# FNA Biopsy - Diagnose Hashimoto's in Absence of Positive TPO/AG Antibodies?



## RH789 (Jul 30, 2012)

Hello hugs1

I had a subacute (silent) thyroiditis starting August 2010. Three years later, and I have been physically inactive/fatigued ever since.

My Thyroid labs, off meds are:

TSH 2.79 (Range: 0.40 - 4.50 mIU/L)
Free T4 1.0 (Range: 0.8 - 1.8 ng/dL) (20 percent of range)
Free T3 2.8 (Range: 2.3 - 4.2 pg/mL) (26.3 percent of range)
Reverse T3 20 (11-32 ng/dL)
Thyroid Antibodies (ATA, TPO) NONE
RT3 ratio: 14

As you can see, I have no antibodies. I have never tested positive for antibodies or ANA. I also have zero family history of thyroid disease and/or autoimmune disorders. Since I feel physically exhausted/fatigued and have muscle aches, my endo said that I could possibly be part of that unique 10 percent of people who have Hashi's, but they simply do not test positive for antibodies. Endo said there is only one way to find out: FNA biopsy.

I have no nodules/goiters and have had two clean ultrasounds. I have been on and off thyroid medication FOUR times. Does it make me feel better to be on medication? Maybe a little bit, but not much. NOTHING has helped me feel well enough to get off the couch the past three years.

I have been to a multitude of doctors. I have even spent several days at a major clinic (Cleveland Clinic) to see if any doctor could discover something, ANYTHING wrong with me. Result? Nothing. No doctor could find anything else wrong with me. I have been checked up and down, inside out.

Naturally, I want the biopsy to see if I have Hashimoto's or if I am barking up the wrong tree. I asked my endo if I could get the FNA to determine Hashimoto's diagnosis. He said no and said it was "too invasive".

I still want the FNA. My question is:

Do you think I could find another doctor perform an FNA (in the absence of nodules/goiters) to diagnose Hashimoto's through the hurthle cells in a biopsy? (I don't know if I am making a silly, impossible request or this endo is just extremely conservative and another endo might justify it.)


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## joplin1975 (Jul 21, 2011)

I honestly don't know. But I guess my question is...even if you were dx'ed with Hashi's, your labs are still pretty darn hypo. So, you'd have a name to the condition, but it wouldn't change anything, ya know? So I guess the question is...to what end?

Also...was TPO the only thyroid antibody that was tested?


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## RH789 (Jul 30, 2012)

Thanks for the reply.

I had TPO, AG, and ANA = ALL negative (and tested multiple times)

The thing is, I have been on thyroid medication. FOUR times. Did I feel much better on it? No. Was I able to be more physically active on it? No.

Do I want to get back on the medicine and waste another six months of my life titrating up the dosage when I don't even have a thyroid problem? No.

I want answers. If I have a autoimmune disease, you betcha I want to know for sure.


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## Octavia (Aug 1, 2011)

What other causes of fatigue have you been tested for? Anemia? Low ferritin? Low B12? Low vitamin D?


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## joplin1975 (Jul 21, 2011)

RH789 said:


> Thanks for the reply.
> 
> I had TPO, AG, and ANA = ALL negative (and tested multiple times)
> 
> ...


I hear you -- I do! If I sounded dismissive, that wasn't my intent.

My intent was to say that you ARE clearly hypothyroid. You clearly have some kind of thyroid dysfunction -- your labs support that. Hashi's and hypothyroidism are not one in the same. You would have a cause for the hypo labs, but your treatment plan would remain, more or less, the same. Which is all that titration business that is so frustrating.

Instead of fighting for a FNA (which, again, I appreciate your rationale), I would try brainstorming around other related issues. Off the top of my head (and there are lots of others who are more knowledgeable):

-Vit D
-Ferritin
-testing other thyroid antibodies (TSI, TRAb, Tg and TgAB, TBII)
-gluten sensitivity
-experimentation with adding Cytomel to the mix or possible doing a trial of dessicated thyroid medication

All of those *might* get you to a place where you feel better.


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## jenny v (May 6, 2012)

When you say you've been on thyroid medication four times, could you give us some more detail? What kind of medication? How long were you on the medication each time? Did you do labs while you were on the medication?


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## Andros (Aug 26, 2009)

RH789 said:


> Hello hugs1
> 
> I had a subacute (silent) thyroiditis starting August 2010. Three years later, and I have been physically inactive/fatigued ever since.
> 
> ...


You most certainly should. There are Hurthle cells indigenous to Hashimoto's and those that are indigenous to cancer...........................; do it.

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

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

http://www.mayoclinic.com/health/hurthle-cell-cancer/DS00660

Cancer Hurthle Cells
http://www.thyroidmanager.org/Chapter21/ch01s12.html

Also, antibodies do was and wane. But TPO is not definitive; it is suggestive of many things.

Plus, did you have any of the others listed here?

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://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test

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

TBII
http://www.ncbi.nlm.nih.gov/pubmed/9364248

TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin and 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/


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## Andros (Aug 26, 2009)

RH789 said:


> Hello hugs1
> 
> I had a subacute (silent) thyroiditis starting August 2010. Three years later, and I have been physically inactive/fatigued ever since.
> 
> ...


Try seeing an ENT. I know one thing; your TSH while in range would be too high for the most of us and you hardly have any FREE T3 which is your active hormone.

The majority of us feel best when TSH is @ 1.0 or less and FREE T3 is in the 75% range of the range given by your lab.


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