# Possible Hashi's diagnosis... and hives?



## Amanda_Joy (Nov 28, 2012)

So a little background... 6 months ago I went in to my PCP feeling really run down and with a lump in my neck. I had an ultrasound which showed an enlarged thyroid with 2 nodules - 1mm I believe. At that time my PCP tested only my T3 and T4 which were both in the range of "normal" (I don't remember what those labs were) but she said I was right on the edge of being hypo. Her recommendation at that time was to re-test in 6 months. I've continued on with life even though I'm just not myself - some issues are dry hair, hair loss, fatigue, constipation, anxiety, severely dry skin, cold hands/feet, and possible mild depression, although I attribute that to the fatigue. About 6 weeks ago my eyelids started swelling on a regular basis (probably 2 times per week). It got so bad that I ended up in the ER, diagnosed with severe urticaria (hives), my eyelids were swollen shut and whole face was red and puffy. I went to my PCP the following day and she said that it looked like I had Chronic Urticaria but was quick to attribute it to soap or some other "product" I may have used. I was frustrated because I had a feeling that this was a result of my thyroid and NOT some other allergen. Reluctantly, she ran more labs. The results are as follows:

TSH 1.670 (0.55-4.78)
Free T4 1.0 (0.76-1.46)
T3 Uptake (?) 32.8 % (22.5-37.0)
Thyroglobulin Auto Antibody 609.0 (0.0-40.0)

These were the only results given. She said that the high antibodies points to Hashimoto's but she's setting up an appt. for me with the endo. My guess is that it'll be a long wait... So I started researching the urticaria (eye is swelling again!) and found links between Hashi's and Chronic Idiopathic Urticaria or angioedema as both are autoimmune disorders. A couple questions I guess... Is it possible to have severe hypo symptoms but normal test results?? Can hashi's alone cause those symptoms? And has anyone else had issues with hives/angioedema and hashimoto's?


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## Andros (Aug 26, 2009)

Amanda_Joy said:


> So a little background... 6 months ago I went in to my PCP feeling really run down and with a lump in my neck. I had an ultrasound which showed an enlarged thyroid with 2 nodules - 1mm I believe. At that time my PCP tested only my T3 and T4 which were both in the range of "normal" (I don't remember what those labs were) but she said I was right on the edge of being hypo. Her recommendation at that time was to re-test in 6 months. I've continued on with life even though I'm just not myself - some issues are dry hair, hair loss, fatigue, constipation, anxiety, severely dry skin, cold hands/feet, and possible mild depression, although I attribute that to the fatigue. About 6 weeks ago my eyelids started swelling on a regular basis (probably 2 times per week). It got so bad that I ended up in the ER, diagnosed with severe urticaria (hives), my eyelids were swollen shut and whole face was red and puffy. I went to my PCP the following day and she said that it looked like I had Chronic Urticaria but was quick to attribute it to soap or some other "product" I may have used. I was frustrated because I had a feeling that this was a result of my thyroid and NOT some other allergen. Reluctantly, she ran more labs. The results are as follows:
> 
> TSH 1.670 (0.55-4.78)
> Free T4 1.0 (0.76-1.46)
> ...












They need to order FNA on those nodules; did the report say what kind of nodules i.e. cystic, calcified, solid, vascular etc.?

Your Thyroglobulin Ab is very high and that raises an eyebrow. Please read the info I provide.

cancer TPO and thyroglobulin
http://onlinelibrary.wiley.com/doi/10.1111/j.1699-0463.1994.tb04888.x/abstract
http://www.wikigenes.org/e/gene/e/7173.html

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...963/?news_id=811&newsdt=092010&subspec_id=419

The healthy person has a small amount of Thyroglobulin but should not have any Thyroglobulin Ab.

These tests would be a very very good idea.

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583

TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/

When you had the uticaria, did you ingest anything w/iodine? Supplement/vitamins, seafood, Krill Oil?

Listen to your body; your "feelings" are most likely right on.


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## Amanda_Joy (Nov 28, 2012)

Ok, now you have me nervous. Is a high TgAb more indicative of cancer than Hashimoto's? The ultrasound report states: "The thyroid is heterogeneously enlarged. There is a vague mid to upper pole 6 mm nodule on the right. There is a left lobe hypoechoic 4 x 6 mm cyst. There is increased blood flow to the thyroid." (I was a little off before on size ) The endo who reviewed the report before it was sent to my primary didn't seem concerned and said that the nodule is too small for biopsy and recommends one year follow-up.

