Isn't this Hashi's?

[Letterer]

I have lots of symptoms - extreme fatigue, foggy thinking, emotional, irregular menses, tingling extremities, foregetfulness, neck pressure, mild sore throat, etc.

My latest labs are:
TSH 2.48 (range 0.4-4.0)
Free T4 0.8 (range 0.5-1.6)
Sed rate 24 (range 0-20)
Thyroid Perox Ab <10 (range 0-35)
Anti Thyroid Ab 2095 (range 0-40)

I saw a new Endo today but he said he was on the fence with these numbers. Don't the high antibodies + symptoms + low FT4 + upper range TSH warrant treatment? My TSH was 2.02 and FT4 0.7 in April, the above results are from earlier this month. I believe this is clearly Hashi's, but two Endo's now have said they're not certain they would treat at this point. I am awaiting result of a new round of bloodwork from the new Endo, but am concerned he still won't want to treat me. Any thoughts?
Thanks

[GravesLady]

Diagnose and treatment is not based on symptoms or antibodies alone. Levels are the prevailing diagnose and the other two just confirms.

Thyroid symptoms are so non-specific and not exclusive to thyroid.  In other words, a lot of other health conditions have the same symptoms as thyroid, it is very difficult to distinguish where the symptoms are coming from or which health conditions are the cause.  If your TSH level was above 10 or below 0.1 with symptoms, then it would suggest thyroid. None of the thyroid hormone medications or drugs are a 100 percent cure-all for symptoms. Each one might have to treated  separately from each other.

Antibodies are not curable nor treatable, there is nothing that can be done about them. A lot of people with no thyroid conditions can have antibodies, as well as other health conditions.  We are treated from the damage that the antibodies do to the thyroid, which clearly states in our thyroid blood levels.

PER AACE 2006 amended guidelines,  the US Government 2004 Guidelines, UK 2006 Guidelines,  American Thyroid Association and The Endocrine Society -  Albert Einstein College of Medicine, New York. September 23, 2004 .  
TSH ........ 10:  No routine levothyroxine treatment for patients with TSH levels between ......... 10 mIU/L, but thyroid function tests should be repeated at 6- to 12-month intervals to monitor for improvement or worsening in TSH level. Early levothyroxine therapy does not alter the natural history of the disease,.........

TSH Higher Than 10 mIU/L Hypothyroidism Levothyroxine therapy is reasonable.

Data do not confirm clear-cut benefits for early therapy....... - unquote

Having normal levels states that your thyroid has not failed as yet, but the antibodies suggest perhaps thyroid may fail some day in the future.   With this scenario it is suggested to be tested on a regular bases.

[borninquisitive]

I certainly would not be happy with those labs, certainly not with your symptoms. I belong to a forum: http://thyroidhost.proboards30.com/index.cgi
I'm not one to post this (however, it's in my profile) but I'll post it here because I think you DO have problems and I know this group will "sit down" and discuss them with you. A group that I do not think is "radical" in one direction or the other.

That said, I think it would be worthwhile for you to post to Dr. Lupo ( a licensed endocrinologist in Florida) on this site.

Best to you!

[borninquisitive]

To your question,  "Isn't this Hashi's?" I would say, Yes!  Do you have a goiter? Has an U.S. been ordered for you?

[Letterer]

I'm not happy with the labs, they were ordered because of the symptoms and there has been no reasonable explanation offered to explain them, except for these labs in my opinion. I have to disagree with GravesLady above as to the marker for TSH, I've read a number of times that the new standard in the U.S. is 0.3 to 3.03 or so. That certainly puts me moving into the upper range. It'll be interesting to see what the next set of labs show.
None of the docs have said anything about a goiter. I don't see anything myself, the only complaint I have there is a feeling of pressure, sometimes a slight suffocating feeling, mild sore throat and collarbone/arm/hand pain on both sides. I would have assumed a swelling would be detectable during exam. No ultrasound has been ordered. I've been through 4 docs since July (not just for the Thyroid, there have been other issues as well), I'll have to see what my labs are with this latest one and keep trying to get to the bottom of this....

[GravesLady]

0.3 to 3.03 numbers are SUGGESTED as TARGET levels ONLY, for already DIAGNOSED and TREATED patients.

Feel free to google AACE 2006 amended guidelines,  the US Government 2004 Guidelines,
UK 2006 Guidelines,  American Thyroid Association and The Endocrine Society -  Albert Einstein College of Medicine, New York. September 23, 2004 .  

When looking for info., at least go to legit sites as above.

You can disagree with me all you want, which in turn says that you disagree with legit info. from legit sites, from legit thyroid associations, orgs, medicals, and government, and disagree with your doctor. Which is no skin off my nose. I am happly diagnosed and treated.

Best of health.

