Thyroid UK
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Hashimoto's Flare Up

Hi all,

Having been "reasonably" well treated on 125mcg Levothyroxine for over a decade, a routine blood test showed that my TSH had crept up from the 1s to the 2s. I increased my dose to 150mcg and 3 to 4 months later I developed symptoms of hyperthyroid - anxiety, weight loss, sweating, shaking, diarrheoa, nausea, loss of appetite. I reduced my dose right back to 100mcg for a while before reverting back to 125mcg, but my symptoms remained the same (the anxiety being the worst symptom to manage).

A Medichecks blood test revealed that I was hypothyroid, results as follows

TSH 12.5 (0.27-4.20)

Free Thyroxine 11.9 (12.00-22)

T4 69.2 (59.00-154.00)

Free T3 2.86 (3.10-6.80)

Thyroglobulin 14.200 (0.00-115.00)

Thyroid Peroxidase 13.9 (0.00-34.00)

Active B12 133.000 (25.10-165.00)

Serum Folate 19.98 (2.91-50.00)

CRP High Sensitivity 0.74 (0.00-5.00

Ferritin 53.9 (13.00-150.00)

Since then I've increased my dose to 150mcg Mon, Wed, Fri, Sat and 125mcg Tues, Thurs, Sun, but my symptoms of anxiety etc haven't abated, even though my bloods are now heading in the right direction.

I've heard of Hashimoto's flare up and I wonder if this could be the cause of my symtoms even though my antibodies are hardly raised. Is it possible to have Hashimoto's even though my antibody levels are pretty low? Should a healthy person have antibodies of 0 or what?

I find it difficult to understand how to tell the difference between Hashimoto's and regular hypothyroidism, and if I have suffered a Hashimoto's flare up, should this just eventually subside spontaneously?

I'd be grateful for any thoughts and comments.

Thanks.

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Given your terrible levels, I doubt that tiny increase is going to do much for you. You doubtlessly need the TSH at 1 or under, and the Frees up near the top of the range. There's a long way to go.

You can have Hashi's without high antibodies, yes. I imagine you only had TPOab tested? There is another type of antibody - TgAB - which could be high, meaning you have Hashi's. Or they could both be low, but you still could have Hashi's.

But, I don't think what you experienced was a Hashi's flare - I always think that a very bad name for it, because it's not a flare as in a skin problem, or something like that. I prefer to use Hashi's swing. What happens with a swing is that the immune system attacks the thyroid, and the dying cells release their store of hormone into the cells, causing FT4 and FT3 to shoot up, and subsequently, for the TSH to fall. This does go away by itself, as the excess hormone is used up or excreted.

But, very often, people don't seem to get hyper symptoms with it. And, the symptoms you describe could just as easily be hypo symptoms - probably were, given your levels, because your FT3 didn't get that low over-night. And, the TSH takes a long time to adjust, so I don't think it would have had time to get your 12.5 in your time scale.

I don't know what happened, looks like your thyroid just deteriorated. In any case, you now look very hypo.

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Thanks Greygoose, glad to hear from you, you're always so wise and reassuring. :-)

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Thank you, Jud! :)

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Sorry Greygoose, I see that you answered my questions in a previous thread. I hadn't spent a lot of time considering Hashimoto's because my antibodies were low, and probably took on board what you said in your reply above. I have a memory like a sieve (probably worsened by hypothyroid brainfog), and yesterday I started reading stuff and watching stuff online about Hashimoto's flare up. Hence my questions (above), asking what you'd already answered! So sorry about that - it's not that I don't take it in at the time, it's just that I read stuff, get side-tracked, forget what's been said previously and start clutching at straws.

I really do appreciate you taking the time to respond to my questions :-) I

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It's not a problem. :)

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