Treatment for Hashimoto/goiter

[ciaobellaxoxo]

My labs are:

t4 0.8 (0.8-1.7)
tsh 1.60 (0.30 - 4.5)
thyroperoxidase 430.4 (0-8.9)

cbc
hgb 11.6 (12-16)
hct 36.8 (37.0-47.0)
mcv 76.7 (81-99)
mch 24.1 (27-31)
mchc 31.4 (33-37)

thyroid ultrasound
right lobe is 5.9 x 2.3 x 2.4cm
left lobe 5.4 x 2.5 x 1.9cm
isthmus is "also thickened at 9mm and irregular"
"diffuse multinodular goiter."

My symptoms include fatigue, unexplained weight gain, lightheadedness, cold sensitivity, trouble concentrating, general weak feeling and I have had trouble breathing and swallowing and in the last few weeks I have also had brittle nails, thinning hair/hair loss, sore throat and started having some pain in my right chest.

My Dr said nothing is a concern and there's no treatment. My main concern is the goiter. It has been enlarging even more and I have trouble breathing and swallowing and I choke a lot.

Any ideas what I can do?  Should I not be on any type of medication or anything? Thanks.

[Mark Lupo, M.D.]

You likely have a goiter due to Hashimotos thyroiditis, but currently with normal thyroid function.  With the TSH of 1.6, you could start levothyroxine to to see if that helps shrink the goiter, but would also need to monitor closely for the small chance that this is autoimmune thyroid disease that could lead to Graves Hyperthyroidism.  I would test TSH Receptor Ab level for a baseline before starting meds - this would help me determine the risk of swinging to hyper (which of course would be further aggravated by being on thyroid meds).

If the choking/breathing issues are severe, some patients need thyroid surgery - so if this worsens -- talk to your doctor again.

would consider seeing a thyroid specialist who can do an ultrasound again him/herself, to make sure there are no suspicious nodules that need biopsy.  but the description is most consistent with inflammation due to hashimotos.

[cosmicsoul]

I believe that you should be getting some thyroid hormone medivation to reduce the Hashimotos - the autoimmune disease. The reason you have high level of antibodies because your body begun the process to distroy your thyroid gland. I am no expert but I think you should hook up with a decent doctor who knows about this stuff. Search the net for information too! I just know that your antibodies will continue to rise and distroy your thyroid - your TSH will grow to a higher number. Your goiter should be checked for a biopsy. I am not an expert on goiter either - just a woman with HT myself. I do not have a goiter. Keep those antibodies down - the only way you do that is by thyroid hormone. I wish you good luck!

[Maggie2007]

I have Hashimotos as well and just started meds, but don't know how our labs compare. I'm not a doctor, but I'd recommend seeing an endocrinologist. I would think that if you are choking and have dificulty breathing...that it would warrant some treatment. I hope that you are able to find a good endocrinologist that will take your symptoms seriously. I hope you feel better and get some answers. Best of luck.

[lisseree]

I'm with you on the symptoms. Mine are very similar. Just had the ultrasound last Thursday which showed my goiter to be very close to the same size as yours. I'm choking on food and for a good part of each day I have the sensation that something is caught up in my throat, or hanging there. It's just so hard to deal with scary symptoms like these when you're too tired to thnk, isn't it? I've gained weight too, and I'm not even hungry or eating much at all. I'm forcing down 600-900 calories/day, but beyond that I'm terribly nauseated. (NOTE: I'm a healthy girl who loves good food and has NO eating disorder, so this really stinks!) This site has given me hope that I'm not crazy. Seems like there are others of you who are having the same issues, so I'll be sure to keep posting as I figure my situation out.

I live near one of the best teaching hospitals in the country, and they're taking me seriously, so I'll share whatever wisdom I get from them with you all. I'll especially post on here if a treatment works to help these symptoms! I think we're all looking for that magic solution.

[lisseree]

Well, just had the appointment with the endocrinologist today. It took him 5 minutes to discern what was wrong with me. Something that no other doctors have been able to do! He said very simply "you've got a huge goiter. How do you feel about surgery?" He said that even with no large nodules, when a goiter starts pressing on your esophagus and surrounding structures, it's time to come out. I asked why my thyroid levels for years have been normal, even when I've felt terrible. He said it's because the diseased gland just keeps growing to make up for its inability to produce enough hormone. Eventually it just can't keep up and you end up hypothyroid anyway. He said unfortunately most doctors don't know what to do if tests come back "normal" but the goiter is growing. Maybe mine could have been slowed down with some good care years back, but who knows.

Anyway, mine is done. No more room to grow, since I can't get much food down without gagging. I have a Pharyngeal Study and an Esophogeal Barium Swallow next week to see exactly where the pressure and problems are, but they've already put me in the surgery line-up so I can unload this thing. Frankly, I'm excited. I've made my sick thyroid gland last for 32 years (yes, strangely I've had a goiter since I was a toddler,) but for many of those years I've not felt entirely well, so onward. Looking forward to enjoying food again when I'm all healed up. Enough with the soup and tea already.

[Maggie2007]

Glad you were able to find out what was wrong. I hope, and imagine, you will begin to feel better.
Best of luck.