# Hashimotos



## Summer555 (Apr 9, 2015)

Hi I've been told I have Hashimotos but my symptoms are a mixture and I can't understand them.

Over active symptoms - sweating, weight loss, bulging eyes, tremor
Under active symptoms - constipation, joint pain, arthritic pain in knee, heavy periods, pale skin, hair loss

Recent labs say I'm normal but I don't feel normal. Can someone please advise?

TSH 2.87 (.2-4.2)
Free T4 - 14.7 (12-22)
Free T3 - 3.8 (3.9-6.7)
Peroxidase antibody - 141 (<34)
Thyroglobulin antibody - 103.5 (<115)


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## Andros (Aug 26, 2009)

TBII
http://www.ncbi.nlm.nih.gov/pubmed/9364248
http://en.wikipedia.org/wiki/Anti-thyroid_autoantibodies
(Copy and paste into your browser)

Blocking TRAbs (also known as Thyrotropin Binding Inhibitory Immunoglobulins (TBII)) competitively block the activity of TSH on the receptor. This can cause hypothyroidism by reducing the thyrotropic effects of TSH. They are found in Hashimoto's thyroiditis and Graves' disease and may be cause of fluctuation of thyroid function in the latter. During treatment of Graves' disease they may also become the predominant antibody, which can cause hypothyroidism.

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

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/health-medicine/understanding-thyroid-why-you-should-check-your-free-t3
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Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm
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Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.

TPO Ab should be negative, 0
http://www.nlm.nih.gov/medlineplus/ency/article/003556.htm
(The normal thyroid has TPO but should not have antibodies to TPO)

Thyroglobulin Ab
A negative test is normal. A negative test means no antibodies to thyroglobulin are found in your blood.
http://www.nlm.nih.gov/medlineplus/ency/article/003557.htm
(The normal thyroid has Thyroglobulin in low titers but should not have Thyroglobulin Ab)

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)

Welcome to the board!

Have you had an ultra-sound of your thyroid? If not, you really really need to press for that! Antibodies demand it!

Your FREES are very very low. So, I know you don't feel good.

Info above............ Lots of reading but it will serve you well.


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## Summer555 (Apr 9, 2015)

Thank you 

I had an ultrasound 3 years ago and the doctor said to me afterwards the thyroid was enlarged and was bulky on one side.

I've examined my thyroid from the front and I can feel round lumps where it is, mostly in the middle. I have trouble swallowing and I get pain in my neck sometimes.

Is another ultrasound a good idea? The doctor is adamant there's nothing abnormal.

Sorry, I forgot to mention, I'm on T4 only. My doctor stopped it a year ago because my TSH was suppressed and she thought I over medicated but I hadn't done that at all. It was only when my TSH rose again and my hypo symptoms crept back in that my doctor put me back on the T4.


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## joplin1975 (Jul 21, 2011)

You should definitely have another ultrasound, particularly if you hare having trouble swallowing.


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## Summer555 (Apr 9, 2015)

joplin1975 said:


> You should definitely have another ultrasound, particularly if you hare having trouble swallowing.


My doctor has felt my neck, she says she can't feel anything but I put my point across by saying over and over again that I can feel lumps in the thyroid area. She has said that even though my thyroid test is normal she has now referred me to an endocrinologist who I'm hoping will order an ultrasound.


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## joplin1975 (Jul 21, 2011)

Good! Tell them you are having trouble swallowing and that sometimes food feels like it gets "stuck"...that should get you an ultrasound.


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## Summer555 (Apr 9, 2015)

joplin1975 said:


> Good! Tell them you are having trouble swallowing and that sometimes food feels like it gets "stuck"...that should get you an ultrasound.


Will do! 

I've sent a letter to my doctor setting out what I want done, including the ultrasound through an endocrinologist if not through an ultrasound department. Although I saw the doctor last week about this there is nothing to say on their system that I requested to see an endocrinologist. I'm just wondering if I'll be expecting a letter instead but how long that could take I don't know.


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## Summer555 (Apr 9, 2015)

Update:

My doctor is now referring me to a specialist. The referral has gone through today.

BUT

I am not having a dose increase even though I have hypo symptoms from my latest results. The ones at the start of the thread are for March. Here are April's:

TSH 3.52 (.2-4.2)
Free T4 12.8 (12-22)
Free T3 4.4 (3.9-6.7)

Any ideas please?


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## Andros (Aug 26, 2009)

SUGGESTED TESTS
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/
(Copy and paste into your browser)

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583
(Copy and paste into your browser)

Truly; do consider getting a better doctor. Once on thyroxine replacement, always on and you "do" need an ultra-sound and further testing for antibodies.