And no, I haven't ingested anything high in iodine. This uticaria has happened probably 6 or 7 times in the last month but the episode that had me in the ER looked to be more like angioedema. As we speak, I have hives breaking out on my neck 

I'm still waiting on my primary to get back to me with appointment information for the endo.


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## RandomUserAZ (Nov 21, 2012)

From what I've read and what my Endo told me, it is much more indicative of Hashimoto's. Cancer incidence rate is on the order of 1-3%.

I asked my Endo about cancer possibilities and whether or not I needed to do a biopsy via FNA, and he recommended simply monitoring it and doing a followup ultrasound in 6 months to see if there had been any changes. He also started me on a low dose thyroid supplement.

I had very similar labs/ultrasounds to you. My antibodies were 644 and I had multiple nodules with the largest being 1.7cm. Despite this, I felt no sense of urgency from the doctor and had the feeling that this was 'normal'.


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## Andros (Aug 26, 2009)

Amanda_Joy said:


> Ok, now you have me nervous. Is a high TgAb more indicative of cancer than Hashimoto's? The ultrasound report states: "The thyroid is heterogeneously enlarged. There is a vague mid to upper pole 6 mm nodule on the right. There is a left lobe hypoechoic 4 x 6 mm cyst. There is increased blood flow to the thyroid." (I was a little off before on size ) The endo who reviewed the report before it was sent to my primary didn't seem concerned and said that the nodule is too small for biopsy and recommends one year follow-up.
> 
> And no, I haven't ingested anything high in iodine. This uticaria has happened probably 6 or 7 times in the last month but the episode that had me in the ER looked to be more like angiodema. As we speak, I have hives breaking out on my neck
> 
> I'm still waiting on my primary to get back to me with appointment information for the endo.


Increased blood flow is vascularity. This should be pursued further w/FNA.

As far as I know, Thyroglobulin Ab in high titers is "suggestive" of cancer.

Have you read the links I provided?

High TPO is "suggestive" of Hashimoto's; it is not definitive.

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

Please know that I am not saying that there is cancer; my contention is that you need to know that you do not.










http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/


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## surge (Aug 15, 2012)

Hi, Amanda-- I tried to reply to you earlier when the board wasn't up and running. I had a bad flare of hashis starting this summer, on one of my symptoms was shingles. As my body experienced the stress of being majorly inflammed, it threw out sort of mini-bouts of shingles-- they only last 2-3 days, as opposed to 2 weeks. I had shingles in the fairly recent past (2 years ago) and I guess it's still very present in my system. The worse my other thyroid symptoms got-- nausea, sleeplessness, heart rate issues, fatigue, major hair loss-- the more likely I'd have a run-in with the shingles. I had about 5 bouts. Three on my neck, ear and scalp. Twice they hit in my eye. So I think what's happening with you could be this kind of complex reaction-- your body is stressed and as a result, your haywire immune system is also presenting other issues. I'm glad you've got a doctor watching it with you and hope you can do whatever makes sense to support your immune system (trying to reduce inflammation in general with fish oil, limited sugar, dairy. alcohol and gluten, vitamins c and d, etc). Hope the intervening week b/w when I first tried to post and this post has led to some relief for you!


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## piggley (Sep 15, 2012)

surge said:


> Hi, Amanda-- I tried to reply to your earlier when the board wasn't up and running. I had a bad flare of hashis starting this summer, on one of my symptoms was shingles. As my body experienced the stress of being majorly inflammed, it threw out sort of mini-bouts of shingles-- they only last 2-3 days, as opposed to 2 weeks. I had shingles in the fairly recent past (2 years ago) and I guess it's still very present in my system. The worse my other thyroid symptoms got-- nausea, sleeplessness, heart rate issues, fatigue, major hair loss-- the more likely I'd have a run-in with the shingles. I had about 5 bouts. Three on my neck, ear and scalp. Twice they hit in my eye. So I think what's happening with you could be this kind of complex reaction-- you're body is stressed and as a result, your haywire immune system is also presenting other issues. I'm glad you've got a doctor watching it with you and hope you can do whatever makes sense to support your immune system (trying to reduce inflammation in general with fish oil, limited sugar, dairy. alcohol and gluten, vitamins c and d, etc). Hope the intervening week b/w when I first tried to post and this post has led to some relief for you!


