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Hypothyroid without Hashimoto-what could be going on?
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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Hypothyroid without Hashimoto-what could be going on?

Dear Doctor,

I have written to you before. I am persistently hypothyroid (125 mcg Levaxine) with a nodule on the left lobe. I also have a persistently reduced cd4/c8 ratio (between 0,5-0,7) in PBMC (HIV-negative). I have taken two FNACs of the nodule, but it is apparently normal. My impression before was that I had Hasihmoto
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97953 tn?1440868992
There are times when there is no cause for the hypothyroidism -- FNA can help determine if there is any disease or infiltration causing it -- hashi should be evident on FNA (about 10% of hashi paitents have negative thyroid antibodies) and it's possible the FNA missed the lymphocytic infiltrate.  MUCH rarer causes would be hemochromatosis (iron overload), amyloidosis, sarcoidosis, fibrosis -- but we rarely see these.

The thyroid levels look okay -- if anything the TSH is a bit low suggesting that the levothyroxine dose may be slightly high.

Good luck with this.
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