Do I have a thyroid disease (Hashimoto's)?

Hi! I am wondering if I have a thyroid disease that needs treatment. My dad had a thyroid problem and I take after him in my body type in many ways. I have symptoms of weight gain, fatigue, managable depression, feeling cold, and hair changes (a lot fell out during 2 pregnancies and went from straight to pretty curly). My concern is with the Antibodies test, as the other thyroid tests appear to be normal. Here are my numbers: T3 result is 122 with standard range of 58-159 (looks normal); T4 Free result is 1.22 with standard range of .81-1.54 (appears normal); Thyroperoxidase Antibody is 27.4 with standard range of <5.6 (looks high to me!); TSH result is 2.12 with standard range of .35-4.00 (appears normal). I have been consistently frustrated with a past doctor who refused to do any thyroid testing except the standard TSH. I recently switched to a new doctor who ran all the tests above. I have had the symptoms described above for about 8 years at least. I am a 43 year old woman 30 lbs. overweight with very good eating habits and who exercises consistently. I have no other health problems at all. What do you think?

[JeeWee]

By the way, I also checked the website mentioned in other comment 'answers' related to symptoms of hypothyroidism. Of the 26 symptoms listed I have about 14-15 of them, and the one obvious symptom I forgot to mention in my first comment list was severe joint pain. I have had tests for arthritis run, and the basic testing revealed no sign of arthritis. I have joint pain noticeably in my feet, ankles, knees (wow, a lot), and hands. Thankfully, no signs of menstrual problems or female trouble. No symproms present there at all. I am menstrually very regular and had 2 normal pregnancies, with a few exceptions: hair loss with both pregnancies, and I was very depressed while pregnant the 2nd time (no external reason to be depressed, I was excited to be having another baby); I was pretty swollen with the 2nd baby as well (ankles especially). My weight went to a great place after I stopped nursing, and then within a short time after losing all the baby weight, it had come back.

[goolarra]

Your FT4 looks really good.  It's above midpoint of range, which is perfect.

Unfortunately, your doctor ordered total T3 rather than free T3.  Total tells the total amount in your blood, but some of that is chemically bound by protein and thus unavailable to cells.  FT3 tells what's available.  But, for what it's worth, TT3 looks good, too.

AACE recommended several years ago that TSH range be adjusted to 0.3-3.0.  Labs and dctors have been very slow to adopt that range.  

What are the units on your TPOab?  That's a bit of an unusual range.  Usually we see reference range as <40 or <20.  I just want to make sure I'm comparing apples to apples.

[JeeWee]

Thank you very much for your response.  According to the lab test, the Thyroperoxidase Antibody test (TPOab) says I have a result of 27.4 IU/ml as compared to a standard range of <5.6.  Yes, I agree - that seems high?? I am typing verbatim what I see on my medical record test online. They give a standard range on that test as <5.6??? From reading I have gathered that ones other thyroid tests can be within a 'normal range', but that the presence of high antibodies in the TPOab test can indicate the presence of an autoimmune thyroid disease?  I don't want to play my own doctor, which is why I am asking you :-).  I like my new doctor, but would like more research and background on my own before I see him again.  Unfortunately, the test results I gave are the only ones I have.  Again, they are:
T3  result 122, standard range 58-159
T4 Free result 1.22, standard range .81-1.54
TPO Ab result 27.4, standard range <5.6
TSH result 2.12, standard range .35-4.00
The term "T3" on the report I have does not indicate 'free'. so it is probably total.
Thank you so much for your time. Any input you have would be very helpful to me.
.

[goolarra]

I know that a TPOab of 27.4 with a reference range of <5.6 SEEMS high.  However, it's probably not as bad as you think it is.

We customarily see TPOab range of "<40" or "<35" or "<20".  A quick google search just told me that reference range for TPO ab varies a lot and is often "arbitrarily set" (thanks, guys, for all the precision).  "<5.6" is one of the lowest ranges I've ever seen.  So, at your lab, your TPO ab would be considered positive, at mine, it would be considered negative.

