Thyroiditis from Hashimoto's or Virus?

[Judes81]

Hi all,

I went to the doctor recently for a variety of blood tests due to increasing fatigue and difficulty concentrating and other symptoms I now know to be hypo related. The Doctor told me he will test my thyroid as I have been experiencing such fatigue.

My TSH level came back as a 5 (0.40-4.00)

The doctor said this was mildly elevated and wasn’t a huge concern but sent me for a thyroid ultrasound and antibodies blood test to be sure nothing more was occurring.

They ultrasound result came back as follows:-

Hetergogenous appearance of the thyroid with several cysts and nodules, the largest in the midpole measuring 3mm. There is increased vascularity of the thyroid, suggesting Thyroiditis. This can be seen following viral infections or autoimmune conditions.

The blood test came back

Free T4 13 (10-20)

Athyri’gb 17 (<60)

APeroxase 34 (<60)

No T3 was tested. The blood test noted that  antibody levels are not suggestive of thyroid inflammatory, however 15% of Hashimoto’s does not produce measurable antibodies.

The doctor looked at the ultrasound and said ‘it looks like a little bit of Hashimoto’s (??) but couldn’t be sure as the blood test came back pretty much stating no evidence of thyroiditis. He didn’t seem hugely concerned as the largest nodule was only 3mm.

I am still experiencing huge amounts of fatigue and brain fog and it is a struggle to get through a days work. The doctor told me I do not need to go on medication if I do not choose to, however suggested 50mcg of Eutroxsig (believe this is Synthroid in the states) on alternate days to see if this will help my symptoms. I just started the medication last week and will have another blood test to check levels in 6 weeks.

So I am very confused, The blood test and ultrasound which I had on the same day came back with differing results?  Could thyroiditis be due to a virus and not Hashimoto’s and would the symptoms be different?? Or do you think that I do have Hashimoto’s and my antibody levels are not high enough to register?

a couple of other blood test results are as follows :-

B12 Total 224 (162-811)

Iron 14 (10-33)

Ferritin 81 (20-290)

Would appreciate thoughts/opinions or anyone who has experienced something similar.


Thanks for reading 

[goolarra]

"Could thyroiditis be due to a virus and not Hashimoto’s and would the symptoms be different??"

Has anyone mentioned deQuervain's thyroiditis, sometimes called subacute thyroiditis?  It usually occurs after a URI, so I was wondering if that's what you were referring to "due to a virus".  It's a "temporary" thyroiditis and is usually characterized by a hyper stage, followed by a return to normal and then a hypo stage.  However, some people skip either the hyper or hypo stage.  It usually is self-resolving although it can last long enough to warrant treatment until the thyroid recovers.

deQ's is characterized by very elevated ESR.  Has anyone tested that?  

[Barb135]

Many doctors think that anything within a reference range is good enough and that's just simply not the truth... my lab even puts a note on the report that says any B-12 level under 500 can cause symptoms of deficiency.  Some countries, Japan particularly, use 500 as their low range - go figure; why would labs in the U.S figure that 200 is okay?

I have Pernicious Anemia, which is an autoimmune disease in which I don't absorb B-12 through my stomach, therefore, I "do" self-inject on a weekly basis to keep my levels up.  My deficiency was ignored for so long, the nerve damage in my feet is permanent and is very painful, without medication to keep the pain under control... don't let that happen to you,  

You're correct that taking the Eutroxisig every other day averages out to 25 mcg/day... it takes 4-6 weeks for the med to reach full potential in your blood.  If you find that you're doing well on it, you may be able to increase to the full 50 mcg/day after a couple of weeks.

[Judes81]

Thanks Barb for reading and taking the time to respond to me.

I think you are right regarding the B12 levels. The doctor did not mention it at all. i asked for a copy of all my results and noticed it seemed on the lower side of normal.

I have started to feel tingling in my toes and fingers.

Also within my B12 and folate assays was the following

Active B12 63 (>35)

S.Fol 48.2 (8.4-55)

Did you have B12 injections for your levels? i have ordered some B12 sublingual liquid and hope this will help. I used to be a vegetarian for 13 1/2 years (stopped about 7 years ago) and took iron supplements back then so will go back on them to try and get my levels up.

I am on 50mcg of Eutroxsig every second day so thought that be the same 25mcg every day?

I haven't been tested for Vitamin D so will ask the doc for that next time.

Thanks again for your response, i appreciate your thoughts and comments.

[Barb135]

I think you have a couple of things going on... the biggest one is vitamin B-12 deficiency, even though your result is within the range.  Vitamin B-12 deficiency causes the most horrible fatigue imaginable, along with inability to concentrate.  If left at your current levels, you will eventually begin to have numbness/tingling and pain in your feet and hands and if left untreated long enough that numbness/tingling and pain will become permanent... I say this from experience because this is what happened to me, when doctors insisted that my tiredness and brain fog/inability to concentrate were simply hypochondria...

Another issue is your iron level, which is too low in the range, as well... Low iron levels will also cause extreme fatigue.  Additionally, iron is necessary for the metabolism of thyroid hormones.  Low iron levels can also contribute to hair loss and other hypo symptoms.

Your ferritin levels are good, but ferritin isn't "always" a good indicator of iron stores, as higher ferritin can often indicate inflammation in the body.

Moving on to the thyroid... Your TSH is higher than the reference range, indicating hypothyroidism.  Your FT4 is also lower in the range than recommended.  Rule of thumb is for FT4 to be about mid range and yours is only at 30%, again, indicating hypothyroidism.   Your doctor may not think these levels are significant, but he's not living in your body...

Thyroiditis can triggered by a virus, but symptoms will be the same.  Hypothyroidism is hypothyroidism, no matter what the cause and it needs to be treated, as it will, typically, only get worse.

Nodules are very common with Hashimoto's and it's true that not all Hashimoto's patients have elevated antibodies.  It's also possible that your antibodies simply haven't amped up yet and may be higher at a later date.

Personally, I'd recommend starting the Eutroxsig, but maybe at a lower dose - perhaps 25 mcg instead of 50, with the understanding that you might need to increase in a few weeks.  Many of us (especially those over about 50) do better starting off on a lower dose. Discuss this with your doctor.

You will need to get your B-12 levels up higher - I, personally, have to have my level at the very top of the range in order to feel best.  You'll also need to bring your iron level up a little.  Many vegetarians/vegans are deficient in B-12 since it only comes from animal sources of food, such as meat, dairy, eggs, etc

Since your B-12 and iron are low range, you might want to have your vitamin D tested also... vitamin D is also necessary for proper thyroid hormone metabolism and deficiency can cause some hypo-like symptoms.