# Can you have Hashi's without it coming up in bloodwork?



## Zugora (Feb 14, 2010)

Help! Considering my strong family history of thyroid/hashi's issues and my symptoms, I suspect something thyroid is going on. However, all thyroid tests come back "normal", but my ANA antibodies is positive. *Is is possible to have Hashi's without it coming up in the normal bloodwork? 
*
SYMPTOMS:
- Strong family history of hypothyroidism/Hashimoto's. Mother, sister, and every woman on my mother's side is either hypo or has hashi's.
- Severe cold intolerance ( feet,legs, hands, and arms very cold) - getting worse
- Muscle cramps at rest
- low blood pressure (86/50-ish) at times.
- low basal body temp [ave: 96.5 (armpit) & 97.3 (oral)]
- very fatigued, foggy, absolutely no energy
- dizzy feeling at times
- feeling depressed, also anxiety
- arm/hand tingling, numbness
- diagnosed with chronic dry eyes
- dry hair (thinning around temples, front)
- pale in the face
- irregular periods/PCOS
- post nasal drip that won't go away (it doesn't feel like typical allergies)
- feels like something is stuck in my throat at the front of my throat

TESTS:
ANA Antibodies: Positive, but other specific autoimmune tests came back negative
Last TSH: 1.07 (range: .27-4.2)
FT4: 1.2 (range: .85-1.71)
FT3: "normal" don't have the results with me
Anti-TPO: <10.0 (<35) "normal"
Thyroglob AB: <20 (<40) "normal"
Ferritin: 68.3 (range: 13-150)
Vit D: 61.2 (range: 30-100)
Glucose: 95.0 (range: 65-100) High side of normal
Cortisol: "normal", but don't have the results with me
Fasting Glucose: "normal", but don't have the results with me
Head MRI: "normal"

Thanks for your advice regarding this.


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## Andros (Aug 26, 2009)

Zugora said:


> Help! Considering my strong family history of thyroid/hashi's issues and my symptoms, I suspect something thyroid is going on. However, all thyroid tests come back "normal", but my ANA antibodies is positive. *Is is possible to have Hashi's without it coming up in the normal bloodwork?
> *
> SYMPTOMS:
> - Strong family history of hypothyroidism/Hashimoto's. Mother, sister, and every woman on my mother's side is either hypo or has hashi's.
> ...


They say that if a patient has high titers of TPO (thyroid peroxidase) that that means the patient has Hashimoto's. I do not happen to agree w/that and if I recall correctly, you and I did discuss this.

As far as I am concerned, FNA would be definitive for Hashimoto's "if" the patholigist finds and identifies Hurthle cells indigenous to the thyroid.

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

Regarding ANA (Antinuclear Antibodies); what tests did you have.? Were you tested for Lupus?

You may wish to read this about ANA...................

http://labtestsonline.org/understanding/analytes/ana/tab/test

Sounds like you also need a Ferritin test. You have symptoms of low ferritin.

Ferritin (should be 50 to 100; the closer to 100,the better) http://www.thewayup.com/newsletters/081504.htm


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## Zugora (Feb 14, 2010)

Thanks for remembering me, Andros. Yes, still feeling crappy and still struggling to find a diagnosis. I recently moved, so I will be seeing a new rheumy and endo soon.

Ferritin is: 68.3 (range: 13-150) - listed under "labwork".

My TSH has always been 1.7-1.9, but recently I went gluten-free and it is now 1.07. Not sure if there is a connection. Still feel like crap, though.

Had tests for lupus, Sjogren's, RA, Sclerderma, and I think a few others. Blood-work came back "normal". I still think there is something going on with the thyroid, but it's not coming up in the blood-work.


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## Zugora (Feb 14, 2010)

Sorry, the *very last* Thyroid lab-work from new doc was :

*TSH:* 2.24 (range: .340 - 5.60), time before that (last month) was 1.07 (different range: .27 - 4.20)
*
FT4:* 0.9 (range: .7 - 1.9), time before that (last month) was also 1.07 (different range: .85 - 1.71)

Any thoughts on the TSH level going up in one month? It is a slightly different range, though.


