Suspected Hashimoto’s? Any help is appreciated.

[annex]

Hi,

First off, thanks for taking the time to read and answer this. I’m a 17 year old girl who’s about to go to college, so I really want this sorted out before I leave. However, everything is SO slow here and my appointment with the endocrinologist isn’t until 2 weeks from now. My blood work from a week ago shows the following:

TSH: 0.03 mIU/L
T-4: 1.6 ng/dL
T3: 396 pg/dL
Thyroglobulin antibodies: 1177 IU/mL
Thyroid Peroxidase Antibodies: 11 IU/mL

Bilirubin: 1.4 mg/dL
Triglycerides: 36 mg/dL

After reading around a lot online, it tentatively seems to me like I have Hashimoto’s Disorder. I feel terrible, mostly because I am so tired everyday I can barely get out of bed after sleeping 14 hours. My neck is also very swollen.

Anyway, I guess the question is just if I’m probably on the right track and can expect the endocrinologist to say the same thing, and what type of treatment I should be expecting (generally) him/her to give to me. I only have about 2 weeks before I need to leave, so it’s important that I get a treatment and adjust it to get rid of my fatigue before I go to college.

Thank you very much for taking the time to read this!

[Mark Lupo, M.D.]

With the low TSH and high-normal T3 & T4 the labs suggest HYPERthyroidism and the positive antibodies suggest Graves Disease.  The other possibility is a transient hyperthyroidism due to subacute thyroiditis -- but then with the positive antibodies, the risk of long-term hypothyroidism is present.  So either way, close follow-up and understanding of this process is important.

With limited time, the best way to sort this out is to do all the work-up at once:  I-123 uptake/scan (probably most helpful test at this point), TSH-Receptor Antibodies (test for graves), sedimentation rate (marker of inflammation --high in thyroiditis) and perhaps ultrasound.

perhaps your primary could order these so the endo can interpret it all once you have the consult appt.

[cosmicsoul]

Your thyroid numbers are normal. Because your antibody is only 11 (TPO) you probably do not have Hashimotos. But lets see what the DR responds here on the forum. You can be tired due to MANY other issues. Have you been screened for vitamin and mineral defficiancies? Did you have a complete blood work done recently? Do you eat a balanced and healthy diet? Do you get all nutrients that you need? It is also good to check all your other hormones. I hope you get some answers before you head off to college. If not - still sort this out so you are healthy for the school year. It will be worth it. Good luck to you!  

[cosmicsoul]

One more thing - try getting an ultrasond of your thyroid (swollen neck) to get some idea on what is going on.

[borninquisitive]

From what I understand, a person can have Hashimoto's without elevated TPO. To say, a Hashimoto's patient can have both elevated antibodies or one or the other.

http://www.thyroidmanager.org/Chapter8/8-frame.htm

Table 8-2 Guideline for the diagnosis of Hashimoto's thyroiditis (Chronic thyroiditis)  
Clinical findings Diffuse swelling of the thyroid gland without any other cause (such as Graves' disease)

Laboratory findings  
Positive for anti-thyroid microsomal antibody or anti-thyroid peroxidase(TPO) antibody  
Positive for anti-thyroglobulin antibody  
Lymphocytic infiltration in the thyroid gland confirmed with cytological examination

A patient shall be said to have Hashimoto's thyroiditis if he/she has satisfied clinical criterion and any one laboratory criterion.Notes

A patients shall be suspected to have Hashimoto's thyroiditis, if he/she has primary hypothyroidism without any other cause to induce hypothyroidism.
A patient shall be suspected to have Hashimoto's thyroiditis, if he/she has anti-thyroid microsomal antibody and/or anti-thyroglobulin antibody without thyroid dysfunction nor goiter formation.*
If a patient with thyroid neoplasm has anti-thyroid antibody by chance, he or she should be considered to have Hashimoto's thyroiditis.
A patient is possible to have Hashimoto's thyroiditis if hypoechroic and/or inhomogeneous pattern is observed in thyroid ultrasonography


I'm not saying this is the case here but if I remember right, it seems that I have seen you essentially write that a person can not have Hashimotos in absense of an elevated TPO?

[cosmicsoul]

True - could be also beginning stage.

[Maggie2007]

I imagine your doctor ruled out mono, right?