Hashimotos and 1.5 positive ANA

[JRHEAR]

I just saw my rheumotologist and he thinks I have Lupus due to a 1.5 ANA and high thyroid antibodies which he says is hashimotos.  He prescribed me hydroxy chloroquine 200 MG to be taken two times a day while we wait to see how my blood work comes back. I am not sure if I should take this until I know for sure what is going on. Did anyone else have this experience?

[gimel]

Would Wayne NJ be close enough to interest you?

[JRHEAR]

My location...is west milford nj

[gimel]

Sorry, just noticed that the ranges did not show up when I tried to copy and paste them above.

  or =6.0 U (strongly positive)

Reference values apply to all ages.

[gimel]

Lupus is something I am not familiar with; however, when I did some reading, I found this about the reference range for the ANA test.  

or =6.0 U (strongly positive)

Reference values apply to all ages.
Interpretation

A large number of healthy individuals have weakly-positive antinuclear antibody (ANA) results, many of which are likely to be clinical false-positives; therefore, second-order testing of all positive ANAs yields a very low percentage of positive results to the specific nuclear antigens.

I agree with what Barb said previously.  " You should be aware, though, that there are some people with Hashimoto's that have a positive ANA and that many of the symptoms of Lupus are the same as those of hypothyroidism caused by Hashimoto's.  For this reason, I'd want to make sure my thyroid levels were optimal (not simply "in range") prior to taking any medication for Lupus."

So, I'm not sure how your doctor could think you have Lupus, with the one ANA test.  I am sure that you do have  Hashimoto's.  As I mentioned previously, your symptoms of muscle ache/joint pain and hair loss are frequently associated with being hypothyroid.  Your only test of actual thyroid hormone was the Free T4 which was actually below range, which we don't even see very often.   You really need a Free T3 test.  Free T3 largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlates best with hypo symptoms, while Free T4 and TSH did not correlate at all.  

You don't necessarily need to see an Endo, just a good thyroid doctor.  Endos frequently specialize in diabetes, not thyroid.  Also many of them have the "Immaculate TSH Belief" and only want to use TSH for diagnosis and treatment.  That does not work.  If they go beyond TSH and test Free T4, they will tell you that a result that falls anywhere within the range is adequate.  That also is wrong.  

So, I suggest that you find a way to go ahead and get tested  for Free T3 and Free T4 again, along with ferritin and a full iron test panel.  Then you will need a good thyroid doctor.  If you will give us your location, perhaps a member can recommend a doctor.

[JRHEAR]

So...I contacted my Gen practitoner to see if I could get the t3 a t4 test done in addition to a complete iron panel. I was told to go through the rheumotologist.  I did see the rheumotologist to get blood work done to rule out other auto immune issues...and these were the results
Albumin 3.9 range 3.5-5.0
Albumin globulin ratio 1.1 range 1.2-2.0
Globulin level 3.5 range (2.0-3.5)
Platelets  160 L range 163-337...they were high 2 weeks before this lab result..all cbc different were normal
DNA ds abs 19 H range <=4
Negative for sm ab eIA
Negative for sjogren ssa
Negative for sjogen ssb
Negative for histone ab
Scl70 ab eia negative
Centromere b, ab negative
Taking this info and correlating this with the lab results previously posted...I'm not sure if this also means I have sle with hashimotos.  I feel like maybe the hashimotos is making my results on the double stranded dna test and my ana test positive. Truthfully my symptoms are hair loss fatigue and some muscle and joint aches but not something so painful that I c ant function...very minor. I have a follow up appointment with the rheumotologist next week. I'm not sure if I should hold off until I see the endocrinologist before going back to the rheumotologist.  Unfortunately I cannot get in to see the endocrinologist until october. I am really scared and am prayin that I do not have lupus and hashimotos.  Can you help me piece this together a little bit better and further advise me. Thanks for your help...it's really appreciated.

[gimel]

It is a good idea to always make sure they are testing you for both Free T3 and Free T4.  Insist on it.  Your Vitamin D is only a bit below middle of range, which is recommended.  Your B12 is lower than recommended, which is the upper part of its range.  Interestingly, in Japan and Europe, I understand that the lower range limit is 500.  So room to supplement.

Ferritin is very important to metabolize thyroid hormone adequately.  For women the recommended range is 70-80.  You might want to get a ferritin test done, along with a complete iron test panel.  

