Did my endocrinologist get it right?

[Jules77733]

After pontificating that it might be a case of sub-clinical hypothyroidism gone horribly awry (as in, having stretched on for a year), my endocrinologist tossed that idea aside in favor of a diagnosis of Hashimoto's thyroiditis. Despite my Tg antibodies being much higher than my TPO antibodies, which were both negative anyway, she felt that I may be one of the lucky cases of Hashimoto's with negative TPO antibodies (she didn't seem to care about the Tg antibodies even though they were very high-normal). I mentioned that my RAIU scan was elevated by about 5 - 8%, but she said that it should never have been done unless hyperthyroidism was suspected, and that the reason it was elevated is due to the Hashimoto's antibodies retaining iodine and giving a false appearance of elevated uptake in the scan results.

I asked about adrenal insufficiency since I had been exhibiting some symptoms of this and I have a sneaking suspicion that the pineal cyst near my brain is interfering with the hypothalamus, which messes up the release of pituitary hormones like TSH (causing thyroid problems) and ACTH (causing adrenal problems). It seemed to me that she wasn't entirely convinced I have Hashimoto's, but she had no other ideas, and admitted that she'd never come across any cases where a pineal neoplasm was causing endocrine dysfunction (she was fairly young, though, so I'll cut her some slack :) ). My GP had also suggested I have a cortisol stimulation test done, but said she would leave it up to the endocrinologist to order.

I'm starting on 50mcg levothyroxine daily and will be seeing the endo again in 8 weeks to determine if medication is helping or not. When I have bloodwork done in 8 weeks, she only wants to measure TSH and TPO antibodies...is it standard to only measure TSH? I thought she'd at least measure my T4/fT4 levels. And if I have some manifestations of adrenal insufficiency for whatever reason, won't taking levothyroxine wreak havoc on my system?

Does it sound like she got the diagnosis right, or do the puzzle pieces not fit together? I'm not entirely convinced, but I don't know to get doctors to view my case from a systemic perspective. I've listed a bunch of medical information below if you're interested in reading more about my case or need more information before responding.

Thanks!!!!!!




Bloodwork/Test Results:
--consistently fluctuating TSH that tends to be more elevated: never above 5.51 in the past 9 months, never below 1.41
--negative TPO and Tg antibodies when tested twice in the past year
--free T4 is always normal and was actually increasing over time
--T4 and T3 (total) were both measured within normal ranges, once each
--slightly heterogenous thyroid echotexture evident on thyroid ultrasound
--elevated RAIU scan (5% after 6hrs, 8% after 24hrs, or something like this)
--increasing WBC count, decreasing RBC count (I'm anemic by most online standards, I believe)
--1.3cm pineal cyst on MRI, stable after 3 months but a nasal polyp was observed on second MRI, not there on first
--history of allergies to grass pollen and dust mites, moderate obstructive sleep apnea, and common migraines
--symptoms: lump in throat, extreme fatigue even on CPAP and Provigil, dry skin, brittle nails, slightly thinning hair, excessive sweating, essential tremor, headaches, low blood pressure, random fevers, really hot sometimes, really cold sometimes, no appetite, abdominal tenderness and soreness (my liver enzymes are elevated from the NSAIDs I've been taking since last June), extreme exhaustion after a small amount of exertion, swollen and painful joints in hands, knees, feet, and wrists, double vision at night and with illuminated objects that is slowly worsening, slight paralysis of upward gaze, lost 25 pounds after starting Provigil 1.5yrs ago, slowly losing weight since then until I began taking Propranolol (my low blood pressure was before Propranolol), high cholesterol that has since normalized, but is still high-normal

[mommy2two2008]

Ahh Jules - welcome to my diagnosis!  It doesn't make me rest much easier! Hope the med helps you soon!

[Jules77733]

What would they see? Thyroid antibodies attacking the tissue? Thanks!

[898]

In worse case they can do biopsy of thyroid tissue, which should show Hashimot's