Primary hypothyroidism, Hashimoto's or both?

[Granny56]

Today my  copy of the endo report arrived confirming a diagnosis of Hashimoto's autoimmune thyroiditis. I was originally diagnosed with primary hypothyroidism; since 2011, does this mean I have both types or has Hashimoto's taken over as the lead diagnosis?

[humanbean]

This is how I understand the terminology :

Primary hypothyroidism is hypothyroidism caused by the failure of the thyroid gland.

There can be several reasons for a thyroid gland to fail.

1) Hashimoto's Thyroiditis is one of them.

2) Insufficient iodine intake in the diet.

3) Radioactive iodine treatment given to someone who has previously had hyperthyroidism.

4) Viral thyroiditis

5) Idiopathic i.e. arises spontaneously for unknown reasons.

6) Probably several others I can't remember.

So, your Hashimoto's is a reason for you having primary hypothyroidism.

[helvella Administrator Thyroid UK in reply to humanbean]

Secondary is when the pituitary isn't sending enough TSH to the thyroid.

Tertiary is when the hypothalamus isn't sending enough TRH to the pituitary.

The above are commonly combined as "central" hypothyroidism, at least partly because it isn't always easy to work out which is the cause. (Or it's too expensive! )

So the thyroid might in itself be perfectly healthy.

[Granny56 in reply to humanbean]

Hashimoto's cannot be the reason as I have been hypothyroid for 5 years with normal TPO and thyroid gland (ultrasound), only TSH was high.

Please see my response to @ radd

[radd]

Granny,

Unless you were tested for thyroid antibodies at the time of your original diagnose, how would you know ? ? ..

You probably had Hashimotos all along as it is the main reason for hypothyroidism to develop. We do not know the reason for the autoimmune response to attack our own tissues but thoughts that a series of actions//reactions to an invading virus// bacteria, certain foods, toxins, trauma and also being genetically predisposition to it developing anyway, are being explored. 

Now you know you have Hashimotos, it is important to keep antibodies low to avoid inflammation which can cause fatigue, puffiness, aches & pains, brain fog. Many members have found a gluten free diet helps.

.

Hashimotos

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

.

Gluten/thyroid connection

chriskresser.com/the-gluten...

[Granny56]

radd  thank you for your response and the links.

My antibody levels were tested at the time of my diagnosis in 2011 and at 6 monthly intervals thereafter. In January TPO was 9 and in March 75 ml/l , bloods were rechecked because an ultrasound in January indicated an attack on my thyroid gland. The endo said that I was showing signs of Hashimoto despite TPO being within normal limits, the subsequent blood test in March was just to keep an eye on my TPO.

I have other autoimmune disease (PA for 30 years) and have symptoms of Coeliac disease though not confirmed. Biopsy in 2005 confirmed lactose intolerance but excluded Coeliac disease.

I have all the symptoms you mention that I should avoid plus many more and my CRP (inflammatory marker) was 23 at one point now 13 which is still very high. Doctors have no idea where the inflammation is coming from despite my legs being fluid filled and as red as tomatoes. 

At my first appointment in the newly diagnosed diabetic clinic a doctor and medical student looked at my legs and noted the difference in temperatures beteen above and below knee, the swelling and inflammation. Nothing was mentioned on the report to my GP. They obviously just ignored it as it wasn't their domain. They only reported peripheral neuropathy in both feet.

So my question remains, how should I describe my hypothyroid diagnosis?

[radd in reply to Granny56]

Granny,

Have you ever had TGAb tested ?  Thyroglobulin antibodies can also indicate Hashimotos but are rarely checked. 

I would describe your condition as Hashimotos which covers having both the auto immune disease and primary hypothyroidism. Medical treatment is the same for both: to render the patient back to a ‘euthyroid’ state with hormone replacement . This also helps to suppress Hashi attacks & keep antibodies low. 

Functional treatment looks at keeping the antibodies low as these are likely to cause inflammation and predispose you to other conditions.

Are you medicating thyroid hormone replacement ? Have you addressed your many nutrient deficiencies ? What did endo say about such a low cortisol result?

[Granny56]

I remember Tgab being tested a few years ago and it was normal, I must look out old results to check.

Results from 18/03/2016 (diabetic clinic)  : ACTH (basal) 19.5 pg/ml cortisol(basal) 8.2 ug/dl, DHEA-S (basal) 0.65 mg/l, TSH (basal) 0.924 mlU/l, FT3 2.48 ng/l, FT4 1.13 ng/dl, TPO 71.2 U//ml.

The cortisol level has only just started to creep into the lower normal range. A short synacthen test in January demonstrated that I was in the grey zone and should have further tests to exclude a HPA problem. However, endo does not agree despite me providing literature evidence from RCT's 2014-2015 and American pituitary associaton guidelines.

My TSH has increased in the last 3 months as it was barely on the scale. I take T4 only, L-thyroxine 50/75 mcg on alternate days but endo recommends 50 mcg only while TSH below 1.0 mlU/l. Endo thinks I should be feeling wonderful with these results, the problem is that I am not feeling good.

I have corrected my vit D 9 ( range 30-120) and am now at  51 , lower end of normal, iron was low so I took supplements with vit C , should get result on Monday, folate was below range, after supplements now lower end of normal. Selenium and iodine never checked, endo says not necessary. I get hyydroxycobalamin 1000 injestions every three months but find that I cannot go longer than 2 months in the last year. Cholesterol values within range on 40 mg Simvastatin, LFT's now normal for the first time in years. Although I am much improved ( my worst days in 2012-2013 when TSH>4.0) I am still not my old self and am particularly tired with poor concentration levels. Sleep apnoea diagnosed in 2014, excluded in 2015 and re diagnosed 2016 based upon the results of 2015 by a professor in the same clinic. I am waiting for an overnight appointment to repeat the sleep apnoea tests.

[Treepie]

sleep apnoea is a symptom of hypothyroidism .Was for me with mega snoring.

Maybe you are not on high enough dose of T4 regardless of what TSH says.

Perhaps you should consider private tests to include FT3 and FT4.

[Granny56 in reply to Treepie]

I know but Dr's can't make up there minds whether I have it or not. For the last 6 years I have been snoring like a pig, waking up in the middle of the night unable to breathe. However, I do have mixed form asthma so not sure if asthma is the cause for that.

My results of free T3 & 4 are included in the post above.

[Treepie in reply to Granny56]

I had missed those results but you need to show the ranges ( shown in brackets) for the experts on here to comment.

[Granny56 in reply to Treepie]

No ranges were provided on the report. The text included only a summary of blood results.