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hashi without antibodies?
Hello, I have hashimoto's, confirmed with labs. My daughter has just had labs run which included thyroid panel, antibodies test, iron, vit d. Her TSH is normal (mid/higher end of normal), panel is normal, antibodies are negative. That said, due to iron, vit d scores along with weight, brittle hair/nails, not sure what else, her doctor is starting her on levothyroxine (I don't yet know the dosage).
Here are results she has passed on to me so far:
TSH 3.55 (.4-4.5)
T-3 uptake 25 (22-35)
T-4 thyroxine 10.1 (4.5-12)
Vit D 33 (30-100)
thyroglobulin antibodies less than 20 (less than 20)
thyroid peroxidase AB 17 (less than 35)
My questions are: Can one have symptoms before the antibodies are present? Has anyone been treated for hypothyroidism when labs are WNL for the most part? If so, at some point, were antibodies present? Thanks.
Here are results she has passed on to me so far:
TSH 3.55 (.4-4.5)
T-3 uptake 25 (22-35)
T-4 thyroxine 10.1 (4.5-12)
Vit D 33 (30-100)
thyroglobulin antibodies less than 20 (less than 20)
thyroid peroxidase AB 17 (less than 35)
My questions are: Can one have symptoms before the antibodies are present? Has anyone been treated for hypothyroidism when labs are WNL for the most part? If so, at some point, were antibodies present? Thanks.
I haven't actually actually looked for why antibodies are negative in the blood. Okay so i've been lazy...lol that is so me. So i thought i really should have a look online. Ummm it took a minute. Nothing in literature..pfft.
This study "Seronegative Hashimoto thyroiditis with thyroid autoantibody production localized to the thyroid" concludes with...
"These studies show that lymphocytes capable of producing antithyroid antibodies can be present in the thyroid glands of patients with Hashimoto disease without evidence of a peripheral immune response, thus indicating that Hashimoto disease can exist as an organ-restricted autoimmune disorder."
This study "Seronegative Hashimoto thyroiditis with thyroid autoantibody production localized to the thyroid" concludes with...
"These studies show that lymphocytes capable of producing antithyroid antibodies can be present in the thyroid glands of patients with Hashimoto disease without evidence of a peripheral immune response, thus indicating that Hashimoto disease can exist as an organ-restricted autoimmune disorder."
I agree with you. I checked definitions for Hashi's yesterday, and there wasn't a single one that didn't say it was an autoimmune disease. I then found this definition of autoimmune disease: "a disease resulting from a disordered immune reaction in which antibodies are produced against one's own tissues, as systemic lupus erythematosus or rheumatoid arthritis."
So if Hashi's is AI, and AI diseases are defined by antibodies, you have to ask "Where's the antibodies?" TPOab in this case was 17 (0-35). Considering we often see TPOab and TGab testing in the thousands, you have to wonder if the test is flawed at picking up just "a few". TPOab can also be somewhat elevated with other AIs.
Not only is hypo funny (as in peculiar, not as in ha ha), but autoimmune diseases are funny. You see AI running in families, but it's often NOT the SAME AI.
So if Hashi's is AI, and AI diseases are defined by antibodies, you have to ask "Where's the antibodies?" TPOab in this case was 17 (0-35). Considering we often see TPOab and TGab testing in the thousands, you have to wonder if the test is flawed at picking up just "a few". TPOab can also be somewhat elevated with other AIs.
Not only is hypo funny (as in peculiar, not as in ha ha), but autoimmune diseases are funny. You see AI running in families, but it's often NOT the SAME AI.
Hashimoto is by definition, a thyroid gland under attack by antibodies causing hypo symptoms. The only other way I've ever heard of DXing Hashi is visual by U/S.
So if its visually noticed on ultra sound, but TPO and/or TGAb is still under the limit, this would be from testing flaws, as in the full antibody count just isn't being picked up for some reason. Negative just means under the limit, not zero. It could be very close, but still under so its negative. Antibodies close to the limit but under, many times exceed the limit (positive) in time.
Hypothyroid is funny. Sometimes when it runs in families, some are hypothyroid, some are Hashi in the same family. I have Hashi hypothyroid while a sibling has just 'regular' hypothyroid, and does a lot better, as in no symptoms left at all.
So if its visually noticed on ultra sound, but TPO and/or TGAb is still under the limit, this would be from testing flaws, as in the full antibody count just isn't being picked up for some reason. Negative just means under the limit, not zero. It could be very close, but still under so its negative. Antibodies close to the limit but under, many times exceed the limit (positive) in time.
Hypothyroid is funny. Sometimes when it runs in families, some are hypothyroid, some are Hashi in the same family. I have Hashi hypothyroid while a sibling has just 'regular' hypothyroid, and does a lot better, as in no symptoms left at all.
Thank you! I will encourage my daughter to ask for an US. Appreciate all the information in this thread!!
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I, too, have read that antibody tests can be negative with Hashimoto's. An ultra sound will show if there's inflammation/swelling, which could also diagnose Hashimoto's.
The doctor is giving this a trial, due to symptoms and yes, my daughter is borderline. She has some health issues going on though and has some symptoms that are a little hypo-ish. Since I have hashi, the doctor thought it might be worth a try. Retesting in 12 weeks. Thanks for figuring the percentage.
