Do I have Hashimotos?

[bwinkler27]

I have been chronically ill for several years now. Frequent respiratory and gastro infections. My primary ordered a CBC and CMP earlier this year and everything came back normal. I know something is wrong so I am taking my healthcare into my own hands and ordering my own more extended lab work. Some of my more recent symptoms, occurring in the last year or so, led to me to do a full thyroid panel. They include:

- Increased fatigue
- Frequently feel as though my lymph nodes are swollen
- Weight gain
- Irregular periods and increase in PMS symptoms
- Weird heart palpitations where it seems hear rate slows down or skips a beat
- Digestive issues
- Muscle/joint pain
- Complete lack of sex drive
- Increased depression/anxiety

Below are the results of my thyroid panel:

TSH - was 2.1 for CBC and a week later was 1.46

Free T3 - 3.2 (reference range 2.3-4.2 pg/mL

Free T4 - 0.9 (reference range 0.8-1.8 ng/dL)

Thyroid Peroxidase Antibodies - 3 (reference range <9)

Thyroglobulin Antibodies - 4 (reference range <1)

I've been doing a lot of research and a lot of what I read said any level of thyroglobulin antibodies is a positive for Hashimoto's. But I've also read that isn't really treatable until everything else is out of whack too. Does that apply even when you're very symptomatic? I'm just wondering if I should bother seeing an Endo when the only thing that's abnormal is the antibodies.

Any advice or guidance would be appreciated!

[gimel]

Fasting can make a difference on some tests, but not required for thyroid related tests.    But thyroid med should never be taken before the blood draw for  thyroid related tests, to avoid false high results.  

[bwinkler27]

Thanks for your replies. Do any of you know if eating or drinking before a blood test makes a difference on the results? I didn't fast for these labs and am wondering if I should do them again.

[gimel]

Any doctor can be a good thyroid doctor if willing to diagnose and treat clinically (for symptoms), rather than just based on TSH.   So, I would not just assume that an ENT would be a good thyroid doctor.  

I am sending you a PM with info.  To access, just click on your name and then from your personal page, click on messages.  

[gimel]

Although any doctor can be a good thyroid doctor if willing to diagnose and treat clinically, rather than based on TSH, I would not just assume that an ENT would be a good thyroid doctor.  

Sending you a PM with info.  to access, just click on your name and then from your personal page, click on messages.

[gimel]

Yes, the TG ab result is positive for Hashimoto's.  Apparently it is in the early stages, since your TSH has not gone out of range yet; however, from that list you are already suffering with symptoms of hypothyroidism.    Just because your FT4 and FT3 levels are within range does not preclude hypothyroidism.  

Doctors have been trained that hypothyroidism is "a diseased thyroid gland" or "insufficient thyroid hormone".  The comprehensive definition of hypothyroidism is "insufficient thyroid hormone effect in tissue throughout the body due to insufficient supply of, or response to, the hormones."  So it is not only the amount of thyroid hormone that is important, but also the response to it at the tissue level.  Also, each person may have different levels of thyroid hormone at which they feel best.  

Hypothyroidism is certainly treatable before everything goes "out of whack".     Why should hypo symptoms be ignored just because FT4 and FT3 are somewhere within their reference ranges?  Those ranges are  far too broad and skewed to the low end, due to the questionable procedures used to establish them by the labs.  Your FT4 is barely within the range, which is too low.  Your FT3 is below mid-range, which is not optimal for many people.   Your FT3 being higher in range than FT4 may be an indication that your body is converting extra T4 to T3 in an effort to maintain body function.  

Doctors typically diagnose based on TSH, and FT4 if needed.   Evaluation of the patient’s medical history, signs and symptoms, the biologically active thyroid hormone Free T3 (FT3), and Reverse T3 (RT3) have become insignificant under the current standard of care.  Unfortunately for the patient TSH has a negligible correlation with tissue thyroid status.   FT4 has only a weak correlation with tissue thyroid status.  Symptoms are strongly associated with FT3 levels, but not TSH and FT4.  

A good thyroid doctor understands all this and will diagnose and treat a hypothyroid patient based on clinical evaluation for symptoms that occur more frequently with hypothyroidism, supported by expanded testing for FT4, FT3, TSH, TPO ab, TG ab,  cortisol, Vitamin D, B12 and ferritin.   When hypothyroidism is diagnosed, then thyroid medication should be increased enough to relieve signs/symptoms of hypothyroidism, without creating signs/symptoms of hyperthyroidism.   Cortisol should be neither too low or too high.  Vitamin D should be at least 50 ng/mL, B12 in the upper part of its range, and ferritin should be at least 100.   TSH should not be used to determine medication dosage.  TSH alone cannot reliably determine if the medication dosage is adequate to restore the euthyroid state.

Regarding your question about the Endo.  Only if the Endo is a good thyroid doctor that will diagnose and treat clinically, as described.  Most Endos will not.  Instead they have the "Immaculate TSH Belief" and use "Reference Range Endocrinology".      If you do not know of a good thyroid doctor we might be able to help locate one, if you will tell us your location.  

[bwinkler27]

Thanks so much for your response! I've also read that sometimes it's better go to an ENT for thyroid. Not sure why though. I am in Atlanta.