Silent thyroiditis question

[Ruthiejb]

Hello, Last year I went to my doctor because I was losing weight, my heart was racing at rest, and I had developed an intolerance to exercise.  The doctor did blood tests and sent me for a scan, after which I was diagnosed with silent thyroiditis.  After an initial stage of hyperactive thyroid, I went into hypothyroid stage which was expected at which time the doctor prescribed 50 mcg Synthroid.  I've been on the Synthroid for a year now.  My question is...how would I know if/when my thyroid starts working again on its own?  I've recently started losing weight again, but I don't have the other initial symptoms of racing heart and exercise intolerance.  Can the weight loss be a sign that my thyroid is working again and I should go off the Synthroid?  Thank you.

[hyperthyroidman]

to the gentleman with thyroiditis, did you ever have any change in the texture of your hair or hair loss?

[stella5349]

What are the types and clinical course of thyroiditis?

Hashimoto’s thyroiditis – Patients usually present with hypothyroidism, which is usually permanent.

This is exactly where I was going this it. Your doctor is basing a Dx of thyroiditis which really - Hashimoto thyroiditis should be the issue.  and Hashi antibodies should be suppressed to se if your thyroiditis is linked to antibodies.

[Ruthiejb]

Now I'm confused.  According to the American Thyroid Assoc website, silent (or painless as it's referred to here) does have antibodies.  It says the hyper phase is followed by a hypo phase (as what happened with me).  Most patients (80-95%) return to a normal state after 12-18 months.  Some patients remain in the hypo state permanently.  So if I don't go back to normal, I have Hashi, and if I do go back to normal, I have painless (or silent) thyroiditis?

Here's the information and the link:

http://www.thyroid.org/patients/faqs/thyroiditis.html

What causes thyroiditis?
Thyroiditis is caused by an attack on the thyroid, causing inflammation and damage to the thyroid cells. Antibodies that attack the thyroid cause most types of thyroiditis. Thyroiditis can also be caused by an infection, such as a virus or bacteria, or certain drugs

3
DIAGNOSIS
What are the clinical symptoms of thyroiditis?
There are no symptoms unique to thyroiditis. If the thyroiditis causes slow and chronic thyroid cell damage and destruction, leading to a fall in thyroid hormone levels in the blood, the symptoms would be those of hypothyroidism (see Hypothyroidism brochure). If the thyroiditis causes rapid thyroid cell damage and destruction, the thyroid hormone that is stored in the gland leaks out, increasing thyroid hormone levels in the blood, and produces symptoms of thyrotoxicosis, which are similar to hyperthyroidism (see Hyperthyroidism brochure). Pain in the thyroid can be seen in patients with subacute thyroiditis.

What are the types and clinical course of thyroiditis?

Hashimoto’s thyroiditis – Patients usually present with hypothyroidism, which is usually permanent.

Subacute, painless and post-partum thyroiditis – These disorders follow the same general clinical course of thyrotoxicosis followed by hypothyroidism. The thyrotoxic phase usually lasts for 1-3 months and is associated with symptoms including anxiety, insomnia, palpitations (fast heart rate), fatigue, weight loss, and irritability. Thyroidal pain in subacute thyroiditis follows the thyrotoxic phase. The hypothyroid phase typically occurs 1-3 months after the thyrotoxic phase and may last up to 9 –12 months. Typical symptoms include fatigue, weight gain, constipation, dry skin, depression and poor exercise tolerance. Most patients (80-95%) will have return of their thyroid function to normal within 12-18 months of the onset of symptoms.

[Ruthiejb]

Thank you, stella.  I'll look into the selenium.  I hope you're doing well.

[stella5349]

That is not the case in every Hashi situation.

I don't think you have a knowledgeable doctor. With the high TPOab test - Hashi's is the reason - and a symptom of Hashi's is the swelling in the neck, kind of a grabbing sensation.

Silent thyroiditis is associated as a normal antibody test - with enlarged thyroid.

In my personal experience - I did not do well on just T4 treatment alone for my issues. I do very well in T3/T4 combo treatment.

You might want to do some reading on the positive effects selenium can have on suppressing the Hashi antibodies. I think if you look at suppression more so than treatment - the Synthroid medication may help you in the long run.

