Is Subacute thyroiditis made me permanent hypothyroidism?

[Meriam881]

Hi all,

In April the last year (so it has been a year since then) I am diagnosed with viral thyroiditis (Subacute thyroiditis).According to Ultrasound, My thyroid is inflamed and enlarged. I took prednisone for several months for the inflammation and as this case caused me hypo I took thyroxine 75 for 7 months. When testing anti bodies for Hashimoto,the result was negative.For the last year,there was good days and bad days but  generally I felt better at the end of the year,and the blood test for thyroid functions was good as I took the 75 dose ( My TSH was 2.1 with this dose).Then My doc told me to stop taking thyroxine as the inflammation was temporary and he wanted to know if my thyroid will work again from itself.Therefore, I stop taking thyroxine for 2.5 months. After I stop the medication, I suffered from thyroid pain,skipped heart beats, feeling hot all the times, sweating despite the cold weather.But I decided to wait to stimulate my thyroid to work again without thyroxine. Today, I got the lab results and these are the results without thyroxine for 2.5 months.

TSH 7.33 (Ref. 0.4- 5.0)

Free T4 .87 (Ref. 0.8- 1.9)

Free T3 2.1 (Ref. 2.0-4.4)

What do you think? Can the temporary condition of virus infection of the thyroid turn me hypo for ever ? Do I need to retake my medication or the thyroid can work again from itself if I wait longer as this is not an immune disease ?

Thanks for your support.

[Meriam881]

Since a week, I had slight fever and severe thyroid pain,and I felt horrible.I visited my doc who told me that these symptoms may be from a recurrence of Subacute thyroiditis or this is not a viral thyroiditis and may be an immune one. He put me on prednisone for two months with a taper schedule for the thyroid pain and thyroxine 50 for hypo .He also asked me to repeat the anti bodies tests.

The lab now called me and these are the results:

Anti Thyroglobulin Abs: My Result: 187.8 IU/ml

BIOLOGICAL REFERENCE INTERVALS:
0 - 60

Anti Thyroid Peroxidase Abs : My result >1300.0 IU/ml

BIOLOGICAL REFERENCE INTERVALS:
0 - 60

I am frustrated and really I am crying right now.What is this means ? Is this Hashimotos? What should I expect ? What I should do to reduce these anti bodies which made my life miserable? Did no gluten diet will make a difference?

Thanks for your help

[Barb135]

Well, so much for a temporary situation!!  Your antibody tests are both positive, which means you now have Hashimoto's and your hypothyroidism is permanent.   Some studies have shown that you can lower antibody counts by taking selenium (which is also high in Brazil nuts), but it's rare to completely eliminate antibodies in this manner.  

What this means is that the antibodies will continue the attack on your thyroid and it will eventually be destroyed.  As your thyroid produces less hormones, you may, most likely need increasing amounts of thyroid hormones to replace what your thyroid can't produce.

A gluten-free diet does help some people to feel much better because many of us have digestion issues with Hashimoto's/hypothyroidism and it's difficult to maintain proper bacterial balance.  Although a  gluten-free diet can help you feel better, it will not cure your Hashimoto's or hypothyroidism.

[Meriam881]

Thanks Barb for your reply. I am new to all this as I spent the last year thinking what I suffer is a temporary condition and all things will resolve  from its own.

I will try selenium tablets,reduce gluten,and hope things get better soon.

[Barb135]

Selenium can be taken at 200 mcg/day as recommended on most brands.  

It doesn't help to "reduce" gluten; if you're going to do anything, you must eliminate it completely from the diet.  This is no small fete if you eat prepared/processed foods, as gluten hides in almost everything these days.   Grains that contain gluten include wheat, barley and rye, so you need to watch for all 3.  I do find that preparing my own foods, as opposed to eating ready-made/processed foods makes a huge difference in the amount of inflammation in my body and the way I feel, even if it hasn't given me the opportunity to reduce/eliminate my thyroid hormone dosage nor did it lower my antibody count.  My antibody count decreased when my thyroid "died" and there was no more healthy tissue for the antibodies to attack.  Still -whatever we can do to make ourselves healthier, the better...

[Meriam881]

You are right Barb.But Gluten did not only exist in food.In my country, a lot of local medications and supplements contains Gluten.There is no alternatives for these and if the alternatives  exist,they will be too expensive to buy.So, I hope I can totally eliminate gluten but in the mean time I am afraid I can not.

[Red_Star]

"...resolution of all thyroidal abnormalities after 12-18 months is seen in most patients (~95%)."

