Hashitoxicosis & Toxic Goitre?

[salvome2]

Hello everyone.

First time poster here and I'm hoping for your valuable opinions on my diagnosis.

I'm 50yo man with a family history of hypothyroid, Hashimoto's Disease and Lymphoma. I've had various hypo and hyper symptoms over the last 15 years or so, including a

swollen neck that comes and goes. Several GPs couldn't detect any swelling but the Endocrinologist has described my Thyroid as 'bulky'.

My blood test results are:

Dec 2016 TSH 0.688 (0.27 - 4.2)T3 4.92 (3.1 - 6.8)T4 125.5 (59 - 154)TPA 149 (0 - 34)TA 440 (0 - 115)

Jan 2017 TSH 0.303 T3 5.91 T4 118.5 TPA 227.3TA 667.6

April 2017 TSH 0.103TA 755.4

Aug 2017 TSH 0.400TA 770

The April and August T3 and T4 were described to me as 'midrange' whilst the TPA was not tested.

My ultrasound and iodine scan detected some 1-2mm nodules but the "uptake is slow". Since January 2016 I have been left with the feeling of constant pressure to the

right side of my Thyroid region but the Endocrinologist isn't concerned about the nodules at this stage but prefers the TSH to be over 0.3. I'm not taking any medication.

The first provisional diagnosis was Multi-nodular Toxic Goitre and more recently Hashimoto's Toxicosis.

I'm getting a little confused between all the different terms and possible outcomes so I'm wondering if anyone can offer any advice?

If I have Hashitoxicosis wouldn't that result in an above range T3 & T4?

My Doctor described it as 'transient'. Does that mean I will recover or continue to cycle between hypo and hyper symptoms?

As the T3 & T4 are 'midrange' with the TSH supressed, does this point to a problem elsewhere?

Or is it that despite the symptoms my Thyroid is fine and I'm worrying about nothing?

Thanks in advance

Salvo

[greygoose]

Hi salvome2, welcome to the forum.

So, complicated! First of all, you have Hashi's. Your antibodies say so. And, there's not need to keep testing them, because although antibodies fluctuate, they don't go away. Once you have them, they're for the life of your thyroid.

How much do you know about Hashi's? Don't want to tell you things you already know, but it is the nature of the beast to have levels fluctuating, too. But, the thing that confuses doctors, is that the TSH doesn't move as fast as the Frees - oh, and by the way, the T4 test they're doing is the TT4, which doesn't give much useful information. What you need is the FT3.

You're right about Hashitoxicosis, the Frees do have to be over-range for that. Just because your TSH is suppressed - although it seems to be slowly rising - doesn't mean you have too much thyroid hormone - which is what toxicosis means. TSH is a pituitary hormone. And, the problem with doctors - one of them - is that they insist on basing their 'diagnosis' on the levels of healthy people. We Hashi's people are not healthy. So, our levels aren't going to look anything like that.

Difficult to know what a doctor means when he uses a word like 'transient'. I sometimes wonder if they know themselves! Or do they just use 'big words' to sound intelligent? lol 'Transient' normally means that it will go away. But, as I said, Hashi's is for life. But, it will swing from hypo - through euthyroid - to 'hyper' - and back again. How long each phase will last, is anybody's guess. But, at some point, it will always come back to hypo.

At the moment, you're OK, from a thyroid hormone point of view. Some suggest that just because you have antibodies you should be taking thyroid hormone replacement just to 'support' the thyroid during attacks. Quite how much 'support' that actually provides, I'm not sure. But, in any case, it's doubtful that your doctors will agree with levels like that. But, keep an eye on it. Get tested regularly, so that when your TSH does rise over-range, or your Frees go under-range, you can get treated immediately.

'As the T3 & T4 are 'midrange' with the TSH supressed, does this point to a problem elsewhere?'

As things stand, no, it doesn't. But, if your Frees get lower and lower, and your TSH still doesn't rise, then you should investigate Central Hypo, where the problem is with the pituitary or the hypothalamus, rather than the thyroid itself.

Quite how 'fine' your thyroid is, depends on how long you've had Hashi's. And we can't really know exactly. But, the antibodies themselves could be causing symptoms. And, whilst there is no cure for Hashi's, there are thing you can do yourself to help you feel better. Your endo might want your TSH to come up to 0.3, but you don't. It's best kept suppressed, to limit immune attacks. It's gland activity that attracts the attention of the immune system, and makes it attack.

Secondly, you could try adopting a 100% gluten-free diet, which could lower antibodies, and make you feel better. And, you could try taking selenium, which will not only reduce antibodies, but also help with conversion - although we don't really know how good your conversion is at the moment, because you haven't had the right tests.

Hope all that helps, but if you have any questions, don't hesitate to ask.

[salvome2 in reply to greygoose]

Hello Greygoose

Thank you for your kind and very informative reply which has made things much clearer.

It took a few years to get a referral to hospital but they do at least appear to want to monitor me fairly well and I have another Endocrinology appointment in two months to see where the TSH is.

Thanks again

best wishes

Salvo

[greygoose in reply to salvome2]

You're welcome.

But, you do want to know about more than the TSH is. It's a very unreliable test, and doesn't always reflect thyroid status. Ask to have the FT4 and FT3 tested, also, if they don't suggest it.