Hashi's Complicated by Something Else...

[WatchTheWeatherChange222]

28 y/o female, 5'0, 150lbs. dx/ Hashimoto's 4 years ago. No one has ever explained to me why my TPOab started at near 6,000 and has stayed in the thousands despite 4 yrs of meds.

MVP, difficulty swallowing, diarreah and constipation, symmetrical Arthralgia of feet, pain in lower back, hips, neck, and chest, muscle pain everywhere else, Headaches increased frequency and intensity, irregular menses, snoring, feeling of a lump in my throat, craving sugar at night, craving salt during the day, confusion, unrefreshing sleep, blurry vision w/o cause, low-normal body temp & blood pressure, high Cholesterol, twitches in, eyelids, fingers, legs, arms, feeling like there is something on my skin, 40lb. weight gain in abdominal region.

Findings:

•Stopped T4, started T3 at 50mcg to titrate up to 500mcg. Could not get beyond 50mcg without racing mind and elevated pulse (140 bpm).
•Had "Lyme Literate" doctor test for Lyme. p58 Ab, Abnormal.
•TSH shot up from 3.0 to 12.0, TPOab shot back up to around 3,000. Restarted Levothyroxine 88mcg/day & 50mcg/day. Argues against PTRTSH.
•Slightly elevated WBC count for three years 11.0.
•Swelling in lymph nodes (neck 1.0cm, base of skull, armpits) for about three years.
•Cystic acne worsening.
•Fatigue worsening.
•Mild cervical and lumbar spinal stenosis.
•Absolute CD3 = 2326
•Absolute CD4 = 1784
•% CD4 Helper = 61.5%
•Hemoglobin = 15.6
•Hematocrit = 46.0
•Neutrophils = 7.9
•Antidiuretic Hormone, Osmolality = 348
•Leptin = 33.2
•Fasting Glucose Serum = 114
•LDL = 168
•Testosterone, % Free + Weakly Bound = 26.5%
•Persistent (1 year) Septated cyst in left ovary, new Hemorrhagic cyst right ovary.

Awaiting results on 24 hour urine test to r/o Cushing's, Addison's. Doctor reported elevations in all blood levels and is recommending hematologist.

I'm out of ideas. It doesn't make sense to me any more. What else could be causing all of these abnormalities and my crushing fatigue?

[WatchTheWeatherChange222]

Thanks Dr. Lupo; I had a feeling you would say that.  I guess I just wanted to hear my own thoughts come out of someone else's mouth for verification.  I don't want to admit that this is the direction life is taking for me, but I can't really ignore it anymore either.

Thank you again...

[Mark Lupo, M.D.]

keeping TSH in the 0.5-2.5 range is the best suggestion for the hypothyroidism but the scenario likely goes beyond thyroid -- this is obviously a complicated situation and if the current evaluation does not resolve the cause then a university based approach for a second opinion might help.