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Old 08-25-2011, 02:31 PM   #1
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eshigu HB User
Exclamation Help! Confused About Hashimoto's

Hi everyone. I am a 22 year old female and have recently had a lot of symptoms related to some kind of thyroid problem. One of the more worrying symptoms that actually got me to go to the doctor was a loss of my menstrual cycle. They decided to test my thyroid, and my test came back "abnormal," I was told. I was then sent to an endocrinologist, who looked at my lab results and decided to treat me with Levoxyl (75mcg per day) - I was also told to go get an ultrasound. I had that done, and no nodules were found.

What I am confused about is the fact that on my ultrasound order, the endocrinologist put "Hashimoto's" in the "symptoms/diagnoses" field. I had no idea what this was, so I looked it up online and read that it is an autoimmune disorder. I don't know how she came to that conclusion, however, since my antibodies do not seem to have been tested. And, for the blood work that I am to have in 2 months, she did not order the TPOAb and TGAb tests.

Why would she write down Hashimoto's, and then not order those tests? Instead she ordered another round of Free T4 and TSH tests, along with insulin and cholesterol tests.

Basically I am just confused out of my mind, and could really use some help working through all of this. For quick reference, here are my symptoms and test results:

SYMPTOMS:
extremely tired all the time
loss of period
weight gain

TEST RESULTS:

T4, FREE, NON-DIALYSIS
result = 1.0
reference range = 0.8 - 1.8

TSH W/ FREE T4 RFX
result = 4.59
reference range = 0.40 - 4.50

Any comments / help at all would be greatly appreciated. Thanks!

 
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Old 08-25-2011, 04:49 PM   #2
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Alexandra23 HB UserAlexandra23 HB UserAlexandra23 HB UserAlexandra23 HB User
Re: Help! Confused About Hashimoto's

Hi,

Your TSH is high so it does look like you have Hashimoto's which is an underactive thyroid. It's diagnosed mostly on TSH and T4 initially rather than antibody tests.

The important blood tests you want to have done are TSH, freeT3 and freeT4. Ask your doctor to add in freeT3 to your blood tests. T3 is the active version of T4. Antibodies are also useful to have. If they are high they will confirm the diagnosis (but there is a 20% chance you can get a false negative with this test). If they are not high it's still useful because it can be used to compare against future tests.

Having an untreated underactive thyroid can give you high blood sugar and high cholesterol so that's why those have been ordered.

Extreme tiredness and weight gain are classic symptoms and loss of periods is too (although people more often get heavier periods, it is a symptom and I have no periods too because of it).

I think it would be helpful if you looked up full lists of symptoms as you may have other symptoms. It affects the whole body so there is a long list. Just look up something like "checklist of hypothyroid symptoms".

You've taken a great step by coming to this board. It's given me a lot of useful advice.

Thyroid medication will take a while to work. It usually takes 3 weeks to notice a difference and it takes 6 weeks to get into your blood so they can test your levels again. It can take some time to get the right level for you and in reading this board you will find many people trying to get their doctor to get the right dose for them, the optimal dose or set point, rather that just getting them into the "normal range". The good news is that you don't really get side effects with thyroxine. It's the same drug as your body would make so you only really get side effects if you take too much.

It will take a while but you will get better

 
Old 08-25-2011, 05:27 PM   #3
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eshigu HB User
Re: Help! Confused About Hashimoto's

Thank you for the information and help. I will ask the doctor about including some of those tests (like the T3) and inquire as to why she left them out. I think mostly I was mostly upset because I was finding out this stuff myself instead of having her talk me through it. And that's good to know about the drug. Thanks again!

 
Old 08-25-2011, 10:48 PM   #4
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Re: Help! Confused About Hashimoto's

Eshigu,

I just wanted to say hang in there. If you ever want to talk I am here. I just recently been diagnosed with Hashimoto-secondary hypothyroid. I have my list of questions as well. Just know that you are not alone!

Blessings
Missydawn

Last edited by Administrator; 01-08-2012 at 01:50 PM.

 
Old 08-26-2011, 06:17 PM   #5
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Re: Help! Confused About Hashimoto's

First off you can not tell an autoimmune thyroid disorder by TSH. Not saying any more on that fact.