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## Andros (Aug 26, 2009)

Zugora said:


> Thanks for remembering me, Andros. Yes, still feeling crappy and still struggling to find a diagnosis. I recently moved, so I will be seeing a new rheumy and endo soon.
> 
> Ferritin is: 68.3 (range: 13-150) - listed under "labwork".
> 
> ...


Some of that blood work might be in normal range but that is tricky. There are some antibodies and immunoglobulins the healthy person should not have at all.

A for instance, TSI (thyroid stimulating immunoglobulin), TPO Ab, Anti-DNA etc.. The list is long. The range is provided only to establish a "baseline" and to detect movement to see if the patient is responding or not to treatment.

Your ferritin is good; keep it there.

Have you ruled out diabetes?

You can look all your lab work up here; many times they will clearly say the the healthy person should have no "whatever."

http://www.labtestsonline.org/


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## Zugora (Feb 14, 2010)

Thanks Andros. I'm seeing the highly recommended rheumy in a few weeks and the highly recommended endo in Nov. Based on last blood work, diabetes was ruled out, although sugar is on the high side of "normal" and I definitely seem to have sugar issues. I'm thin and have PCOS, but ever since going on a gluten-free, low-carb, low-sugar diet, I have had a period every month! There must be a connection! I still suspect something thyroid going on based on the STRONG family history, the symptoms, the discomfort in the front of my throat, and the positive ANA antibodies.

Is there any other blood-work to request besides the ones listed so that I'm prepared for when I see the new docs?

-Thyroid Panel: TSH, Free T3, Free T4
-TSI (thyroid stimulating immunoglobulin)
-TgAb (Antithyroglobulin antibody)
-anti-TPO (Anti-thyroid peroxidase antibody)
-TBII (thyrotropin-binding inhibitory immunoglobulin)
-Various specific auto-immune tests (ie. Sjogren's, Lupus)
-Fasting glucose

Thanks so much!! You are truly a gem for all the help that you provide with this site!! I can't tell you how much I appreciate your input!


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## Andros (Aug 26, 2009)

Zugora said:


> Thanks Andros. I'm seeing the highly recommended rheumy in a few weeks and the highly recommended endo in Nov. Based on last blood work, diabetes was ruled out, although sugar is on the high side of "normal" and I definitely seem to have sugar issues. I'm thin and have PCOS, but ever since going on a gluten-free, low-carb, low-sugar diet, I have had a period every month! There must be a connection! I still suspect something thyroid going on based on the STRONG family history, the symptoms, the discomfort in the front of my throat, and the positive ANA antibodies.
> 
> Is there any other blood-work to request besides the ones listed so that I'm prepared for when I see the new docs?
> 
> ...


Really no specific test for Sjogrens' except the presence of ANA which is "suggestive" of a myriad of things and a biopsy of the saliva glands. Not sure I would do that. Ouchy.

Tests for Lupus are Anti-DNA, C3, C4

You can look that up here: http://www.labtestsonline.org/

It would be good to at least get a sonogram of the thyroid. Just play it by ear with the new doc; see how it goes. And I am saying a special prayer that it goes well. You need help and you need it now.

Thank you for your very nice comment and you have no idea how much I appreciate you and "all" our very wonderful posters. It would be nice to see "everybody" well one day!


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## hochelaga (Jul 10, 2011)

Zugora said:


> Sorry, the *very last* Thyroid lab-work from new doc was :
> 
> *TSH:* 2.24 (range: .340 - 5.60), time before that (last month) was 1.07 (different range: .27 - 4.20)
> *
> ...


Hi Zugora,

Judging from your labs you still look to be hypo. Will you be getting an increase in you meds?

