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Thyroid Cancer, Nodules & Hyperthyroidism (Expert Forum)
Hypothyroid without Hashimoto-what could be going on?
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
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.
Hypothyroid without Hashimoto-what could be going on?
by ScandinavianMale, Mar 26, 2007 12:00AM
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´s not based on anti-TPO (I am persistently negative) but on cytology reports. However, to my surprise, I was now told that none of the two cytologies reported any lymphocytic infiltration (and not atrophy, the thyroid looked normal on sonography). While having pain in the thyroid stretching out to the ears on occasions, and experiencing familiar hypothyreosis tiredness and modes weight gain, I am now confused about the etiology of my disease. No other tests (and I have taken a several) have been abnormal, including hormon panels (advanced adrenal function tests and glucose resistance tests have not been taken). My wife (who fortunately loves me) still tells me that I have been ageing (aging) surprisingly fast over the last years (I am 45 now). What are the alternative explanations of this kind of hypothyroid condition? My TSH and T4 have been varying a good deal, last time I checked they were: TSH: 0,2, T4: 15.
Happy for any comments. And impressed by your work!
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´s not based on anti-TPO (I am persistently negative) but on cytology reports. However, to my surprise, I was now told that none of the two cytologies reported any lymphocytic infiltration (and not atrophy, the thyroid looked normal on sonography). While having pain in the thyroid stretching out to the ears on occasions, and experiencing familiar hypothyreosis tiredness and modes weight gain, I am now confused about the etiology of my disease. No other tests (and I have taken a several) have been abnormal, including hormon panels (advanced adrenal function tests and glucose resistance tests have not been taken). My wife (who fortunately loves me) still tells me that I have been ageing (aging) surprisingly fast over the last years (I am 45 now). What are the alternative explanations of this kind of hypothyroid condition? My TSH and T4 have been varying a good deal, last time I checked they were: TSH: 0,2, T4: 15.
Happy for any comments. And impressed by your work!
Doctor's Answer
by Mark Lupo, M.D., Mar 26, 2007 12:00AM
, Mar 26, 2007 12:00AM
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.
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.
Member Comments (1)
by JaHo, Apr 23, 2008 06:31AM
A related discussion, Hypothyroidism and hemochromatosis was started.