That is info The American Thyroid Association on Subacute Thyroiditis. Good news there. :)

[Barb135]

Right, but I wonder how many patients would agree with them.  lol  I wish I could remember how many cases of subacute thyroiditis we've had here.  It seems like we've seen more become permanent than be resolved.  Or if they are resolved, the resolution is temporary and the patient ends up with Hashimoto's and permanent hypothyroidism.  :-(

[Meriam881]

To Barb,

I wish I could say you are not right and this is a temporary condition.But ,in fact, you are absolutely right. This association knows nothing. Even in the good days the last year,I felt better but not as I used to be before my thyroid is infected.In the bad days, I can not even leave my bed at all.Since I stopped my medication, I feel exhausted all the time even after 10 hours of sleep.Can I be from the 5 % who ended in permanent hypo or these  statistics is not right at all ? I really do  not know.

To Red_Star,

Thank you for your reply. But from my personal experience these statistics is not accurate at all.

[Red_Star]

At least see how you are after 18 months.

[Red_Star]

Yeah Barb...permanent hypothyroidism gets a sad face :( and a few unrepeatable words lol

[Barb135]

Hi Meriam... It's not unusual for Subacute Thyroiditis to become permanent hypothyroidism because it's believed that some viruses can trigger Hashimoto's.  Even if your antibody levels were negative last year, they could be positive now.  You don't say which antibody test was done or if both of the tests for Hashimoto's was performed, so it would advisable to have them repeated.  The test for Hashimoto's are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).  Some of us have one or the other of these antibodies and some have both of them.  Since they're both markers for Hashimoto's, if you don't have both of them done, you can be misdiagnosed.   In addition, some people are diagnosed with Hashimoto's, based on the characteristics of the thyroid as noted on ultrasound.

For right now, since you have a variety of hypo-like symptoms and your thyroid levels are very low in their ranges, I'd strongly suggest that you go back on the medication, assuming that your doctor will prescribe it again.

It actually sounds like you might have been able to use a higher dose than the 75 mcg since it sounds as though you might have had still had some symptoms even before you stopped taking the medication.  Even though your TSH was at 2.1, that doesn't mean all was well.  We need to go by symptoms first and actual thyroid hormones second.  TSH does not correlate well with either once we're on medication.

[Meriam881]

Hi Barb135,

Thank you for your reply. The tests for Hashi I performed last year was as follows:


Anti-Thyroglobulin  Ab (ATG):  My result was : 27 IU/ml

Normal (less than 40 IU/ml)

Anti-Microsomal Ab (A-TPO):  My result was 29 IU/ml

Normal (less than 34  IU/ml)

I do not know what is the characteristics of Hashi with regards to the Ultrasound. But the ultrasound shows the enlargement of the two lobes of my thyroid.


My doc told me that my diagnosis for Subacute was based on  my symptoms which is prolonged low grade fever lasted for months and did not subside except by steroid and severe thyroid pain.He told me that Hashi patients do not suffer from fever nor thyroid pain.Also, I had viral respiratory infection before my symptoms appear.

I will visit my doc at the end of the month and will ask him to repeat my anti bodies and put me on thyroxine again.But ,in fact, I am bit frustrated as two doctors I met last year said it is a temporary condition and I will not need thyroxine for ever.But now I have to get used to living with hypo.

[Barb135]

Your doctor is right that the low grade fever is, typically, present with subacute thyroiditis, however, as I noted, it's not uncommon for that to become permanent, even though they say it's only temporary.  

It's incorrect, however, to say that Hashi's patients do not suffer from fever or thyroid pain.  During periods of acute thyroiditis, which can be present with Hashimoto's, there can be, both fever and pain.  I had them numerous times during periods of antibody attacks.

Also, as I noted, some doctors believe that some viruses, such as Epstein Barr (EBV) or others trigger Hashimoto's.  I've read that even having had chicken pox or measles as a child could be a trigger for autoimmune conditions.  

I found the following excerpt: "Subacute thyroiditis

The primary laboratory abnormalities are consistent with abnormal thyroid function. Initially, the thyroid-stimulating hormone (TSH) level is suppressed, and the free thyroxine (T4) level is increased. As the disorder progresses, transient or sometimes permanent hypothyroidism may develop."
https://emedicine.medscape.com/article/925249-workup

If you haven't been tested for Vitamin B12, D and Ferritin, you might ask for those tests, as well.  Those vitamins/minerals are needed for proper production, metabolism of thyroid hormones.

[Meriam881]

I do not know if my subacute thyroiditis is resolved or not,But until now I suffer from periods of fever and thyroid pain which last for several days then subside? Can these from Hashi ? Can Hashi be present without anti bodies? I will ask my doc about this also.

I take Iron,Vitamin B12 daily and will ask my doc to prescribe me calcium supplement  as I do not think my insurance will permit to do these tests.