[Letterer]

Wow, that's a pretty negative response. I was not attacking you, just suggesting that the ranges you quoted were not the same as the ranges I've found in my research so far. I am simply compiling info from multiple resources (traditional western medical and nautropathic) and it seems to point toward early Hashi's. My lab report uses a range not higher than 4.0, so your 10+ seems a little high. I'm not only looking at the TSH, but that TSH viewed in combination with the low normal FT4 and + antibodies may suggest EARLY hypo, which along with the presence of symptoms I believe trial meds might be in order. This actually is not in disagreement with my endo, I simply said he was on the fence with it and I want to try treatment and am hoping he will let me try a trial. The other 2 docs classified me as normal based on TSH alone (one of them never even met me). That to me represents a pretty narrow-minded view point (one you seem to be able to appreciate, are you a right wing republican as well by chance?). Kudos to you for getting treatment and feeling better, glad you're so empathetic to others who are trying to understand their symptoms and get help (apparently as long as they agree with you). IMO you shouldn't elevate yourself to such a level as to assume that just because somebody disagrees with YOU they must in turn be unwilling to listen to all docs and medical literature. That seems a bit arrogant to me.....

[alysmum]

Too many doctors do not listen to thier patients.  If your doctor will not treat you, see another.  I personally think that it is ludicrous to feel like ***** all the time, and so I have no patience for a Dr. who does not take me seriously.

Doctors I know would say your antibodies are high, so therefore you may have early signs of Hashimotos.   They say that while your TSH may look normal in and of itself, with your symptoms and antibodies, now is the time to treat it.  They tell me that getting your TSH around 1.0 is a good goal, depending on your symptoms.  Do not listen blindly to the **** numbers.  The AACE Guidelines mentioning a TSH of 10.0 has to do with not wanting to "routinely" treat patients who are not asking for treatment because they are not showing any other signs of hypothyroidism.  Many people routinely get these yearly blood tests when we are not looking for anything in particular, we are just going in for our yearly physical, and the AACE does not want our chart to be flagged just because our levels may be slightly high.  If someone has symptoms, this may warrant meds--- at least further follow up.  You quite obviously have symptoms and the antibodies!  I personally would not take "no" for an answer.  

[Letterer]

Thanks for your response  :)  That was my point to the poster above, that I'm seeking treatment for SYMPTOMS which seem to be backed up by lab results, and I'm frustrated with docs who dismiss me based on just the TSH levels. I'm currently waiting for the newest labs to come back, I won't be surprised if the TSH has increased again. I almost hope it does so I'll be taken seriously! The doc didn't definitively say no to treating me, just that he was on the fence, so I'm going to push for a trial when I talk to him next.

[Hashi18]

I had very similar labs to yours and very similar symptoms, when I was diagnosed with Hashis.  I was treated right away and instantly felt better.  My doctors have always dosed my medication based on keeping my TSH around 1.0, or I begin to have symptoms again.  Find someone who will treat you!  You'r TSH does NOT have to be in the normal range to benefit from being treated.

[wondering121]

agree... and dont belive that there is nothing you can do about antibodies..; Thyroid meds will drive TSH low and antibodies will think there isnt thyroid hormone to attack and will slow down..

TSH upper limit may need to be lower than 5.5 more like 3.0 google and read the literature. Many physicians dont understand why a target TSH of under 2 for patients but unwillingness to treat fro TSH of 3 or slightly higher. Why 2 standards? Do your Googling and take control of you care.

[Louwrite]

I'm going to tell any medical professional who uses words like, 'on the fence' to delay getting me the medication I know I need by saying, "Thanks, doc, and until I fall off the fence, I will be very close by.  On your couch, in fact, so I hope you have the fridge stocked with healthy, supportive foods for me, and maybe a personal trainer can come in every morning so I can try that good exercise everyone always suggests?  I'm certainly not able to work in this condition, so don't expect me to pay any bills, but hey, it's okay, right?  Because I'm on the fence, and that's just fine.  Right?  Hey, you have cable and high speed internet, right?

[Letterer]

Love your response Louwrite  :)  I like that. It's funny how they contradict themselves - this doc said he likes to keep his patients between 1-2, yet with me at 2.48 + FT4 + antibodies + symptoms it wasn't a clear yes to him. He's running his own panel of tests, so maybe he just needs to see the numbers come up within the lab ranges he's used to working with. The most frustrating thing? I try to express how exhausted I am, how by business has suffered, how my general feeling of health has plummeted. All I get back is fibromyalgia and sleep apnea. I think those must be the catch phrases of the season. Anyway, thanks for the kind words and humorous thoughts!

[kitty9309]

0.3-3.0 is the new REFERENCE RANGE according to the AACE. A TSH of 1-2 is the recommended level for someone being treated with thyroid hormone. Close to the upper end of range and positive antibodies and symptoms warrents treatment with a trail of low dose thyroid hormone. Look at the forum with Dr. Lupo- Ask an Expert. You will see that this is what he recommends. I work for Quest Diagnostics and have a medical background. Be careful who you listen to if you are uncertain.