I have recently had my thyroid bloods done. I feel like I’m having a Hashimotos flare up. I’ve got tons of symptoms:
Heart palpitations, Exhausted, anxiety, pain in thyroid, joint pain, restless legs, mood swings, carpal tunnel, hair loss, bloating, changes in bowel movements - the list goes on.
My results are:
TSH - 0.73 (0.35-5.0)
Free T3 - 5 (3.5-6.5)
Free T4 - 14 (9-24)
I feel like my free T3 and free T4 are too low.
Also, my ferritin is 35 in a range of 15-250 and I have weakly positive ANA antibodies and also weakly positive Anti Smooth Muscle Antibodies. I’ve googled like crazy and terrified myself as those two can indicate autoimmune hepatitis but my liver levels are normal and I don’t have any hepatitis symptoms so I’m pretty sure it’s my Hashimotos causing my body to freak out. I’m 6 months postpartum so I was expecting it to get bad now ish. My TPO antibodies are 19 in a range of <50. Last blood test they were elevated.
Any thoughts?
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Paolatello
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Hi Paolatello. You are very under medicated. Both your FT3 and FT4 are much much too low and are contributing to your symptoms. Your FT3 (5) is 1/2 range. It should be over 1/2 (5) but not much higher than 3/4 (5.75). Your FT4 is also much too low. Yours ( ) is not even half (16.5). To have the least symptoms, it should be over 1/2 (16.5) but not as high as 3/4 (20.25). With both FT3 and FT4, results under 1/4 and over 3/4 range is where the most symptoms exist. The sweet spot is over 1/2. Some people have levels too high and at the very top of range. They never ever feel well. Same for people below 1/2 range.
There are two thyroid antibodies, not just one. They are called TPO/ab and TB/ab. If your doctor has failed to thoroughly and correctly test your antibodies by testing both, you need to get your TG/ab tested to know if you have Hashimoto's or not. If your TPO antibodies were previously barely elevated but are not in range, this does not mean that you don't have Hashimoto's.
Positive ANA and Anti Smooth Antibodies can mean other autoimmune diseases and are not part of Hashimoto's. Aside from autoimmune hepatitis, positive SMA can mean hep c, binary diseases, infectious mono, or cancer. Just because you do not currently have hepatitis symptoms does not mean that you don't have it. Did you have a liver panel? What did the doctor who ordered those tests for you have to say about the results? Most doctors would sit up, take notice, pursue more diagnostics and a final diagnosis.
I return to the doctor on the 11th. Regarding my liver panel that was and has always been normal. I don’t believe I have hepatitis. I definitely have Hashimotos. In the past my TPO antibodies were over 1500
That's awful! I'm sorry you're not getting the great medical care that you need and deserve. You are not euthyroid. Euthyroid is a normally functioning thyroid gland. You have thyroid disease, which means your thyroid does not function normally. Your low levels reflect this. Plus your thyroid disease is autoimmune in origin and now you've got new autoimmune markers. Your thyroid levels are much too low and are contributing to your list of thyroid symptoms. Shame on your doctor, leaving you untreated with those levels and all those symptoms. It's no wonder you feel so ill! He/she doesn't understand Hashimoto's, thyroid lab results, optimal ranges, causes of symptoms, or how Hashimoto's is treated. People with Hashimoto's are treated with life long with thyroid hormone replacement to try to slow down the damage to their thyroid and to keep hormone levels in good range in order to minimize symptoms.
How long ago was your last TPO test? Have you had TG/ab tested?
Plus you've got whatever is causing your positive ANA and positive SMA. This clearly means something, and it's not Hashimoto's. Answering your question, my thoughts are it's past time to get a new doctor who understands Hashimoto's, knows how to treat it, and sees the urgency in pursuing the cause of your other autoimmune disease markers. None of this should be ignored.
you could try sourcing your own levo and see if it helps. Also ask for a referral to an endo for possible central hypothyroidism - as with that TSH will never rise and cannot rise. Do you have high antibodies?
Angel_of_the_North , good catch! Thank you for pointing that out. Those were some wild FT3 numbers! They were completely wrong (obviously) and all over the board. Looked like a combination from someone else's range. Who knows. The FT4 numbers are correct.
Some dodgy maths there, but the basic premise is correct, Free t3 is 50% of the range and free t4 FT4 33.3*%, so both too low for optimal wellness. So it looks as though you convert OK, but are just undermedicated and need an increase in levo. Your results look more like the results of someone on NDT. You are aiming for >5.5 for free T3 and >20 for free T4 if on levo.
Hi Paolatello . Your doctor doesn't understand Hashimoto's, unfortunately. You're definitely not euthyroid with your levels and with your symptoms. How could your doctors possibly think that you are? You have a lot of symptoms! Someone with Hashimoto's will never be euthyroid, unless you are one of those rare people who has Hashimoto's and antibodies, but their thyroid hormones are optimal and they have no symptoms. (I know of one person like this. She has family members who are the same. I know of a second person who is borderline like this, but she does have minor symptoms, so should be on medication. Symptoms are a sign that the thyroid is struggling.).
Thank you. What should I do in that case? I’m worried because my latest result shows different autoimmune antibodies weakly positive and I’m terrified I’m developing more problems
Hi Paolatello . You're welcome. Your Hashimoto's and low thyroid hormones are a separate issue that needs to be addressed. Optimizing your thyroid hormones might greatly reduce your symptoms. First you need to find out if you have positive TG/ab or not. What are you doing to reduce autoimmune reactions with your Hashimoto's? Are you following an autoimmune diet, one that if free of gluten, soy, and dairy? Are you using protective precautions when exposed to environmental toxins, chemicals, and antigens? (like protective clothing, rubber gloves, face masks, washing hands frequently, staying away from people who are sick, avoiding any allergen if you have allergies, taking allergy meds to reduce allergic response, etc.).