Just because levels are within the so-called "normal' range does not mean they are functional for you.  The ranges are far too broad, due to the erroneous method used to establish them.  In addition, TSH is affected by so many things that it is totally inadequate as a sole diagnostic for thyroid issues.  At best it is only an indicator, to be considered along with more important indicators such as symptoms and also levels of Free T3 and Free T4, the biologically active thyroid hormones.

It seems that hypo patients frequently start noticing symptoms even before their lab results get their doctor's attention.  Your Free T4 is already below range, and I expect that you will find your Free T3 to be low/below range as well.  So I see no reason to wait to get started on thyroid meds.  Even with a good thyroid doctor, it will take some time to get your meds/dosages optimized, so that you feel well.  And yes, muscle aches and joint pains and even hair loss are common symptoms of hypothyroidism.  Although there are many more, you can see some of the typical hypo symptoms in this link.

http://endocrine-system.emedtv.com/hypothyroidism/hypothyroidism-symptoms-and-signs.html

As you proceed, keep in mind that a good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."

http://hormonerestoration.com/files/ThyroidPMD.pdf

[JRHEAR]

Thank you! I double checked my lab results...they did not test me for my free t3. They did check my vitamin D which is 42 (18-78PG/ml), vitamin B 12 is 477 (239-931PG/ml)..I'm not sure if they checked for ferritin.
If my levels are normal right now does that mean I caught this early? Also is muscle ache/joint pain along with hair loss common symptoms of hashimoto's? My last question is should I just wait on the results from the blood work the rheumotologist took to see what it shows before entertaining any medication? The only reason why I went to the rheumotologist before an endocronologist is due to the suggestion of my general practitoner. Now I feel like I made a mistake.

[gimel]

Before taking any med for Lupus, I'd want to take care of the thyroid problems first and then see how you feel.  Your TG and TPO antibodies say you have Hashimoto's.  Your Free T4 is below range.  They didn't test for Free T3 which is very important, since it largely regulates metabolism and many other body functions.  Scientific studies have even shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.  

In the words of a good thyroid doctor, ""The free T3 is not as helpful in untreated persons as the free T4 because in the light of a rather low FT4 the body will convert more T4 to T3 to maintain thyroid effect as well as is possible. So the person with a rather low FT4 and high-in-range FT3 may still be hypothyroid. However, if the FT4 is below 1.3 and the FT3 is also rather low, say below 3.4 (range 2 to 4.4 at LabCorp) then its likely that hypothyroidism is the cause of a person's symptoms."

With Hashi's the associated antibodies produced by the autoimmune system attacks the thyroid gland and eventually destroys its function.  As thyroid hormone levels diminish symptoms start to appear and will become worse over time, if not treated with thyroid hormone med.  

So I suggest that you should get your doctor to test for Free T3 along with Free T4, and do both each time you go in for tests.   Since hypo patients are also frequently too low in the range sfor Vitamin D, B12 and ferritin, you should get those tested as well.

Also, since your Free T4 is already below range, the doctor has no excuse to defer starting you on thyroid med.  A normal approach would be to start with 25 mcg of a T4 med, and then re-test and adjust dosage about every 4-5 weeks as necessary to relieve symptoms.  Many members say that symptom relief required Free T3 in the upper third of its range and Free T4 around the middle of its range and above.  

[JRHEAR]

My TSH is 2.310 (0.465-4.68 UIU/ML)
My free t4 is 0.74 (0.78-2.19 NG/DL) L
My thyroglobulin antibody is 288 (<116IU/ML) H
My thyroidoxidase TPO antibodies is 20.4 (<9.0 IU/ML) H

I am truly nervous about taking this medication. When I spoke to the rheumotologist again...he said you can have a false positive for lupus but they won't know unless I take the medication to see if it works.

[Gin52]

I have a high ANA and Hashi's. All Lupus tests and workups negative.

[Barb135]

Have other thyroid related tests been done, such as Free T3, Free T4 and TSH?  If you have results for those, please post them, along with reference ranges, so we can better tell what your thyroid condition might be.

Hydroxychloroquine (plaquenil) is common treatment for Lupus.  

To my knowledge, we don't have anyone on the forum, at this time, with both Lupus and hashimoto's.  You should be aware, though, that there are some people with Hashimoto's that have a positive ANA and that many of the symptoms of Lupus are the same as those of hypothyroidism caused by Hashimoto's.  For this reason, I'd want to make sure my thyroid levels were optimal (not simply "in range") prior to taking any medication for Lupus.