Surge, that must have been awful, just awful- My Son had shingles from Glandular fever, he was told to take L lysine along with other stuff-wonder if that would help you if God forbid it got active again...
Amanda, good luck with the Hives, guess all you can do is watch out for inflammatory foods like Wheat and Nightshades and see if that helps,

Right now I have nice big itchy Psoriasis lesions which happened coincidentally with thyroid problems,

(another Day in Paradise when our immune systems go birko)


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## meliss917 (Oct 31, 2012)

In Dec 2010 I had an allergic reaction (shingles) it was never pin pointed what caused it hmmmm thyroid?? I was in the ER the day after it started and it flared the following day also.


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## CA-Lynn (Apr 29, 2010)

Shingles is the reactivation of the chicken pox virus in another form. Anything can activate it, including stress. Often found in people with weakened immune systems.


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## Amanda_Joy (Nov 28, 2012)

Well I finally got in to see an endocrinologist today and left in tears. He took one look at my labs and said I'm fine. He went even further to say that maybe I should see a psychologist for the anxiety and fatigue because it's probably not thyroid related. And he said the hives I've been having (including another huge outbreak just 2 days ago) could be from anything and not likely to have anything to do with hashimoto's. Then he said he wanted to send a note to my PCP to check for Celiacs disease. He ended the appt. by saying that they don't need any further follow up with me and to have a nice day.

I'm so upset right now. He made me feel like this in all in my head and that I'm crazy. I don't even know what to do at this point. My husband wants to find another dr. but they'll probably just tell me the same thing and I'm so tired of this run-around.


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## surge (Aug 15, 2012)

I am so sorry. I know that feeling. It's so frustrating and kills any optimism you can manage to get brewing inside yourself while dealing with complications like hives.

#1: your husband is right. Find another endo.

#2 At the new endo, you need TSI and TPO tested. Did this endo do TPO? That's the one you need to see if this is indicative of hashis, and that would be helpful, as far as planning out future treatments, etc. It would be helpful to know if you do have an autoimmune disorder of some sort since that could be contributing to the frequent hives.

#3 a test for celiac's isn't a bad idea, and I would follow up with your primary, just to see what else the two of you can rule out AND to brainstorm about another endo...this one's a dud.


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## Andros (Aug 26, 2009)

Amanda_Joy said:


> Well I finally got in to see an endocrinologist today and left in tears. He took one look at my labs and said I'm fine. He went even further to say that maybe I should see a psychologist for the anxiety and fatigue because it's probably not thyroid related. And he said the hives I've been having (including another huge outbreak just 2 days ago) could be from anything and not likely to have anything to do with hashimoto's. Then he said he wanted to send a note to my PCP to check for Celiacs disease. He ended the appt. by saying that they don't need any further follow up with me and to have a nice day.
> 
> I'm so upset right now. He made me feel like this in all in my head and that I'm crazy. I don't even know what to do at this point. My husband wants to find another dr. but they'll probably just tell me the same thing and I'm so tired of this run-around.


Listen to your husband, dear one!! Try to find an NP or DO; you don't really need an endo.


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## Amanda_Joy (Nov 28, 2012)

surge said:


> I am so sorry. I know that feeling. It's so frustrating and kills any optimism you can manage to get brewing inside yourself while dealing with complications like hives.
> 
> #1: your husband is right. Find another endo.
> 
> ...


This endo didn't test TPO and when I asked about it, he said that he saw no reason for it. I thought that was a must.... He said that judging by the TgAb results, he would confirm Hashi's but then said he sees no need for further treatment. I'm scratching my head.....


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## jenny v (May 6, 2012)

Dump that endo ASAP and find a new doctor! I had to go through 3 endos before I found a good one, so I know full well how depressing it is to have a doctor tell you you're "fine" and just dismiss all of your symptoms. I had one appointment like that where I sat and cried in my car in the parking lot afterward. You feel alone and frustrated and at your wit's end. But you aren't alone and you're not crazy!