It's true that once the immune system is damaged and we have one autoimmune disease, we have a greater chance of developing more. Your new antibody levels are currently weak positive. You don't want these to get out of control and become strong positives. You'll have to follow up with appropriate doctors to find out the significance in your new positive antibodies. If you end up with some doctor who thinks these results do not matter, quickly find another doctor who has better qualifications. These results should not be ignored.
Thank you, I will definitely follow up the antibodies with my doctor. Regarding an autoimmune lifestyle, I haven’t made any changes. I should be eliminating dairy and gluten?
Hi Paolatello . Yes, you should try it and see if you feel better. People with autoimmune diseases and especially those with Hashimoto's often have malabsorption and gut issues. The less things your body has a chance to react negatively to, the better. You want to reduce systemic inflammation when you have autoimmune disease. Gluten, soy and dairy are all inflammatory foods. Gluten free, means 100% gluten free. If cheating here or there, it's still causing inflammation and reaction. There is something called an AIP Diet - autoimmune protocol - that some people follow. I personally am completely gluten free, completely soy free. I was completely dairy free for several years. I can now have small amounts on occasion. If I get too much, I do not feel fell, and it's not a lactose issue, either. It's systemic inflammation.
Nightshade foods are too. Some people find that they feel better eliminating such foods. Nightshades are all types of peppers, tomatoes, potatoes, eggplant, chili spices, other spices and several other fruits and vegetables. Probiotics are recommended to help gut bacteria and digestion.
Some grocery stores carry them. Health food stores, nutrition or supplement stores. I order mine on line from a reputable store. The kind I get needs to be refrigerated. I once made a mistake and ordered them from Amazon. They arrived unrefridgerated. Some fermented foods also provide some antibiotics (some sauerkrauts, etc), but you'll have to read the labels to make sure. They usually only provide a few strains of good bacteria, so they are not a good source. They are a good supplemental source, however. Bottled probiotics are the best way to get many strains of good bacteria.
There is always a cap on how high in the range levels should be. Too high in range means increase increased symptoms, just like too low in range. 75% of that FT4 range is 20.25. The problem with going over 75% is that at that level, there will be an increase in symptoms. The people who have allowed theirs to get that high always have symptoms.
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I not seen one person on this site who has high levels that feels great. They are always on here with all kinds of symptoms wondering how they can feel better.
Well, your ferritin is much too low, so that will be making you tired, affecting breathing, etc. And your B12 could also be causing symptoms at that level - it should be at least over 500, preferably top of the range.
If you have elevated TG/ab, this could be contributing to your low thyroid hormones. When antibodies go up, thyroid hormones usually go down. Or, whatever other condition (possibly autoimmune) is giving you positive ANA and SMA, that autoimmune response might be somehow interfering with your thyroid. Having two autoimmune problems means extra strain and stress on your entire body.
Just a brief summary of thyroid related problems as I understand it: you have been confirmed Hashimoto's with high TPO previously ( been on a gluten free diet?), but you take no thyroid 'meds', so the thyroid test shows your 'natural' hormones. The Frees are not high suggesting you were not having a Hashi flare. Currently all are in range ( the FT3 being exactly mid way at 5), so doctors would find little to concern them, despite the fact that your FT4 is infact low , below halfway in the range.Your ferritin however is low at 35, could be 100-130 for menstruating women. What about Vit D, B12 and folate levels which also need to be optimum in upper end of ranges for good thyroid health?
Does anyone have any idea on the elevated smooth muscle antibodies and elevated ANA antibodies? Both weakly positive but so terrified I now have autoimmune hepatitis too
I'm so sorry your going through this, Paolatello. Have you had any other tests over the years that have come back as abnormal? It could be autoimmune hepatitis, but is also found in primary biliary cirrhosis, primary sclerosing cholangitis, infectious mono, primary pulmonary hypertension and 3% of healthy individuals. Positive ANA can be found in many conditions. Does your ANA result indicate if there is a speckled pattern present? If it does, this helps narrow down the possibilities.
With your thyroid levels being so low, that is not helping you feel well either.
Hi Paolatello . You need to see a Rheumatologist or other doctor who specializes in autoimmune diseases. There are many other tests that would need to be ran to determine the cause of your positive SMA. Liver enzymes plus a positive SMA are not enough for any conclusion. Your ANA might help narrow down the possible causes of your positive SMA.
Hi Paolatello . Positive ANA is not specific to any one disease. ANA's can fluctuate. I know of people who have had results that are negative, negative, positive, positive, negative, negative, positive. A weak positive speckled ANA may or may not be of any significance at this time. It's something to be monitored.
Normal liver enzymes are good. There can be other causes of a positive anti SMA. You'll need further diagnostics to determine exactly what the cause is.
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Shame on your doctor, leaving you untreated with those levels and all those symptoms. It's no wonder you feel so ill! He/she doesn't understand Hashimoto's, thyroid lab results, optimal ranges, causes of symptoms, or how Hashimoto's is treated. People with Hashimoto's are treated with life long with thyroid hormone replacement to try to slow down the damage to their thyroid and to keep hormone levels in good range in order to minimize symptoms.
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