How your MD noted Hashimoto's via the ultrasound is explainable. First you have to know a bit about the traits of the autoimmune disorder.

Hashimoto's produces TPO AB and TG AB. These are specific antibodies that attack thyroid specific hormones.

The TPO enzyme is used to transport and shuttle T4 in the thyroid. So when TPO is produced and activated it triggers a Hashimoto's suffer to produce TPO Ab to counter the TPO. This TPO Ab literally destroys the thyroid tissue cell to get at the TPO and destroy it. The same goes with TG activity and the TG Ab response.

So what was seen in your scan was mottled and blotchy thyroid tissue. This is a VERY characteristic signature for Hashimoto's destruction of the thyroid. An RAI Uptake scan would show streaks and zones of blue/black dead thyroid tissue.

I would request a thyroid antibody panel run. Why? Well thyroid antibody levels can cause symptoms too. Also the more antibodies you have the quicker your thyroid is going to meet its maker. Extremely high levels of antibodies have been detected in cerebral fluid and noted for attacked mylan in your neural pathways.

TSH is a rough indicator of thyroid health from the view point of your pituitary gland. Your true measure of thyroid function are your FT3 and FT4 DIRECT values.

Antibody thyroid tests are not 100% definitive. There are false negatives. Rarely if ever false positive. The 100% definitive diagnostic test for Hashimoto's is a tissue biopsy. What is the signature of Hashimoto's is the tell tale shredding of the thyroid tissue. WHen Hashimoto's is done with your thyroid you have a noted shredded mass of atrophed tissue. That is what my ENT sees these days. He still checks because I have a weird 9 mm spherical nodule on one side that seems impervious to my antibodies which peaked at >10,000.

You might want to look up an old thread series of mine. Search for threads by mkgbrook and look over the thyroid care and concerns series.

Hope this helped answer the science behind the scan results and what Hashimoto's does.

Sincerely,
MG
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Old 08-26-2011, 06:52 PM   #6
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Re: Help! Confused About Hashimoto's

eshigu;

First you should request the TPOAb and TGAb tests as diagnostic support of your scan.

Why would she write down Hashimoto's, and then not order those tests?

TEST RESULTS:

T4, FREE, NON-DIALYSIS
result = 1.0
reference range = 0.8 - 1.8

Let me show you how to analyze these results:
1.0 - 0.8 = 0.2
0.2/(1.8 - 0.8) = 0.2
0.2 * 100 = 20%

So what does this percentage tell you. Your in normal range right? Well normal is often not normal for you. Optimal region for a woman of your age is 60-80% of normal. NOT 20%. You are WAY to low in T4.

TSH W/ FREE T4 RFX
result = 4.59
reference range = 0.40 - 4.50

First this lab is not upto date on its ranges. Normal range for TSH is actually 0.4-2.5. Hashimoto's patients actually have recommended TSH range narrower than THAT! Either way being above 4.5 denotes you as being hypothyroid.

You do need to get an FT3 run in parallel with your FT4. It is important to work your way back into optimal thyroid levels. This will be somewhere in that 60-80% range for BOTH your FT3 and FT4 levels when your symptoms go away. Now one thing that gets overlooked is thyroid balance. You need to keep your FT4 and FT3 levels with in 10% of each other.

One thing that I think will help you is keeping a journal. Keep a daily log of your symptoms. Try and keep up with severity of the symptom I had a scale from 1-5 and a spread sheet. In addition to tracking symptoms take your body temp, blood pressure, and weight first thing in the morning everyday and record them. When you have new labs run record and track your results in the log as well.

Hum.. any other tips.. AH! It takes 7 - 10 days for T3 meds to reach equilibrium in your blood and another 2-4 weeks for your symptoms to level out at that new concentration. Now T4 takes a bit longer. It takes 14 days for T4 to reach equilibrium in your blood stream after a dose change. Once you reach equilibrium it will take another 2-4 weeks for your symptoms to settle out. Now what does this mean? It means that you can push titration of meds by blood work alone, but that can really take its toll on your body symptom wise. I get my blood work checked 4 weeks after a dosage change and adjust accordingly. I do not believe in waiting 8 or even 12 weeks when symptoms persist.

Good luck in getting the care you deserve.
MG
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