Confused by doctors comments????

My doctor recently told me that I have Hasimoto's based on the following lab results, but from all my research and HU posts, I am unsure.

FT3 4.56 (2.62-5.69 pmol/L)

FT4 1.01 (0.7-1.48 ng/dL)

TSH 0.23 (0.35-4.94 uUl/mL)

RT3 14 (8-25)

TPOAb 1.57 (<5.61 Ul/mL)

Homocystiene 9.7 (5.46-16.20)

ALT 31 (0-32)

AST 21 (0-31)

GGT 31 (7-32)

Vit D3 71 (30-60)

Vit B12 1200 (200-900)

Please let me know your thoughts

27 Replies

  • I don't see anything to suggest Hashimoto's. Ask your doctor to explain why they think you have Hashimoto's.

  • Your TPOAb is under the lab's threshold. This indicates that you do not have Hashimoto's.

  • There are 2 antibodies implicated in Hashimoto's. So thyroglobulin ones need to be tested too

  • I have put in a request to have the following tests run. TSI, TRAb, and TGAb

  • They're less common though, aren't they?

  • They are less common, but I had no TPO but thyroglobulin ones at 100 times above range. So you can have one without the other. Of course mainstream medicine will tell you they don't matter! It is also 3 times more expensive than TPO testing within the NHS so you can draw your own conclusions from that

  • Is this the test you're referring too?

    Anti-thyroglobulin antibody (ATA)

  • Yes. :)

  • That explains a great deal. Thanks!

  • Well in some cases antibodies are not present and to confirm it you need FNA, but can't say why they suggest you would have hashimoto unless your ultrasound showed something suggesting it could be?

  • I had an ultrasound, which showed 3 nodules (7.5mm, 3mm, 2.5mm) the larger one appeared to have fluid (blood) in it and a possible source. But my thinking is more along the lines of an autonomous hyper-functioning nodule "HOT" which is causing the hyper symptoms.

  • Radiologist performing my scan said that hashimoto can cause thyroid gland looking like mushroom/sponge so was thinking if something like that showed up not just nodules?

    I have antibodies yet my thyroid gland looks completely perfect. Tho radiologist with 40 years experience said that messy looking thyroid might work just perfect and perfect looking thyroid might not work properly at all.

  • Perhaps your doctor (wrongly) thinks hypothyroidism and Hashimoto's are two names for the same condition?

  • That could be true, especially since the majority of my symptoms are hyper, not hypo.

    UGGGG!!!!!! Finding a competent doctor these days seems like a lost cause. I am at my wits end.


  • Oh, sorry, I hadn't read your history.

    TPO Antibodies can occur in both Hashimoto's Thyroiditis and Graves's Disease. Could that send a doctor's brain into a spin do you think?

    It isn't clear what your doctor was thinking (or if your doctor was thinking) based on your blood test results though. :)

  • Give me your thoughts on my blood tests, please.

  • Okay. Bear in mind I'm looking at it with the eyes of someone who is hypo.

    Free T3 : Your result is 63% of the way through the reference range i.e. above mid-range but just below the top third. From comments from others, hypo people often feel best if the Free T3 is a smidgen higher. I'm not sure where people who are or have been hyper feel at their best.

    Free T4 : Your result is 40% of the way through the reference range i.e. below mid-range. Hypo people often prefer this figure to be in the top quarter of the range. So yours is rather low.

    TSH : This is under range which would suggest to most doctors that you are actually hyperthyroid. But the Free T4 and Free T3 results don't agree with your TSH. You may have pituitary or hypothalamus damage reducing the TSH, but the evidence for either is rather weak. I'm not saying you don't have this, but I am saying you would need more testing to be sure one way or the other.

    Reverse T3 : Your result is in the lower half of the range which I have always assumed is a good thing.

    TPO Antibodies : Your result is clearly negative. But there are other kinds of antibodies which affect the thyroid. Without tests for these you don't have enough information to say one way or the other about whether or not you have autoimmune issues with your thyroid. See the table on the page I linked to in my previous response :

    Getting a positive result on any one of them can indicate a problem. Just doing TPO antibody testing is not adequate on its own. Also, people can have autoimmune problems with the thyroid and never get a positive result on an antibody test because levels fluctuate, sometimes quite dramatically.

    I know almost nothing about ALT, AST and GGT, but these links might help you :

    Vit D3 : I'm guessing from the numbers that you live in the US because the reference range is not typical for the UK. I'm assuming the units of measurement are ng/mL and am commenting on that basis. If you are supplementing I would stop for the summer. There is such a thing as vitamin D toxicity :

    Since taking vitamin D increases your body's absorption of calcium you might be at risk of getting hypercalcaemia which isn't pleasant. If you haven't been supplementing with vitamin D then your doctor needs to look into why you have levels over the reference range.