That being said, we often see TPOab numbers in the hundreds or even thousands.  Just to give you some perspective, my TPOab on diagnosis was 900+ (<40), and my TGab was 3,000+ (<40).  This is not unusual.  So, I would interpret your TPOab as "marginal to negative".  Slight elevations of TPOab occur in other autoimmune disorders, like RA, lupus, etc.

Also, while a positive TPOab test is considered sufficient to diagnose Hashi's, a negative one does not rule it out.  Some of us with Hashi's are TPOab positive, some TGab (thyrooglobulin antibodies) positive, and some both.  In addition, some people with Hashis test negative on blood antibody tests, but antibodies are present on biopsy.  A next step might be to ask your doctor to test TGab (it's another quick, easy blood test).  

However, as I said above, your TT3 and FT4 look really good.  Perhaps you could ask your doctor to run FT3 along with TGab, just to complete the picture.  

Another approach would be to ask your doctor for a trial dose of thyroid meds to see if it makes you feel better.  

Just to brainstorm a little...have you been tested for vitamin D, B12 (B12 deficiency can be due to pernicious anemia, which is another autoimmune disease that can cause slightly elevated TPOab), iron and ferritin.  Those are some vitamin deficiencies whose symptoms can mimic thyroid.

Another thought:  How long ago did you have your last baby, and did you ever feel hypERthyroid postpartum?

[JeeWee]

Thank you so very much!!
As far as hyperthyroid, no, I do not believe so. I can say that after I stopped nursing my 2nd baby, that I was amazed at how quickly the weight fell off and I went to my ideal weight of 130 (according to doc). I was so happy, and then it bounced right back up very quickly...which was depressing. I am now at 162 and I am 5 feet 1 inch tall.
Not to go on and on...but my lifestyle is not reflected in my current weight. I work out generously and am very careful with my eating. No coffee, no alcohol, rare fried foods, I watch 'white' foods, etc. I have done P90X twice with no change to weight. Very frustrating, and the fatigue as well.
My current blood tests show I am slightly above normal with the vitamin B12 as 1200 with a standard range of 200-910 (so I am a bit high, actually). Ferritin is 53.4 with standard range of 13-150. Iron is 132 with standard range of 60-170 (related iron tests were right in the standard range as well). Vitamin D was not tested.  
Thank you for your helpfulness! Your numbers sound so much more exaggerated than mine, ha ha! Lesson: I should not jump to conclusions. I hope you have come to a happy conclusion in your health here too...
I wish there was a more definitive answer about what is going on with me. Very frustrating to work so hard at being healthy with exercise and eating habits, and to pack around an extra 30 pounds along with fatigue and joint pain, etc. I will print your answer above for reference in asking for further blood tests. Once more, any advice you have as a result of this reply is very welcomed.  Thank you!

[gimel]

Always good info from goolarra.  I was reading this thread and thinking about the difficulty making clear the implications of test results and the difficulty in getting the right diagnosis from a doctor, when a thyroid patient has a major symptom of weight.  It made me think back to an interview with a doctor that was around back before TSH became the "Gold Standard" for most doctors.  At that time the main diagnostics were Resting Metabolic Rate, Basal BodyTemperature, and of course one that is largely ignored by doctors today, which is symptoms.

