# Hashi's or hashitoxicosis or ?



## thumper54 (Sep 2, 2013)

I just had a second FNA because the first was insufficient. I'm hopeful for a diagnosis this time because as the tech and radiologist were looking at the slides the radiologist said it looks like hashis. I've been miserable for four months this time with hyper symptoms/labs and being treated with PTU and prednisone. Since I never have shown high antibodies for ThyAB or TPO, I was wondering if the same might be true for TSI or Trab (which have never been tested. If I'm hyper and they dx hashis, does that mean I also have Graves? Weird things are going on with my labs, like my PTT is high and the PT is on the highest number of the range. And while my ferritin has always been 76-78 its now 120. And I've always been low Vit D even when supplemeting, but latest labs without supplementing is showing in the upper limits of normal. Also, if this is hashis, is the PTU the right treatment. Last labs were four weeks ago, but I still don't feel any different. Those showed undetectable TSH, FT4 3.4 (0.7-1.7). They didn't test FT3, but T3 was my highest ever at 149 (mid range). Shouldn't it be high too? I expect to have results next week, but the possibility of hashis raised these questions in my mind and my doctors are not as well versed as you all are on here. (I'm doctor shopping, but not until Jan due to insur). Thank you.


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## Lovlkn (Dec 20, 2009)

> Also, if this is hashis, is the PTU the right treatment. Last labs were four weeks ago, but I still don't feel any different. Those showed undetectable TSH, FT4 3.4 (0.7-1.7).


PTU is for Graves. Are you taking PTU? Your labs indicate that you are hyper. Have you asked your doctor for a TSI test?


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## thumper54 (Sep 2, 2013)

I can't get the doctor to do antibody testing at all. They kept thinking I had viral thyroiditis, but nothing was adding up. Since the TPO and ThyrAB (out of pocket) weren't suggesting Hashis, if the path says Hashis will that mean I have Graves since I'm hyper?


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## joplin1975 (Jul 21, 2011)

thumper54 said:


> I can't get the doctor to do antibody testing at all. They kept thinking I had viral thyroiditis, but nothing was adding up. Since the TPO and ThyrAB (out of pocket) weren't suggesting Hashis, if the path says Hashis will that mean I have Graves since I'm hyper?


Not necessarily. It gets confusing because Grave's and Hashi's can co-exist. I believe (someone how has Grave's will have to correct me if I'm wrong), there are certain criteria for Grave's...if you don't meet those criteria, then you are hyper due to Hashi's.

I think the antibodies tests are really, really important. If you are hyper due to Hashi's, you'll likely cycle back to hypo and need to constantly monitor your meds. I don't doubt you are miserable...I had TPO, Tg, and TSI...life is so much better without a thyroid when you have so many conflicting antibodies.


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## thumper54 (Sep 2, 2013)

My concern is that if they do find its hashis from the path, but I have never shown high antibodies, would the antibody test for Graves be any different? I've know for 30 years that something was wrong, but have never been able to find out what. This biopsy, if it shows anything, is a victory.... I will spend the money to get a TSI test, but if it also comes back negative, what will I have proven? Can a FNA tell if its Graves like it can for hashis?


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## thumper54 (Sep 2, 2013)

Another question - if I'm taking PTU and prednisone can I still check my antibody levels now or do I have to wait until I'm off of them?


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## Andros (Aug 26, 2009)

thumper54 said:


> Another question - if I'm taking PTU and prednisone can I still check my antibody levels now or do I have to wait until I'm off of them?


I was going to say that the pred especially could skew your antibodies' tests. After all, the sole purpose of prescribing in many many cases of other patients is to quell the antibody activity.


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## thumper54 (Sep 2, 2013)

How long then do you think I should be off of them before I take the TSI test? I have only been taking it almost a month with decreasing levels each week and due to be off altogether by Monday.


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## thumper54 (Sep 2, 2013)

As you know I have been having trouble getting a definitive diagnosis of what is going on with me. The VA has said its viral thyroiditis, then maybe Hashimoto's thyroiditis, then, maybe it is a nodule like the other hospital said, and then when the last FNA was done last week, the radiologist said it looked like Hashimoto's thyroiditis to him as he looked at the slides (but he did say that he wasn't a pathologist). None of this has been a traditional textbook anything.....