Give yourself a little time to wallow in the frustration and then pick yourself up (or "put on your big girl panties" as my grammy likes to say!) and start the search for a new doctor. You deserve to have someone who will work with you and not just with your labs.


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## Amanda_Joy (Nov 28, 2012)

Andros said:


> Listen to your husband, dear one!! Try to find an NP or DO; you don't really need an endo.


What about an Immunologist/Allergist? Seems they could treat all aspects of my condition?


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## Andros (Aug 26, 2009)

Amanda_Joy said:


> What about an Immunologist/Allergist? Seems they could treat all aspects of my condition?


If you know someone that would be willing to take you on w/the goal of getting you the proper tests and getting you well; go for it.

A patient should never leave the doctor's office in tears for everyday conditions such as ours are. That is just disgraceful and what rankles me more is that we have to pay to be berated, heckled and denigrated.


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## piggley (Sep 15, 2012)

Andros said:


> If you know someone that would be willing to take you on w/the goal of getting you the proper tests and getting you well; go for it.
> 
> A patient should never leave the doctor's office in tears for everyday conditions such as ours are. That is just disgraceful and what rankles me more is that we have to pay to be berated, heckled and denigrated.


You bet Andros,
H Amanda,
Any Drs who belittle and insult people who come to them for help are pathetic losers, their ego has expanded so much its obscured what they are there for. 
When a Dr says, "not sure... its not my field-I will send you to somone who would know" they have my respect. problem is many dont have a clue and cant admit it- 
There is quite a lot of discussion over on Mary Shomons site discussing about whether a Endo is the best bet to sort out thyroid problems, seing as how they seem so blood test obsessed- If you have an opportunity to see an Immunologist I would go for it and see how it goes....


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## CorralesNM (Nov 6, 2011)

Aaarrrggghhh...
Oh, Amanda, not only do you have my sympathy, you have my empathy as well. I have been there. I had an endo tell me the thyroid couldn't be causing the emotional reaction I was having and told me she wouldn't treat me unless I saw a holistic psychiatrist (I already see a therapist and my husband's psychiatrist and therapist because he's mentally ill and I manage his care. I don't need yet another psychiatrist.)
What was going on with me was a Vitamin D deficiency which was causing every single symptom I had, and the endo had never checked my Vitamin D levels. I'm not saying you have a Vitamin D deficiency, by the way, I'm just saying that I, like you, was completely dismissed. 
People on the board here and your husband are right, get another doctor. 
I hope you feel better soon.
Hugs...


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## Amanda_Joy (Nov 28, 2012)

Thanks for all the advice! I went back to my primary dr. on Friday b/c I woke up covered in hives again (eyes swollen shut, ect.. ugh, it's getting old). This was the first time she saw me like this. I guess my explanations weren't getting the point across before because she took one look at me and said "Oh my god!!" (second dr. to use that term with me, haha!). She told me that she too is convinced that this is related to my thyroid issues. So I finally have someone in my camp. She made an appt. for me with an Allergist/Immunologist next week. They're going to do the whole allergy testing work-up first, to rule that out as a cause. I'm feeling much more optimistic! Although, no antihistamines for the week before my appt. could be REALLY awful =/


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## Andros (Aug 26, 2009)

Amanda_Joy said:


> Thanks for all the advice! I went back to my primary dr. on Friday b/c I woke up covered in hives again (eyes swollen shut, ect.. ugh, it's getting old). This was the first time she saw me like this. I guess my explanations weren't getting the point across before because she took one look at me and said "Oh my god!!" (second dr. to use that term with me, haha!). She told me that she too is convinced that this is related to my thyroid issues. So I finally have someone in my camp. She made an appt. for me with an Allergist/Immunologist next week. They're going to do the whole allergy testing work-up first, to rule that out as a cause. I'm feeling much more optimistic! Although, no antihistamines for the week before my appt. could be REALLY awful =/


It sounds like your whole body is attacking it's self. I hope you get more relevant testing done. So worried for you.


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## surge (Aug 15, 2012)

It means a lot when a doc finally sees and agrees with you. It sustained me through some ups and downs after I heard my primary say, "You've been so patient. We're going to figure this out." I hope your encounter with the primary went a long way to erase the ignorant dismissal from the endo. I'm glad you're getting care, and ugh, good luck making it through the week w/o anti-histamines! It's for a good cause!


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