[Ruthiejb]

First of all, I'd like to thank you all for your help.  I forgot to ask about the issue of a goiter...which I wasn't told I have or don't seem to have.  I thought a goiter was also a symptom of Hashimoto's.  Or is that not necessarily the case?

[Ruthiejb]

Hashimoto's was never mentioned, just thyroiditis.  So, does that mean silent thyroiditis wouldn't have the anitbodies?  I was hoping my thyroid would right itself but I guess I'll be on the synthroid for the rest of my life.  Which brings up another question....what's the feeling on generic synthroid?  

[stella5349]

You're antibodies are at a 2200 and they didn't tell you - that you had Hashimoto?

Your antibody testing clearly stated Hashi - I don't know where your doctor is basing thyroiditis.

[Ruthiejb]

Please let us know what your doctor says.  I'm not sure if my weight loss is due to my thyroid, but it does make sense I guess.  I'm always afraid I have something worse....the older I get the more I'm turning into a hypochondriac, which is not a good thing :-(.

[bunny235]

I have hashiomotos and I have trouble with weight loss as well. I have a doctor appointment in three weeks to discuss it, but if you find out anything more please let me know because I am tired of eattig through gallons of ice-cream and boxes of crackers.

[Ruthiejb]

Thank you all for your responses.  To answer your questions, my doctor did do the antibody test last year when I was first having symptoms.  They were very elevated, especially TPOab which was 2255 (range 0-34).  My TgAb was 54 (range 0-40).  FT4 was 5.16 (range 0.61-1.76), FT3 was 15.0 (range 2.3-4.2).   I never felt any sensation in my neck.  I had an uptake which showed my thyroid had hardly any activity...the 24 hour uptake value was 0.4% (normal 15-35%).  Because of this the radiologist couldn't see my thyroid to note the size or if any nodules were present but he palpated my neck and didn't feel anything.  Based on this I was diagnosed with "thyroiditis".  My doctor never mentioned Hashimoto's.  How would I know if I had that as opposed to silent thyroiditis?  I do appreciate your all sharing your knowledge with me.  Thank you.

[stella5349]

Usually silent thyroiditis can be looked at as a Hashimoto antibody that is "hiding" in the woods.

In order for your doctor to determine for sure - you have silent thyroiditis - he would of had to run the TPOab and TgAb testing to see if you had antibodies present. Most thyroiditis patients describe a sensation of swelling - or choking in their neck. Was that one of the things you had happen?

With Hashimoto - a person can sway up and down on hyper /hypo symptoms and it can be hard to regulate until the gland dies off to some degree permanently. More than not - nodules can form with Hashimoto too - so an uptake scan should be done on you to see if you have thats going on too.

Your expressing weight loss as an issue going on - so - on a thyroid level, you may be converting the T4 quite well and getting the active T3 hormone in that is higher for you that is speeding up your metobolism. That's not the worst thing in the owrld to happen I suppose - unless you are dropping a ton of weight altogether.

Really, the only way to see if you are preforming thyroid well on its own is to talk to your doctor about decresing your medication to see if you are doing fine without it.

With Hashimoto again, if that's your situation - going off medication could swing you to a miserable hypostate and it could take weeks to get back to where you feel good.

Let's say - you find no hashi's is present too and your Dx of silent thyroiditis is still an issue. That could be an iodine deficiency too and your doctor and you could look at that as a possible issue and start you on a simple iodine protacol to see if that levels things out without medication.

[Barb135]

You need to get your blood tested -- the tests that Tamra recommended above.  It's possible that your thyroid is putting out some hormone now and then, but you should not go off your med because even if your thyroid is putting out some hormone now, it will stop again and you will be left hypo.  

Ask to get the blood tests, then your med may have to be adjusted based on those results, but then get tested again in 5-6 weeks to see where your levels are.  

[TamraW]

You need these labs to determine your plan of action:
TSH
FT4
FT3

Also, have you gotten an antibody test to determine if Graves or Hashi is involved?
TGab
Anti-TPO

Personally, if you feel great and have no palpatations, heart issues, blood pressure issues, etc, why mess with a good thing? If you feel good on the Synthroid, then it might be just what you need.

:) Tamra