# Cancer or Hashi or Both?



## LisaB (Feb 20, 2013)

Hi everyone, newbie here.

My story is long and involved, probably like everyone's. Significant hypo symptoms at 28 yrs. old, countless thyroid lab work coming back normal for years, severe hypo symptoms by 33. My story takes a twist in that at 35, I started self-medicating with Synthroid because there was nothing else I could do. That eventually became Westhroid/Naturethroid (the T3/T4 combo). Then came bartering with my primary care doc to reduce self-medication dosage because of hyperthyroid test results. It takes tons of T4 to get my T3 in range and even with T3/T4 combo, my T3 is always low, while my T4 is more solidly in range. Eventually, just a year ago, I had my first tests that came in range on 1 grain per day of Westhroid (halved and taken in am and pm.) But I feel better on 2 grains per day.

Saw an endo(first time ever) and finally got the hypo diagnosis, but only will prescribe T4. Turned that down. Still manage my own meds. Endo did ultrasound because of palpable enlargement&#8230;&#8230;&#8230;overall enlarged gland, multiple nodules throughout my thyroid, right wing with several small mm nodules, left wing with large, complex 1.7cm nodule, and isthmus with hypoechoic 8mm complex nodule which may contain calcifications. Waiting for FNA appt. right now.

My question is, should I be on alert for cancer? I'm confused as to whether or not Hashimoto's presents this way or not. I know you can have both Hashi and cancer, but I would like more info from those who are further on the journey with all this fun stuff than me. I've heard long-standing thyroid disease can cause calcification (in addition to cancer causing calcification.)

Any help would be appreciated. Also to note, even though none of my docs ever seemed to listen to this part, my grandfather was diagnosed with Hashi when he was in 8th grade, circa 1940. 3 out of 5 of his children are on thyroid meds, though my mom was not one of them but I think she should have been. So I have strong family history.

One more confusing element, I guess I tested negative for anti-bodies, but I've never seen the results myself and I highly distrust the doctors to convey full, accurate information.


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## joplin1975 (Jul 21, 2011)

*raises hand* Me!

I have Hashi's and was treated for cancer a year and a half ago. I didn't know I had Hashi's or was hypo, really, until after surgery. I felt pretty sluggish, but I thought that was part of getting old.  Whoops!

Anyway, my ob/gyn noticed I had a lump in my neck and sent me off for all kinds of tests...it all ended up with surgery and RAI to treat the cancer.

Of the three nodules found on u/s, two were solid and one was complex (cystic with calcifications). My thyroid appeared grape-like, the standard for Hashi's, and I had pretty high levels of antibodies.

I'd be suspicious if your antibody test was truly negative.


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## LisaB (Feb 20, 2013)

Thanks so much for your response. How do you feel now?


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## joplin1975 (Jul 21, 2011)

Fantastic.  I say this partly tongue in cheek, but cancer? It was the best thing that happened to me. Life without a thyroid is exponentially better.


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## LisaB (Feb 20, 2013)

Well, I'm glad to hear that!!! I'm trying to be calm but prepared for whatever the scenario may be, but going hypo again scares me big time. It took so much work to finally feel like an able-bodied human being. Hate to mess it up now, but I may not have a choice.


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## joplin1975 (Jul 21, 2011)

I can absolutely understand that. The process was not fun...and there was no way around it. But it was more of a nuisance and, in retrospect, while I felt crummy then, the time past pretty quickly.

Good luck!


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## Andros (Aug 26, 2009)

LisaB said:


> Hi everyone, newbie here.
> 
> My story is long and involved, probably like everyone's. Significant hypo symptoms at 28 yrs. old, countless thyroid lab work coming back normal for years, severe hypo symptoms by 33. My story takes a twist in that at 35, I started self-medicating with Synthroid because there was nothing else I could do. That eventually became Westhroid/Naturethroid (the T3/T4 combo). Then came bartering with my primary care doc to reduce self-medication dosage because of hyperthyroid test results. It takes tons of T4 to get my T3 in range and even with T3/T4 combo, my T3 is always low, while my T4 is more solidly in range. Eventually, just a year ago, I had my first tests that came in range on 1 grain per day of Westhroid (halved and taken in am and pm.) But I feel better on 2 grains per day.
> 
> ...