Great that you started the gluten-free diet - apparently it's quite important when dealing with Hashi's and other autoimmune diseases. Also, some Hashi patients (myself included) have swings where TSH goes up and down. The gluten-free diet should help as well as supplements to help with inflammation - omega 3's, vitamin C (important for adrenals too) to name just two.

Have you been tested for adrenal fatigue/insufficiency? It presents with low blood-pressure, low body temperature, fatigue, decreased ability to handle stress, muscle weakness, increased allergies, etc.

Elle


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## Zugora (Feb 14, 2010)

Thanks, Elle. 
You mentioned that I appear hypo based on labs. Could you tell me what is suspicious about my numbers? Thanks so much. I really appreciate it.


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## hochelaga (Jul 10, 2011)

Zugora said:


> Thanks, Elle.
> You mentioned that I appear hypo based on labs. Could you tell me what is suspicious about my numbers? Thanks so much. I really appreciate it.


Hi Zugora,

Your latest TSH is on the high side particularly for someone on thyroid meds. Most people feel best around "1", give or take. Your FT4 is low (and it was last month as well) and most people feel best when their FT4 is in the upper third of the range.

If you have trouble increasing your meds, i.e. start feeling hyper, then check your ferritin and adrenals, and stick to the gluten-free diet.

As far as supplements for the thyroid goes it's important to take selenium (as selenomethionine - 200mg/day is a good dose), zinc, omega 3's, and anti-oxidants. However, for Hashi's don't take seaweeds or iodine. Also, it's debatable whether or not Armour (natural thyroid) is good for Hashi patients - but you don't seem to have the antibodies so probably not your problem.

all the best,
Elle


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## Zugora (Feb 14, 2010)

Thanks, Elle, but I'm not on any thyroid meds and never have been. I'm just trying to figure out what is wrong based on my sxs and lab results. So tired of feeling sick. Thanks again.


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## peacesells560 (Aug 9, 2011)

You can have Hashimoto's and not have the antibodies, but it appears to be pretty rare, I have heard that the percentage who don't have the ABs is anywhere from 5 to 30%. I'm one of them, and was diagnosed based on my endo's interpretation of an ultrasound.


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## hochelaga (Jul 10, 2011)

Zugora said:


> Thanks, Elle, but I'm not on any thyroid meds and never have been. I'm just trying to figure out what is wrong based on my sxs and lab results. So tired of feeling sick. Thanks again.


Hi Zugora,

Ooops! Well, as you probably know by now your blood work can be within the lab ranges but you can still be hypothyroid - hopefully one of your doctors will help figure this out with you.

Doing the g/f diet and starting some thyroid supporting supplements probably won't hurt.

Elle


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## Zugora (Feb 14, 2010)

peacesells560 said:


> You can have Hashimoto's and not have the antibodies, but it appears to be pretty rare, I have heard that the percentage who don't have the ABs is anywhere from 5 to 30%. I'm one of them, and was diagnosed based on my endo's interpretation of an ultrasound.


peacesells560,
Thanks for your input. I'm wondering what your Anti-TPO and Thyroid AB lab results were for testing for Hashi's? Did you have any anti-bodies that showed up? What did the endo find with your ultrasound? Enlarged thyroid? Thanks again.


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## peacesells560 (Aug 9, 2011)

Zugora said:


> peacesells560,
> Thanks for your input. I'm wondering what your Anti-TPO and Thyroid AB lab results were for testing for Hashi's? Did you have any anti-bodies that showed up? What did the endo find with your ultrasound? Enlarged thyroid? Thanks again.


The TPO and TG antibodies were:
TPO - <10 when <35 is considered normal
TGab - <20 when <40 is considered normal.
I have no idea why I don't have the antibodies, the thyroid was inflamed at the time of diagnosis. I wonder if it has something to do with disease progression, I'm pretty sure I've had it since I was 14 and I'm 22 now.
I've never had any other antibody tests done.

There were 2 very small nodules found on the ultrasound, around 5mm or so {about the size of a pencil eraser or a .22 bullet.} I was told they were too small to biopsy.


