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CaseyMcG 04-25-2017 08:57 AM

need some expertise
So my wife has had a disorder that's gone untreated for 30 years, since she was in grade school she's had dry flaky skin, extreme fatigue, sensitivity to cold, constipation, coarse dry hair, depression and so on.

We assumed Hashimoto's due to the symptoms, and over the last month she has developed a painful goiter which is sore and makes it difficult to swallow. she also has a family history of Thyroid conditions, her sister had a portion of her thyroid removed due to papillary cancer and a large nodule on her thyroid.

My wife just had an ultra sound which showed a swollen thyroid multiple nodules on both sides. Her doctor (not an endo) determined that they didn't appear to be cancerous. Her labs came back showing low TSH and none of the TPO's which lead her doctor to say it wasn't hashimoto's. the lab failed to do the T3/T4 testing even though they were requested so we have to go back in to get those labs done.

This is all we know at this point and we are getting a bit nervous as to what the cause is, and we're constantly speculating because we know just enough to be worried but not enough to completely pin down what the issue could be.

I'm assuming Secondary Hypo due to the low TSH and because her symptoms point to a hypo condition, is that a safe guess? or am I putting the cart before the horse without knowing the T3/T4 levels?

She's never exhibited any symptoms of hyperthyroid, it's always been hypo. and her symptoms are pretty severe, her dry flaky skin is the worst, followed by her dyr hair, then fatigue and mood swings, she also has menstrual issues where she has little to no period and it's never consistent month to month.
Her thyroid just recently started growing and is becoming a painful nuisance.

my only guess is that due to her symptoms she's not creating enough thyroid horomones because her pituitary isn't producing enough TSH. we were completely shocked to hear a no to Hashimoto's because everything fits, is it possible to have it with low TSH and no signs of TPO?

I've also looked into a lot of other possibilities like cushings and other Adrenal disorders but can't find anything that's as close a match to her hypo symptoms.

any guidance is appreciated.

midwest1 04-25-2017 12:40 PM

Re: need some expertise
First, Hashimoto's doesn't cause symptoms; it causes thyroid gland failure. The failure is what causes the symptoms. Hashi's is the most common cause of thyroid failure in industrialized countries, but it isn't the only one. Negative antibody results don't guarantee the absence of Hashi's, because of limitations on the tests' sensitivity.

How low is the TSH? Very low levels could indeed cause secondary hypothyroidism. Doctors are often unaware of this condition and often refuse to consider it only because they're ignorant of it. By all means, insist on measurements of the free T4 and free T3. If they are at the bottom of or below range, there's your answer.

Edit to add:
Cancer isn't detected or ruled out by the "look" of an ultrasound image. It's almost absurd for a professional to say so. If the nodules are 1 cm or larger in size, they need to be biopsied. Period.
If they aren't that large, watching them for growth is warranted.

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