As you have pointed out, calcification does not always mean cancer but it certainly has to be ruled in or out and I hope the latter is the case.

Has your doctor run Thyroglobulin and Thyroglobulin Ab? This would be important and so is the FNA so I am glad you are making arrangements for that.

Here is a little info which may be helpful.

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

Graves' and Hashi's cancer
http://www.thyroidmanager.org/Chapter18/18-cancothr.htm


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## LisaB (Feb 20, 2013)

Thanks for the info. I don't believe I had those tests, although I don't have copies of my latest bloodwork.


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## CA-Lynn (Apr 29, 2010)

Then your next step is to contact the labs, give them the dates of service, and get copies of the lab tests, to which you are legally entitled.

Self-medicating is never a good idea.


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## LisaB (Feb 20, 2013)

Good idea. Will do.

Believe me, it wasn't my first choice, or even my thirtieth, to self-medicate. It was a necessary evil. I swear I would have died if I didn't take matters into my own hands. It's nice that the doctors are paying attention right now, but they are 12 years late.


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## susieintexas (Mar 4, 2012)

I agree. Get your hands on your labs.


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## LisaB (Feb 20, 2013)

Hey, I'm back.

Good news is my FNA came back benign.

I'm slightly concerned that they only biopsied my dominant nodule and not the nodule in the isthmus that, although it was only 8mm, had "hypoechoic" and "may have calcifications" attached to it. Should I be?

I finally got my hands on test results. No thyroglobulin numbers, but my thyroid peroxidase AB was 17.5 (0-35). I know that isn't a high number, but how is that negative for antibodies? Isn't negative for antibodies zero? Just to round out:

TSH 0.59 (0.27-4.2)
free T4 1.24 (0.7-1.7)
free T3 2.6 (2.6-4.4)

Like some people I read about here, I have trouble getting my T3 up while my T4 is fine. Even on T3/T4 combo meds.

So in the wise opinion of this board...do I appear to have Hashi's? Should I still be alert for cancer since the most suspicious nodule wasn't biopsied? I won't see my endo again until July.


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## lexi731 (Dec 6, 2012)

LisaB said:


> I'm slightly concerned that they only biopsied my dominant nodule and not the nodule in the isthmus that, although it was only 8mm, had "hypoechoic" and "may have calcifications" attached to it. Should I be?


From what I understand, it's very hard to biopsy anything smaller than 1cm so for that nodule, it's really wait and re-check in a few months with an ultrasound to see if there are any changes. I'm in a similar situation with mine - the nodule shows all the signs of being suspicious but it's too small to biopsy. Make sure to get regular (every 3 months or so) ultrasounds to check the size and any changes of the smaller nodule.


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## Andros (Aug 26, 2009)

LisaB said:


> Hey, I'm back.
> 
> Good news is my FNA came back benign.
> 
> ...


That is correct; the answer to you should have been TPO is low in the range. Negative is 0. You are one sharp cookie!

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

And yes, I believe it would be prudent to be concerned about the isthmus. Absolutely. Any calcification makes it suspicious for cancer.

Check this out............

Nodules
Nodules http://www.aafp.org/afp/2003/0201/p559.html

calcified nodules
http://www.ncbi.nlm.nih.gov/pubmed/12112538

Nodules http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1665239/


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## Guest (May 9, 2013)

Dear LisaB , I hope you have a needle biopsy asap. That is what I did soon as they found the nodule . Have you had one ? Annie


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## Guest (May 9, 2013)

Just seen where you had a biopsy was worried for a moment there I missed a post !


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