    Vit B12 : Your result looks fine as long as it is the result of supplementation. If you haven't been supplementing at all in the last few years and your result is over the range then there is a possibility that you have an underlying problem :


    Your TFT results don't suggest either hypothyroidism or hyperthyroidism to me. They may not be ideal, but they aren't bad.

    Some general comments :

    If you do have autoimmune thyroid disease which hasn't been detected yet, then your body may be showing symptoms of thyroid disease before the blood tests have caught up with your reality. If this is the case then your adrenal glands might be pumping out adrenaline (epinephrine) and cortisol to keep you going when you have too little thyroid hormone. This could make you feel hyper, anxious, nervous, twitchy, while your thyroid is actually heading for being underactive.

    Do a saliva test for the adrenal glands. The Stop The Thyroid Madness site has lots on the subject of adrenal testing with saliva and can give links to companies that carry it out in the US.

    Have you had thorough testing for iron deficiency? That is - Ferritin, serum iron, Total Iron Binding Capacity, Transferrin saturation?

    And what about folate?

    Please bear in mind that I am not medically trained and I have written this post on the basis of information I have gleaned from my personal experience, from research on the web, and from other forum members.

  • For the record, I have been dealing with this for a year, so it's not new. I have not had any meds, other than propranolol. They have diagnosed me with everything from hyperthyroid, secondary hypo, clinical hyper, and checked for pituitary issues (MRI and CT Scan) still no true diagnosis. They recently found the nodules.

    I was supplementing VD3 and B12, but not anymore and my iron/ferritin are low in the normal range, been working on getting them up. Folate is also a bit low. Saturation is low.

    I am currently requesting some additional antibodies tests, TSI/TRAb/TGAb, so hopefully they will provide some needed insight.

    What other tests should I look into for Hypothalamus and Pituitary???



  • If you are struggling to get your iron/ferritin levels up, you might get more response to supplementation if you went 100% gluten-free. There are no guarantees - it doesn't help everyone. But for me it was amazingly successful. I've been low in iron all my life, and now, quite suddenly, I'm not.

    I've found the table at the bottom of this link very helpful on the subject of anaemia :

    Be aware that people can have more than one kind of anaemia going on at the same time. That can make interpretation of test results very challenging. Some things can push ferritin up, others might reduce it. Have both in the same body, and ferritin looks nice and normal. The same is true for other factors.

    The additional antibody tests will help a lot, I think.

    I'm not familiar with how pituitary and hypothalamus testing is done. But I can give you a link to a definitive document which should help. You will have to do some translation from UK terms and units of measurement to US ones.

    Good luck...

  • Thank you very much, you feedback and information are always appreciated.


  • DanteNXS,

    TPOab is negative for Hashimoto's. TSI and TRab are the antibody tests for Graves.

    Your thyroid results don't indicate hyperthyroidism. TSH is slightly below range but not suppressed, FT4 is slightly below mid-range, and FT3 is only just in the top third of range. rT3 is mid range which is healthy.

    VitD and B12 are over range. Are you supplementing?

    The other results are within range.


    I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

  • Clutter, I totally agree with you, but I am still at a loss for why I am having so many hyper/hypo symptoms. The only thing I can point to is the nodules? But do I want to get RAI ot surgery?????

    Perhaps I don't have a choice. :-(

  • DanteNXS,

    A radioactive iodine uptake scan would show whether the nodule is 'hot' (hyper secreting). TSI/TRab will show whether you have Graves antibodies. I was euthyroid Hashi's but it felt like I was swinging between hyper and hypo and there is evidence that euthyroid Hashi's impacts health. Perhaps the same is true of euthyroid Graves?

    I don't think you have sufficient information to make a decision to destroy your thyroid gland.

  • Trust me, I do not want to destroy it, but if the nodule is HOT, as I suspect, what are my choices? I am probably jumping the gun, but I am trying to get mentally prepared for this. Perhaps they can do a partial removal of the thyroid.

  • DanteNXS,

    If it is a hot nodule you'll need a hemilobectomy (partial) to remove the lobe the nodule is on. The remaining lobe should provide the thyroid hormone you require but sometimes some Levothyroxine replacement may be required. RAI wouldn't be an option because it would destroy the whole thyroid.

  • I appreciate the info, and I will take your advice on this.


  • I just had my labs drawn for TRAb, TSI, and TGAb, as well as selenium. It will take a few days to get them back, but I will keep you posted.


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