid-point, which is unusual. I would definitely get his TSI tested.
> 
> Because of the relative higher free t3, I would hesitate to jump to a desiccated medication right away. It's possible that he has antibodies skewing the results, but...I had very similar results when I was first treated and *any* thyroid medication would throw me into a hyper state (or, if you ask my husband, make me act like a meth addict). My own thoughts on hyper vs hypo is that as crummy as hypo is, it's a LOT better than hyper. If I were in his shoes, I would be thinking about a t4 medication only, first...but only after that ultrasound.


Thank you! We will definitely look at an ultrasound. He hasn't had any changes in symptoms since his ultrasound in 2013 so we aren't too worried. But better safe than sorry!

We will look at the T4 only meds. The thing is, he doesn't really have any hyper symptoms. He did when he first got sick but hasn't in probably 2 years. He tried Synthoid for two months when he was first diagnosed (summer 2013) but didn't feel any change. I don't know if that was because it wasn't the right dose, he needed T3 or reacted to the fillers. He is very gluten sensitive.

It is so hard to know what to do!


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## sc7 (Jun 4, 2015)

I wonder if he has high levels of reverse T3?

"High T4 and low T3 may mean high levels of RT3."
http://www.drrind.com/therapies/thyroid-scale


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## joplin1975 (Jul 21, 2011)

sc7 said:


> Thank you! We will definitely look at an ultrasound. He hasn't had any changes in symptoms since his ultrasound in 2013 so we aren't too worried. But better safe than sorry!
> 
> We will look at the T4 only meds. The thing is, he doesn't really have any hyper symptoms. He did when he first got sick but hasn't in probably 2 years. He tried Synthoid for two months when he was first diagnosed (summer 2013) but didn't feel any change. I don't know if that was because it wasn't the right dose, he needed T3 or reacted to the fillers. He is very gluten sensitive.
> 
> It is so hard to know what to do!


Yeah, two months on synthroid is often not enough. I mean, he couldn't have gotten a dosage change, since you need to wait six to eight weeks between dose alterations.

And he has low free t4, not high free t4 so I don't think the reverse t3 is an issue at this point.


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## Andros (Aug 26, 2009)

Histologic diagnosis of Hashimoto's
http://emedicine.medscape.com/article/120937-diagnosis
(Copy and paste into your browser)

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

http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/
(Copy and paste into your browser)

Substances not found in normal serum (scroll down to autoantibodies)
http://www.thyroidmanager.org/chapter/evaluation-of-thyroid-function-in-health-and-disease/
(Copy and paste into your browser)

TPO and Thyroglobulin Ab
cancer TPO and thryoglobulin Ab
http://onlinelibrary.wiley.com/doi/10.1111/j.1699-0463.1994.tb04888.x/abstract

Understanding Thyroglobulin Ab.
http://www.labtestsonline.org/understanding/analytes/thyroglobulin/test.html

Thyroglobulin Ab and cancer
http://qjmed.oxfordjournals.org/content/59/2/429.full.pdf

Another Thyroglobulin and cancer
http://www.mdlinx.com/endocrinology/newsl-article.cfm/3305021/ZZ5052128790304906121963/?news_id=811&newsdt=092010&subspec_id=419

Your husband "definitely" needs an ultra-sound. The antibodies present demand it. Cancer must be considered but hopefully ruled out.

It is my humble opinion that the course your husband is on is not wise at this time because he does not have a "definitive" diagnosis. Stimulating the immune system also stimulates antibodies against the antibodies.

I am providing information to back that up.


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## sc7 (Jun 4, 2015)

Thank you all for your insight. We will definitely push for an ultrasound. I do need to clarify, though - I may have written some of his labs wrong (sorry - this is confusing)...

What I have labelled TPO is called Thyroid Peroxidase Antibodies and what I labelled TGAB is called Thyroid Antithyroglobulin Antibodies in his lab report. Did I get that right?


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## joplin1975 (Jul 21, 2011)

Yes you did!


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