Hashimoto's?

[Ginny315]

Hello,
I was diagnosed by a functional medicine internist as having Hashimoto's and he wants to start me on a sustained release T3. I am just a little confused by my results. I am symptomatic and have a goiter on examination, plus low iodine. I do have a sono scheduled next week.Below are my lab results done at Labcorp:
Thyroxine(T4) Free, direct, S 1.02 ng/dL  (norm 0.82-1.77)
TSH 1.050     (norm 0.450-4.5)
Iodine, serum or Plasma  39.6    (norm 40.0-92.0)
Reverse T3, serum  16.2   (norm 9.2-24.1)
Thyroxine (T4) 7.7   (norm 4.5-12.0)
Thyroglobulin Antibody 1.4  (norm 0.0-0.9)
TPO Ab 13 (norm 0-34)
Triiodothyronine, Free, serum 3.1 (norm 2.0-4.4)
Vit D 32.4
Vit B12 489 (norm 211-946)
Selenium 137 (norm 79-326)
Do these results indicate Hashimoto's if I clinically have symptoms too, or should I have further testing done to clarify what is going on? I am trying to do my own research online, but it's not very clear. Thank you for your help.

[Red_Star]

Risk factors for Hashimoto's thyroiditis include a family history of thyroid disorders which you notably have.  There are numerous genes involved but of note in particular HLA-DR3 and HLA-DR5. I clearly have the HLA-DR5 type since my other autoimmune disease are also mentioned (my sister has the same four autoimmune diseases I have).  Most people with Hashimoto’s thyroiditis will have an elevation of one or both of the thyroid antibodies although in a small percentage of cases both thyroid antibodies are negative.

Excerpt from Hypothyroid Mom - A Different View on a Common Autoimmune Disease, Hashimoto’s Thyroiditis...

"Hashimoto’s is a disease process characterized by progressive destruction of the thyroid gland resulting in hypothyroidism. It can be diagnosed by any of the following: 1) enlargement of the thyroid gland / goiter, 2) high levels of antibodies against thyroid peroxidase or thyroglobulin, 3) fine-needle aspiration of the thyroid showing immune-cell infiltration of the gland, 4) an ultrasound showing an enlarged thyroid, or 5) radioactive iodine uptake scan showing a specific pattern of diffuse iodine uptake."

[gimel]

Well you can point out to him Recommendation 18 on page 14 of the link above.  It clearly says cortisol issues should be resolved before starting on thyroid med.  And I would add, especially T3 med, which sometimes causes a reaction if there is low cortisol, or low ferritin.  Which reminds me to suggest that you should also be tested for ferritin.    

[Ginny315]

I will talk to him about it. I know he wants me to go on pregnolone, dhea, 5-http, l-tyrosine and the slow release T3 along with iodine, to which I am adding selenium.

[gimel]

Is your doctor willing to prescribe Hydrocortisone medication for your low cortisol?  Just being within the low end of the extremely broad range is not adequate.  Note that if you do go on cortisol med, you also will need to take a corresponding amount of DHEA, which offsets any potential side effects from the cortisol.  

[Ginny315]

Thank you so much! This all very helpful. I did have my cortisol tested by saliva in a one day 4 times test.  And yes it is low in spite of me doing it on a crazy out of control work day that left me depleted and feeling sick for 2 days after. The reading references are greatly appreciated and I was wondering myself if I should correct the iodine first then retest. Now I have a beginning point and this is good. Again thank you.

[gimel]

I'd say you have hypothyroid symptoms, due to relatively low levels of FT4 and FT3, along with low Vitamin D (should be at least 50).  I don't see enough evidence to say the hypothyroidism is due to Hashi's.  The relatively low TSH levels would point to central hypothyroidism.  With central there is a dysfunction in the  hypothalamus/pituitary system that results in TSH levels that are too low to adequately stimulate the thyroid gland.  

Such a problem might also play into your fibromyalgia.  Note the following links.  

https://www.holtorfmed.com/adrenal-dysfunction-in-fibromyalgia/

https://www.ncbi.nlm.nih.gov/pubmed/20458566

The thought here is that the hypothalamus/pituitary signal to the adrenals might also be affected, resulting in low cortisol.  The best way to test cortisol is the diurnal saliva cortisol panel of 4 tests taken at different times of day.  This tests for Free cortisol.  A serum cortisol is Total cortisol and is not as revealing.  