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## Zugora (Feb 14, 2010)

peacesells560 said:


> The TPO and TG antibodies were:
> TPO - <10 when <35 is considered normal
> TGab - <20 when <40 is considered normal.


Interesting. Your TPO and TGab numbers are exactly the same as mine. See my signature. I'm almost positive I have Hashi's going on considering my sxs (and discomfort in front of throat) and strong family history of it. I'm so glad your endo treated you based on the ultra-sound and your sxs, not just by the bloodwork. I see a highly recommended endo in November and I'll ask for the ultrasound. I have been symptomatic since I was about 16. Symptoms have gotten worse through the years and I'm now 34. Still no diagnosis.


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## Zugora (Feb 14, 2010)

Still suffering with the laundry-list of symptoms listed in this original post including pain/discomfort in the front of my throat and eustachian tube problems. It is not a sore-throat pain, it's a discomfort feeling in the front of throat. It hurts when I turn my head sometimes and sometimes, there is pain that radiates to my ear or to my collarbone. I have had this discomfort for about 2 years and my first episode of it was when I got REALLY, REALLY sick 2 years ago. It was actually very painful then where I could hardly swallow or move my neck. It slowly got better, but the discomfort/mild pain is still there.

I finally see the highly recommended endo next week. Should I ask for a RAIU (radioactive uptake scan)? Do most endos request this test when there is pain in the front of throat?


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## Andros (Aug 26, 2009)

Zugora said:


> Still suffering with the laundry-list of symptoms listed in this original post including pain/discomfort in the front of my throat and eustachian tube problems. It is not a sore-throat pain, it's a discomfort feeling in the front of throat. It hurts when I turn my head sometimes and sometimes, there is pain that radiates to my ear or to my collarbone. I have had this discomfort for about 2 years and my first episode of it was when I got REALLY, REALLY sick 2 years ago. It was actually very painful then where I could hardly swallow or move my neck. It slowly got better, but the discomfort/mild pain is still there.
> 
> I finally see the highly recommended endo next week. Should I ask for a RAIU (radioactive uptake scan)? Do most endos request this test when there is pain in the front of throat?


I would insist on RAIU whether they ask for it or not. Start screaming cancer. That will get some attention, by golly! Hate to use that tact but hey, it works!

Zugora; please let us know. We are all very concerned about you.

If this is a bomb; consider an ENT.


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## Octavia (Aug 1, 2011)

You also need to insist on an ultrasound...I don't see any reference to one in your previous posts on this thread. That discomfort you're feeling could be caused by enlarged thyroid, nodules, cancer, etc. Get an ultrasound not just of your thyroid, but your entire neck, including lymph nodes. The whole shebang.


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## Zugora (Feb 14, 2010)

Octavia said:


> You also need to insist on an ultrasound...I don't see any reference to one in your previous posts on this thread. That discomfort you're feeling could be caused by enlarged thyroid, nodules, cancer, etc. Get an ultrasound not just of your thyroid, but your entire neck, including lymph nodes. The whole shebang.


Thanks, Octavia and Andros. I had an ultrasound of my thyroid at the ENT's office about a year ago. He said that I had a few small nodules but said it was "normal" and that 75% of the population has nodules. I'm kinda thinking, though, that nodules + symptoms + strong family history = a problem.

Can someone tell me when ultrasounds are typically used and when RAIU scans are typically used? What is the difference? What can a RAIU scan show that an ultrasound can't? Thanks.


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## Octavia (Aug 1, 2011)

Zugora said:


> I'm kinda thinking, though, that nodules + symptoms + strong family history = a problem.


I'm inclined to agree with you on this.

I don't know much about RAIU scans, but I can tell you why I had an ultrasound...because I had a big, visible lump in the front of my neck! For me, that lump was going to require surgery regardless of any other kind of scan or test, so RAIU never came up in any of my doc visits.


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