This in turn reminded me of a member who was a nurse who had a weight problem due to thyroid, but each doctor she had seen to that point told her that thyroid was not a problem, that her tests were normal.  In her frustration she finally got a RMR test done that showed just how low her metabolism was and got a doctor to prescribe Armour Thyroid.  You can read the rest of the story here.

pickdaisies | Apr 18, 2009

I was having some major problems with my metabolism.  I am a nurse and I thoroughly researched all the scientific research on the internet and at the medical library.  I, too was going to see doctors who would not help me.  Fortunately, I found a doctor who gave me armour thyroid despite "normal" levels. I brought him a RMR test that showed my BMR in 750-900 range which is very low, I was cold all the time. I was fatigued. When you have to get in the tub 2-3 times a day to warm up your body, you got a problem  I have fake nails and suddenly I wasn't needing to go as normally to have them filled they had really slowed in growth. I put together my own research on my body.   I started taking the medication as prescribed and he adjusted accordingly until I was free of symptoms.  I documented all the thyroid lab work before and after treatment.  I went and had metabolic testing to test my bmr and it measured normal for my age and weight and I was symptom free.  I then tapered myself off the thyroid and within 2 months all symptoms returned and metabolic testing once again was done, and BMR was extremely low. Back on meds. normal. You know your body best and I am not afraid to put the research in front of a doctor's face.  The human body is not black and white.


So, instead of jumping through all the hoops the doctor puts in front of us at times, maybe a RMR test would clear up any questions about your being hypo.

[Barb135]

I agree with goolarra that you need to get TGab tested, along with the FT3, since your FT4 and TT3 look really good.  As she stated, TPOab can be present in other autoimmunes, as well as Hashimoto's and because your level is so low, I'd have to question whether that's what you have, unless you have a more elevated TGab.  If you have Hashimoto's, it, apparently, hasn't progressed enough to affect your thyroid function.

While it's great to have lists of symptoms to help with diagnosing thyroid conditions (or other health issues), we always have to keep in mind that there are a large number of other conditions that can cause those same symptoms.  

Have you looked into insulin resistance or PCOS as causes for the weight gain?  Both can cause the gain, plus make it very difficult/impossible to lose weight.  They can also present a lot of the same symptoms as hypothyroidism.  Additionally, as we get older, our female reproductive hormones start diminishing and can wreak all kinds of havoc, too, so those would need to be tested, as well.

It's very possible that the fatigue and joint pain are due more to the extra weight than anything else.  I know that's a good part of the joint/muscle pain I have, because my body simply wasn't made to carry 30 lbs extra.

B12 is a water soluble vitamin, so there's no toxicity with having high levels.  I would say that even though your ferritin is "in range", it's very low in the range.  Vitamin D deficiency can also cause symptoms similar to hypo, so I'd recommend getting that tested.

You might try taking magnesium at bedtime, as that can help ease the joint pain.

[JeeWee]

Thank you so much for your reply!! It is an effort not to become hopeless in this, as there are no obvious answers here.  I am not in the health profession, and most doctors are wary of people becoming their own advocate (in some cases for good reason). Time to keep my chin up and keep digging!! You people are so encouraging -- bless you all. :-)

[JeeWee]

Thank you very very much!! I did have a glucose tolerance test (the fasting one with the icky sugary orange drink) and my test came out completely normal...which surprised me no end.  My mom is highly hypoglycemic and I have to make sure to eat consistently.  I do get foggy and fatigued, without a doubt.  I have some good background and questions for my doctor in our next appt.  I must say I am blessed with my build.  Though short, I have a very large muscle structure and bone structure. I find that the extra 30 lbs is cumbersome and makes me a bit insecure, but some may not even realize I am that overweight. I sure know, though.  I will keep digging!  Thanks for all the tips -- I will def. try the magnesium and renew my commitment to Vit. D as a supplement.

[Barb135]

Glucose tolerance measures how well your body metabolizes sugar; it won't necessarily pick up hypOglycemia, which is low blood sugar.  Been there, done that and I have to make sure to eat often enough to keep my blood sugar levels up too, even though many mornings my blood sugar is higher than normal.  All things considered, I do have insulin resistance, but have never been formally dx'd with it.

You're lucky that with your stature, you might be able to carry a few more pounds...... my bone structure is very small, so any extra weight really shows.  In the end, it really doesn't matter what others think, does it?  It's about how we feel about ourselves.