Yesterday I went to a new endo and he was great. He was calming and spent almost an hour and a half with me! I had picked up the path results from the FNA on the way to his office and while the radiologist wrote Hashimoto's thyroiditis on his final evaluation, the path does NOT say anything like that. It says "The specimen is low in cellularity and consists of a few aggregates of small, uniform, bland appearing follicular cells, rare aggregates of globular colloid are present. Atypical features, such as a repeating microfollicular pattern, papillary cluster, intranuclear inclusions, and nuclear grooves are not identified. This is a benign thyroid aspirate with no evidence of malignancy". The new endo looked at the path report and at the ultrasounds from both facilities and said I have a large nodule; it is not thyroiditis! He said he thought it was developing back in January and didn't just pop up in August when I became symptomatic, so that was a new thought. My blood work was TSH 6.71 (.27-4.2) and FT4 0.8 (0.7-1.7), so the PTU is working. He had me lower the dosage and will recheck in 6 weeks (just like I read on here that it should be). He is checking FT3 and FT4 (again, I'm thinking I've got a keeper!). And he took blood for TPO and TSI. Those results should be back in a week. When I asked about the prednisone messing up those results, he said it shouldn't make a big difference. He says we will do another ultrasound in four months. So, what do you think, does this sound to you all like a good plan of attack?


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## Prolixity2013 (Nov 8, 2013)

Sounds like a keeper for an endo.

When my endo suspected thyroiditis he performed a complete blood cell count or CBC and an Erythrocyte Sedimentation Rate or ESR in addition to my regular thyroid tests. And this showed a definite infection as my WBCs were elevated and my neutrophils and lymphocytes were skewed and my ESR was elevated. An ESR detects inflammation. My TSH was elevated and my thyroid gland swollen on the right side. It looked as if I swallowed a golf ball. Most doctors/endos would not even think of doing a CBC and ESR for thyroiditis. I had it happen three times and all during the winter months.


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## thumper54 (Sep 2, 2013)

Was your pericardial effusion at all related to your thyroid? I ask because I have had a chronic mild effusion since 2009 and I have no idea why. I saw a cardiologist a year ago who said I have inflammation somewhere in my body and I need to find out where it is and fix it, but my other doctors are not interested. My CRP level which also rates inflammation has been elevated this whole time too (Up to 6.9). I have had trouble for years (30) and have picked up many labels such as mitral valve prolapse, Epstein Barr virus, chronic fatigue, fibromyalgia, and POTS, but these are mostly diagnoses of exclusion - and many doctors don't believe in them because of that. They also fall into the dysautonomia category and I don't know yet what that might mean as dysautonomia is not well understood yet. Anyway, I did have CBC and ESR run and while my WBC almost doubled and neutrophils were higher than before, they were both still within the normal range and the ESR was just over the normal range by 2. I don't think I respond normally to anything because I never seem to test outside limits, but have severe symptoms and reactions. I spent a year eating only raw fruits and vegetables and that really helped with the pains from what they said was fibromyalgia and until this thyroid flare up, I'd been doing well with pain. But now some of them bay be returning (like heel pain). We eat a clean diet, no junk food, mostly organic fruits and vegetables, occasionally some grass fed meat, no gluten. I thought we'd gotten on top of things healthwise until this time last year when I got a kidney infection (no symptoms). Tachycardia that began then is only under control this last month since I began anti thyroid meds. But the hand tremors that began recently and are related to hyper are different from the newest tremor that is left sided only and shakes anywhere from my shoulder blades to the tips of my fingers. I have a friend with Parkinson's and it reminds me of that kind of tremor. Annoying....


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## Prolixity2013 (Nov 8, 2013)

Pericarditis and pericardial effusion are related to thyroid disease. I did extensive research into thyroid disease to discover the links to certain diseases and conditions.

With thyroiditis my ESR was only slightly elevated. With pericarditis and pericardial effusion my ESR about 10 over. The treatment for the pericarditis and effusion was high doses of Ibuprofen. I took 600 mg three times a day for three months. And they used another drug protocol which is popular in European countries. The European protocol is Colchicine and Ibuprofen together. The Colchicine is given until symptoms appear, usually 2 mg, and then backed off to 1 mg until symptoms subside and then raised again and so forth.

Like you, I am sensitive to drugs and have untoward and idiosyncratic (outside the norm) reactions to them. The most I took of Colchicine was 1 mg along with the 1800 mg of Ibuprofen a day. I had to take Nexium to prevent stomach erosion from the Ibuprofen. I was on Flecanide for the atrial fibrillation. My cardiologist assured me that the pericardial effusion and pericarditis would not return. They have not. Some people get recurrences as if it were a cold, coming back on a yearly basis. The Ibuprofen is prescribed and reduces the inflammation. The European protocol prevents recurrences of pericarditis and effusion.

The life saver for me in the ED on the day I almost died from pericarditis and severe atrial fibrillation was Toradol. It took away my pain and inflammation for 24 hours.

I had that left sided tremor in my arm and hand and then found out I was overmedicated again.


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## thumper54 (Sep 2, 2013)

Did your research indicate if the pericarditis and pericardial effusion was related to hypo, hyper, antibody activity, or ? I took aspirin at first and then was switched to colchisine. I haven't had another echo to see if it's gone or not, but I feel better.


