Help and advice

[Nadpa]

Hi.

This is a post for both the thyroid and PA forum.

I'd love a bit of advice and thoughts on my blood tests and history.

A bit of background: I'm a 38 year old woman. In May this year I was diagnosed with hashimoto's in the presence of high anti-bodies and pernicious Aneamia with a positive test to intrinsic factor. Was also found to be b12 deficient with a borderline low b12 and a high homocysteine. The reason why I was being tested was actually because of not getting pregnant even though trying for 5 years. All fertility hormones are normal, as is egg count and my uterus.

I had prior to testing had a mental and physical collapse. Very severe anxiety which rendered me totally invalidated. I've had it three times before in my life. First when 20. And then twice before within the last 5-6 years. I'm desperately ill for several months. Truly the worst nightmare. My mother had Addisons - another autoimmune disease - and she took her own life when I was twelve as she was so sick and the illness had thrown her into a depression. So some of my anxiety has to do with post traumatic stress due to that tragic loss.

I'm now taking sertralin - an antidepressant. That does help with my anxiety and I'm now back to a normal self though still not back to work.

6 years ago I was told there was something wrong with my thyroids. But not enough to treat. My GP back then said I needed to get tested regularly as I most likely would develop a condition. I did for a while. Everything stayed the same. I then changed doctor as I moved to another council. And in a busy life forgot about it. I never got the results of what was actually wrong and they have since been lost.

These were my blood tests from May 2015

(I'm waiting for results from a new batch of tests done a few weeks ago)

THYROID

FT4 20.8 (9.0-22.0)

FT3 5.79 (2.63-5.70)

TSH <0.01 (0.35-4.94)

Anti-thyroglobulin abs 361 (0-40)

Anti-thyroperoxidase 391 (0-35)

Anti-TSH receptor antibodies 0.98 (0-1.75)

B12

Vitamin b12 257 (187-883)

Homocysteine 18 (5.0-12.0)

Anti-gastro parietal cell abs POSITIVE

OTHER results at the border

25-hydroxyvitamin D 80 (75-150)

Phosphate 0.8 (0.8-1.5)

Glucose 6.0 (3.9-6.0)

Total bilirubin 7.4 (1.0-21.0)

Again I'm not being treated for anything relating to the thyroid as there isn't a real problem - yet. I'm slightly hyper which they're observing to see if it settles.

I've been given three shots of b12. One each month. And now with three month interval.

I've also had my thyroid scanned and it showed to function normally.

So my questions are:

Has anybody else lived with hashimoto's without it ever developing to hypo?

Should I be gluten free despite not having a "real" thyroid problem? Would that help me never become hypo for example?

If my anxiety breakdowns are a symptom of hashi and PA I'm concerned that the sertralin now suppresses that symptom - making it unclear how I'm actually doing in relation to the two autoimmune diseases. Does anybody else have experience with that?

Doctors seem to not be aware of the neuropsychiatric symptoms of b12 deficiency and my current endo dismisses it completely. Do you know of any scientific links - that a doctor would trust - I could send to her describing anxiety and depression in relation to b12 deficiency?

Can the antibodies I have and the low tsh and slightly raised FT3 be causing such severe anxiety in your opinion? Especially as b12 deficiency is also present?

Thanks for reading!

[Clutter]

Nadpa, TSH is suppressed because the pituitary gland detects sufficient circulating hormone ie FT4 high in range, and FT3 slightly over range. High FT3 can certainly exacerbate anxiety.

Thyroid peroxidase and thyroglobulin antibodies are both positive for autoimmune thyroid disease (Hashimoto's). In the early days Hashimoto's can cause transient thyrotoxicosis (hyperthyroidism) as attacks on the thyroid gland destroy cells which dump hormone into the bloodstream. This is sometimes described as Hashitoxicosis.

inkling.com/read/williams-t...

Eventually, and this can take years, the attacks atrophy the gland which becomes unable to produce sufficient hormone, causing hypothyroidism. 95% of hypothyroidism is caused by Hashimoto's. You may be able to slow progression but it is unlikely you will be able to avoid becoming hypothyroid eventually. 100% gluten-free diet can be helpful in managing Hashi flares and may help reduce antibodies and slow progression.

chriskresser.com/the-gluten...

thyroiduk.org.uk/tuk/about_...

Hashi's can 'brew' for decades before it causes hypothyroidism but I personally think it may cause significant issues long before hypothyroidism occurs. I've been bipolar since my teens and had become stable over the years but onset of Hashi's destabilised me mentally first, and then physically, as I spiralled between hyper and hypo. Sertraline was helpful in managing anxiety and depression, but not in reducing palpitations which were frightening, intense and left me breathless. Doctors were adamant my symptoms were non-thyroidal because thyroid levels were euthyroid and antibodies "don't cause symptoms". After thyroidectomy some months later many symptoms resolved, I suspect, because there were no longer Hashi attacks once the target thyroid was removed. Bipolar and anxiety are largely back in their boxes now that thyroid medication is optimal, and I stopped taking Sertraline almost 2 years ago.

Most autoimmune diseases aren't able to be treated/cured. The best than can be done currently is to try to slow progression of the diseases to minimise further damage, and manage the symptoms caused with replacement hormone (when appropriate), replacement B12, and, if necessary, SSRIs and other medication. SSRIs aren't 'masking' anything, they're relieving anxiety and depression which may be symptoms of the autoimmune diseases themselves and which may also destabilise PTSD etc. I doubt you'll get an endo to agree that either Hashimoto's or B12 deficiency have a neuropsychiatric impact, although a psychiatrist or psychologist probably would.

VitD is in the replete range but it is worth maintaining levels by supplementing D3 2,000iu daily Oct-Apr when ultraviolet levels are too low to stimulate natural vitD.

Phosphate is bottom of the range and may be worth keeping an eye on exeterlaboratory.com/test/p...

The PA forum will answer your B12/PA concerns better than I can.

[Nadpa in reply to Clutter]

Thanks so much for your insightful reply. It's good to hear other people's stories and get some advice. What I keep being unsure of is if my physical state are the cause - or at least partly contributing - to the mental state. I'm very confused by that.

Im sort of coming to terms with having to take SSRIs for the rest of my life. But I can't help thinking maybe I don't have to if the two autoimmune conditions will be managed properly.

Im considering taking an appointment with the Marion Gluck clinic. Get somebody to look at the whole thing holistically. Thanks again

[Clutter in reply to Nadpa]

Nadpa, you don't have to assume you will need to take SSRIs for the rest of your life. It's very likely you will be able to wean off when the PA and Hashimoto's are well managed.

[Nadpa in reply to Clutter]

I'd love that!