Agree with you. I've found statements that sometimes antibodies aren't present, but no explanation as to why.
FT4 is at 46% of range, pretty close to 50%. That doesn't scream hypo to me. However, meds are worth a try. If they don't help, all you have to do is d/c.
Nothing in literature i can find about why antibodies are negative. They probably don't know either. :)
My daughter has hypothyroid, however, no antibodies. My question, just wondering, is: can someone with hypothyroidism, have hashimoto hypothyroidism, if no antibodies are present? I'm just wondering if they might show up in labs or if they never will. I realize she may not have hashi, but I do, confirmed with antibodies; my niece does; my sister, dad, grandmother all had autoimmune illnesses. It seems reasonable that my daughter's hypo is autoimmune, not that it really matters all too much. Since beginning this post, I have read on Dr. Lupo's board and also on web md that one can indeed have hashi without antibodies, just as someone with the antibodies may never develope hypothyroidism. This is a new dx for my daughter and it presented a little differently than mine so I'm just asking questions along the way. She has not yet had an ultrasound. Thank you for commenting.
Did my fog brain miss something here?
Not all hypothyroidisim is from autoimmune antibodies. There is regular non-autoimmune hypothyroid that is not Hashimoto.
Just how did your Dr diagnose with Hashimoto if there are no elevated TPO or TgAb? Symptoms with one or both elevated antibodies is part of the diagnosis process. Hmmmmmm...........
Was diagnosis from a visual via ultra sound? A Hashi thyroid generally looks different than a regular, or even pain non-autoimmune hypo thyroid, but not at first.
Not all hypothyroidisim is from autoimmune antibodies. There is regular non-autoimmune hypothyroid that is not Hashimoto.
Just how did your Dr diagnose with Hashimoto if there are no elevated TPO or TgAb? Symptoms with one or both elevated antibodies is part of the diagnosis process. Hmmmmmm...........
Was diagnosis from a visual via ultra sound? A Hashi thyroid generally looks different than a regular, or even pain non-autoimmune hypo thyroid, but not at first.
Thanks so much! I will pass this on to my daughter. I'm wonder, as you mentioned, if this is early stage still and antibodies aren't detectable.
My GI specialist told me he missed the schilling test (radioactive B12 along with intrinsic factor) as blood work missed cases of pernicious anaemia that the shillings test picked up. I can only assume the immune system is too suppressed to produce enough antibodies in those cases. Same would apply to Hashimoto's thyroiditis no doubt. Or another thought is antibodies may not show up in the very early stages of the disease. Just throwing out a few thoughts. An FNA biopsy can be done if there is high suspicion of Hashimoto's thyroiditis.
Thank you very much for commenting. I have her free T-4 now: 2.5 (1.4-3.8), if that makes a difference. She just started 50 mcg levothyroxine, 50,000IU of vit D once a week and also sub-lingual B12.
I looked through old posts on Dr. Lupo's group. He was asked about absence of antibodies. He said a small percentage of patients with hashi's do not have antibodies, but that a skilled ultrasonographer can detect subtle inflammation of the thyroid which may also suggest hashi. I'm not sure if she is having an ultrasound of her thyroid, but will encourage her to ask about it at her next appointment.
She may not have autoimmune hypo, but I do, my niece does, my sister has pernicious anemia, my dad and grandmother had autoimmune illnesses. I guess I thought if she had hypo, it too would be autoimmune.
Again, thanks for your input. Very helpful.
I looked through old posts on Dr. Lupo's group. He was asked about absence of antibodies. He said a small percentage of patients with hashi's do not have antibodies, but that a skilled ultrasonographer can detect subtle inflammation of the thyroid which may also suggest hashi. I'm not sure if she is having an ultrasound of her thyroid, but will encourage her to ask about it at her next appointment.
She may not have autoimmune hypo, but I do, my niece does, my sister has pernicious anemia, my dad and grandmother had autoimmune illnesses. I guess I thought if she had hypo, it too would be autoimmune.
Again, thanks for your input. Very helpful.
I've read that some people with Hashi's test negative on antibody tests. However, since Hashi's is an autoimune disease, isn't it an oxymoron to have Hashi's with no antibodies? I don't know if the operative word in that is "test", i.e. do they test negative for some reason but actually have them? I haven't found an answer to that yet.
According to the AACE range recommended about 10 years ago and adopted by very few of 0.3-3.0, she is technically above range on TSH.
Total T4 is not only not low, it's on the high side of the range. T3 uptake is actually an indirect measure of T4 despite the name and is pretty useless.
You can be hypo from other causes besides Hashi's, so yes, it's possible to have symptoms without antibodies, and I don't think that they will necessarily follow.
What about her vitamin D? That's dismal!
According to the AACE range recommended about 10 years ago and adopted by very few of 0.3-3.0, she is technically above range on TSH.
Total T4 is not only not low, it's on the high side of the range. T3 uptake is actually an indirect measure of T4 despite the name and is pretty useless.
You can be hypo from other causes besides Hashi's, so yes, it's possible to have symptoms without antibodies, and I don't think that they will necessarily follow.
What about her vitamin D? That's dismal!
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