General Medicine

» elysia2006 - Hashimoto's -- no antibodies? Hyper symptoms?

Hello,

In September, a GP noticed my thyroid was enlarged. Ordered an ultrasound. The ultrasound showed a slightly enlarged gland with 2 dominant nodules (one 2cm and one 3cm) as well as one or two tiny nodules. I saw an Endo who ordered some blood tests and an FNA. The FNA result of the 2 nodules is benign with mature lymphocytes which they believe is Hashimoto's. In October and part of November, I felt odd--faster heart beat, tremors, muscles twitches and muscle cramps, anxiety and no patience etc. It seems to be better as of 1 week now. I had 2 rounds of blood tests done:

Oct 06

TSH .23 (ref .15-4.7)
Free T4 13.9 (ref 8.0-23.3)
Anti-TPO 50 (ref 60)
Anti-Thyroglobuline 50 (ref 60)

Nov 06

TSH .84 (ref .35-4.94)
Free T4 .94 (ref .70-1.48)
Free T3 3.55 (ref 1.71-3.71)
Anti-TPO .2 (ref 0-5.6)
Anti-Thyroglobuline .8 (ref 0-4.1)
Anti-TSI .3 (ref 1)

I saw another Endo last week. Both say they cannot do anything now (medicine wise) and I must be in the early stages of Hashis with a hyper phase. They told me it could take a long time (even years) for me to go hypo. Is the FNA diagnosis considered definitive for Hashis? I am concerned I don't have antibodies, but the doctors both feel this is ok and they will probably show up later, as you can see Hashis at the cellular level first.

Thanks for your thoughts.

-- posted by elysia2006

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» Elaine Moore - Hashimoto's -- no antibodies? Hyper symptoms?

In response to Hashimoto's -- no antibodies? Hyper symptoms? posted by elysia2006:
Hi,
In Hashimoto's thyroiditis thyroid antibodies usually show up for quite some time before patients move into hypothyroidism. The thyroglobulin antibodies contribute to the thyroid cell destruction that causes hypothyroidism, and TPO antibodies develop in response to thyroid inflammation.
Mature lymphocytes aren't an unusual finding in hypothyroidism although they're not diagnostic for Hashimoto's.
You could have atrophic thyroiditis in which case you'd have blocking TSH receptor antibodies. However, I don't think that's the case as you'd also have TPO antibodies.
You could have hypothyroidism related to dietary factors, for instance, eating excess amounts of soy or goiterogens like raw cabbage, broccoli, almonds, squash, peanuts, peaches, etc.
Or if you're exposed to lithium, bromide, fluoride or chlorine, these elements can contribute to hypothyroidism. Excess dietary iodine in fast/processed foods can cause both hypothyroidism and hyperthyroidism.
Thyroid nodules often develop in people who are hypothyroid. Nodules are also quite common and their incidence increases with age.

Your first set of labs is normal with a shift toward subclinical hyperthyroidism because of your low TSH. Your 2nd set of labs in November is also normal although FT3 is near the high end of the range. This is common when nodules begin to produce excess thyroid hormone.

My guess is that you have a recurring hypothyroidism that may be related to diet or meds (some antidepressants and NSAIDs also contribute to hypoT) and that your gland has produced nodules in an effort to correct the hypoT. This is causing your lab results to fluctuate and you probably have symptoms of both hypoT and hyperT.

In most cases, your doctor would repeat your thyroid function tests every 3-6 months or sooner if your symptoms change. This way if you move into overt hypoT or hyperT, you can receive appropriate treatment. Best, Elaine

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» elysia2006 - Hashimoto's -- no antibodies? Hyper symptoms?

In response to Hashimoto's -- no antibodies? Hyper symptoms? posted by daisyelaine:
Hi,

Thank you for your response!

I am in France, so I don't know if I translated the pathology report correctly. The pathologist is apparently one of the best in France, according to my endo. The report says:

"The slides are populated with mature small and large lymphocytes accompanied by immunoblasts."

The report says the "sample evokes in the first place a Hashimoto thyroid".

Also, my blood tests have never been hypothyroid....at least not that I know of. All of my TSH tests have been 1. I have been living in Europe for 20 years and don't eat fast food etc and in fact, my endo told me here, there is a lack of iodine in the food in general over here. I don't eat soy or any of the other foods you mentioned. And, I do not take any medications (nor have I).

Your idea is interesting--that a nodule is producing the extra hormone...and canceling out the hypo...but, how would they test for this definitively--an uptake scan? And, I wonder why neither doctor is suggesting this could be the problem? One of my nodules (the large one) is primarily fluid, so that couldn't be the problem, right? The other is 2 cm and primarily solid.

Thanks for your thoughts.

-- posted by elysia2006

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