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## Prolixity2013 (Nov 8, 2013)

I went back into my research files and found this info on pericardial effusion. The conditions/diseases which cause it are:

Rheumatoid Arthritis

Systemic Lupus

Scleroderma

Rheumatic Fever

Wegener's Granulomatosis

Ankylosing Spondylitis

Inflammatory Bowel Disease

Thyroid Disease

When I was in the ICU they tested me for all of these believing that I must have at least one of them. Zip.

Other conditions or problems which can cause pericardial effusion:

*Drug Induced Pericardial Effusion *

• Procainamide

• Hydralazine

• Phenytoin

• Isoniazide

• Minoxidil

• Methysergide\ergot derivative

• Phenylbutazone\NSAID

• Anticoagulants

• Cromolyn Sodium

• Dantrolene

• Thrombotics

• Penicillin

• Doxorubicin/ Adriamycin

• Cytoxan/ Cyclophosphamide

*Cardiac Pericardial Effusions *

• Myocardial Infarction

• Postmyocardial Infarction "Dressler's Syndrome"

• Trauma

• Aortic Dissection with Hemorrhage into Pericardial Space

• Postpericardiotomy


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## Prolixity2013 (Nov 8, 2013)

thumper54 said:


> Did your research indicate if the pericarditis and pericardial effusion was related to hypo, hyper, antibody activity, or ? I took aspirin at first and then was switched to colchisine. I haven't had another echo to see if it's gone or not, but I feel better.


I think the connection to thyroid disease has to do with cardiomegaly or heart enlargement. In one article it said that the Hashi's has caused the condition. There is definitely an autoimmune factor involved.

I was originally diagnosed with cardiomegaly and was told it would go away as my thyroid disease improved. To get the proper diagnosis I had to hear the most outrageous conclusions by ED doctors. I was accused of many things including faking it for attention. One ED doctor actually told me to go home and take two Advil the next time one of these episodes comes on.


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## thumper54 (Sep 2, 2013)

Thank you for checking that for me. I had read that too about the enlarged heart, which I also have. And I too have been told that I'm depressed, want attention, am a hypochondriac, it's just anxiety, etc. I think that seems to be the standard protocol when they don't know what's going on to blame the patient. I stopped trying to find out what was going on for almost 20 years because it was just too hard to subject myself to that, but I'm trying again and my husband has been a wonderful support during this. I'm grateful because I know not everyone has that. You probably know more about the thyroid than you ever thought you would. I know I'm learning all I can because it's self preservation. Which state are you in, maybe we've crossed paths? I'm in Oregon.


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## Prolixity2013 (Nov 8, 2013)

I'm in Washington and have lived in Oregon and California.


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## thumper54 (Sep 2, 2013)

I'm from CA originally, but have also lived in WA - Columbia River Gorge area. Is your PTSD under control now? Many people today have this from military deployment, mine was from abuse, but thankfully I've been doing well with it for the last few years. No meds, no shrinks...


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## Prolixity2013 (Nov 8, 2013)

Unfortunately, mine is not and requires meds.

After several years with no memories, my mother died and new memories emerged. My PTSD symptoms went from tolerable but not good to untolerable. When I was 3 years old I witnessed a murder and after that my PTSD began.


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## thumper54 (Sep 2, 2013)

I'm so sorry for the cause of your PTSD. I'm glad you're dealing with it now, though, so it doesn't keep affecting your life to the same degree. I wish there was a short cut for you..... Do you think that the multiple health problems you deal with are related to the trauma at such a young age?


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## Prolixity2013 (Nov 8, 2013)

thumper54 said:


> I'm so sorry for the cause of your PTSD. I'm glad you're dealing with it now, though, so it doesn't keep affecting your life to the same degree. I wish there was a short cut for you..... Do you think that the multiple health problems you deal with are related to the trauma at such a young age?


My therapist does and I agree with him. Allergies started to bother me around age 11 and they are immune responses. Those followed the year I saw more murders. I only figured out these occurred after my mother died as she hid the truth about my father from me. He was a serial killer. At 3 I witnessed him murder someone and yet at the time I didn't know he was my father. I called him "the crazy man."


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## thumper54 (Sep 2, 2013)

Wow! That's a lot to take in and with your mom gone too, no one can answer some of the questions you must have. I'm glad you have a good therapist. My experience is that they can be as hard to find as a good thyroid doctor. I know that for my husband, who had suppressed memories of childhood trauma, that when the stuff came up, with a good therapist, he was able to work through much of what happened, but it still took time to be able to feel OK around people. It's so strange how our bodies will respond to things that our mind can't remember and trigger the PTSD. Certain places or the way people look, etc. Are you a Bible reader at all? We have found that reading it really helps, it's calming, especially the Psalms.


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## Prolixity2013 (Nov 8, 2013)

I'm not able to read the Bible because of the nature of my father's abuse. However, I listen to praise and worship music and that helps me deal with the memories. I have a close relationship with the Lord too.


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## thumper54 (Sep 2, 2013)

I'm glad you can at least find comfort in music....
Did you ever find out what caused your high B12 levels?


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