So, in view of these two issues: low iodine and possible low cortisol, I think I would hold off on any thyroid med until iodine supplementation adequately raises your level.  Also, if there is a cortisol issue, it needs to be resolved before starting on thyroid med.  

You can read about much of this in the following link.  I highly recommend reading at least the first two pages and more if you want to get into the discussion and scientific evidence for all that is recommended.  

http://www.thyroiduk.org/tuk/TUK_PDFs/The%20Diagnosis%20and%20Treatment%20of%20Hypothyroidism%20%20August%202017%20%20Update.pdf

Note especially the different processes and variables that affect the desired outcome: adequate tissue thyroid effects.  This is depicted in Fig. 1 on page 7.  Also note Rec. 18, on page 14.

[gimel]

I would not jump to the conclusion that you have Hashi's just due to the TG ab test.   When doing some quick searching I found that a small amount of TG ab in your blood may indicate issues other than Hashi's.  In addition, about 90% of the time Hashi's will manifest as high TPO ab, which is not the case for you.  Further, your FT4 is at only 21% of its range and your Free T3 is at 46% of its range, yet your TSH is only 1.05.  The relatively low TSH is also not indicative of Hashi's.  

Your goiter is likely due to low iodine. Note the following info.  "Iodine is an element that is needed for the production of thyroid hormone. ... Thus, iodine deficiency can lead to enlargement of the thyroid (goiter) and , hypothyroidism".  

In any evaluation for possible hypothyroidism, the most important indicator is symptoms, followed by the FT4 and FT3 levels.  So, before going further, please tell us about any symptoms you have.  

[Ginny315]

I was diagnosed with fibromyalgia about 20 years ago, with pain, fatigue, brain fogginess and exercise intolerance. Over the years I have learned how to live with this and lessen the symptoms to almost  nothing, through exercise, a healthy diet including lots of veggies and fruit, excluding foods that I can not tolerate, good sleep hygiene and avoiding unnecessary stress. Over the years on and off I have symptoms such as unexplained hives and rashes, medication sensitivity, dizziness/imbalance, hair thinning and falling out, crazy acne for someone my age on face chest and back. About a year ago I was the healthiest I had been in forever, exercising, eating well, felt great.

Then I began with weird sensation in my head, like in the middle. It was a fluttering sensation, which caused ear pain, a tilting or swaying sensation and a sensation of hearing loss and inner ear pain, especially low sounds, facial pain and eventually a headache. This went on for 3 months almost continually. It stops for about 2 months then returns for another 2 months. It has been going on all year. I also developed pulsating Tinnitus in my left ear. Along with this came exercise intolerance, and increased body pain, extreme fatigue, hair falling out again, rashes and acne again, mental fog, hard time remebering things.No matter what I do it just doesn't get better Trips to ENT, Audiologist, Neurologist and PCP revealed nothing. A trip to a chiropractor and neck adjustment caused me to have thoracic outlet symptoms and even now if I pick up anything weighing more than a couple pounds I began with the muscle spasms and numbness tingling, weakness and pain down my arms into my hands and occasionally one foot. MRI of my c spine is normal. MRA shows an extremely small and actually  not dangerous aneurysm that is in an ideal location per the neurosurgeon. But it also showed something moderately big on my thyroid .

So no answers so I paid the money and went to a reputable Functional Medicine MD who is also an internist. He is the one who ordered the tests and wants to start me on a slow release T3.

Family history, my mother and 1 sister have hypothyroidism, my daughter has Graves in remission. My mother and 1 sister have arthritis, one rheumatoid and 1 psoriatic. 2 sister have Raynaud's and one has Barret's. I do not want an auto immune disease, but I would like answers and to feel better again. Definitely at the end of my rope and when he gave me this diagnoses I felt like "Finally something we can treat.". But from researching online it certainly doesn't look like I have what it takes for a diagnosis. For what's it's worth my TSH has been jumping around for the past 4-5 years but always in the normal range and never over 2.5. I also have always had high lipids, but even though they are high right now my ratios are really good. I just got my vitamin D up to 32. It has been around 20-23 for the past 3-4 years. Also I eat a predominately meat/dairy/egg/fish free diet and have been using sea salt. Could the low iodine account for my symptoms even though it is not that low?
Sorry about the long post but that is the whole story. I do not want to start something that may make me worse which is what happened with the chiropractor.