Be proactive. We will try to help you do that best we can from afar.


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## Summer555 (Apr 9, 2015)

Andros said:


> SUGGESTED TESTS
> 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.........
> ...


Thank you, when I see the endo I'll be asking for an ultrasound and retesting for antibodies.


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## Summer555 (Apr 9, 2015)

ANA, TPO and TG have been checked privately, I'm still waiting on the results of those. I forgot to add. The others weren't part of the package of the private test.


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## Summer555 (Apr 9, 2015)

I spoke to my doctor about the ANA results, she said she doesn't have them on screen under my notes. I asked her where they would be and she said that they were requested through immunology at my local hospital. I haven't heard about the results because I figured no news is good news but I'm wondering if it's likely that the appointment with immunology in a month's time would be when they're going to talk to me about them.

Shall I wait until then to know about the results, get the appointment moved to an earlier date or call the department?


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## Summer555 (Apr 9, 2015)

Update: I went to a doctor appointment yesterday. This is what has been said.

The doctor believes my blood test results are in range and I can't have an increase until I see a specialist

An urgent specialist referral has gone through and I should expect to hear back within a month

The specialist might want to run more tests. What they will be I'm not sure

The doctor thinks I've gotten worse especially since I have lost 5 kilograms in a week

She thinks something else is going on

In the referral she has written that a new treatment plan needs to be written up because she thinks the previous consultants I've seen didn't give adequate follow up

My thyroid stimulating hormone levels are all over the place and aren't stabilizing on a substantial amount of thyroid meds

It's funny how she's said my blood test results are normal but my TSH is not stabilizing...


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## Andros (Aug 26, 2009)

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583
(Copy and paste into your browser)

TBG (thyroxine binding globulin) up, hypo............down, hyper
http://www.nlm.nih.gov/medlineplus/ency/article/003374.htm
(Copy and paste into your browser)

TBII
http://www.ncbi.nlm.nih.gov/pubmed/9364248
http://en.wikipedia.org/wiki/Anti-thyroid_autoantibodies
(Copy and paste into your browser)

Blocking TRAbs (also known as Thyrotropin Binding Inhibitory Immunoglobulins (TBII)) competitively block the activity of TSH on the receptor. This can cause hypothyroidism by reducing the thyrotropic effects of TSH. They are found in Hashimoto's thyroiditis and Graves' disease and may be cause of fluctuation of thyroid function in the latter. During treatment of Graves' disease they may also become the predominant antibody, which can cause hypothyroidism.

Antibodies cause constant fluctuation of TSH. There are binding, blocking and stimulating antibodies to the receptor sites.


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## Summer555 (Apr 9, 2015)

Andros said:


> Trab
> http://www.ncbi.nlm.nih.gov/pubmed/17684583
> (Copy and paste into your browser)
> 
> ...


Thank you Andros 

When I get a date for the endocrine clinic I'll write down the list of antibodies you kindly suggested. I don't see how they can say no.


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## Summer555 (Apr 9, 2015)

2 results have come back.

Peroxidase antibody - 47.5 (<34)
Thyroglobulin antibody - 286 (<115)

Endocrinologist referral is now into its first week where I haven't heard anything. At this appointment I hope to get the TRab, TSI and TBII antibodies measured. I feel very hypo at the moment.

The doctor has said I have Hashimoto's going by the antibody results, and not Graves, because the TSH would have been low and the Free T3 and Free T4 would be high. He then said if he could he would give me T3 but the health company can't afford to dispense it hence why I'm still on synthetic thyroxine.

The doctors have already told me to let things run their course with the referral. I have pestered them today to up my meds which they have (finally!) done.


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## joplin1975 (Jul 21, 2011)

Summer555 said:


> 2 results have come back.
> 
> Peroxidase antibody - 47.5 (<34)
> Thyroglobulin antibody - 286 (<115)
> ...


Uh, yeah, again...you need an ultrasound.


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## Summer555 (Apr 9, 2015)

joplin1975 said:


> Uh, yeah, again...you need an ultrasound.


I'll ask for this at the endocrinologist appointment. The doctors are giving me the impression they don't want me to see them.
When I get a date for this I'll let you know.


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## Andros (Aug 26, 2009)

Substances not found in normal serum
http://www.thyroidmanager.org/Chapter6/Ch-6-6.htm
(Copy and paste into your browser)

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)

Insist on that ultra-sound. TPO is only suggestive of Hashimoto's; it is not a definitive diagnosis.

High TPO and high Thyroglobulin Ab are also "suggestive" of cancer; it is not definitive.......................but the ultra-sound is a start and after that FNA.

Please read the info above. Go armed w/credible information.

Sending hugs your way...........


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