I am taking thyroid meds (Synthroid and Cytomel), but do not know what has caused my hypothyroid state. I had antibodies tests and my results are:
Thyroglobulin Antibody <10 (< 40kIU/L)
Thyroperoxidase Antibody 14 (< 35 kIU/L)
These numbers look "normal", but I've heard that people have flares, so that if your blood isn't tested during one of the flares, your numbers won't be high. So how do you determine if you have Hashi's or not?
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raglansleeve
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What happens is, briefly, the immune system attacks the thyroid, and the dying cells dump thier stock of hormone into the blood, causing levels of FT4 and FT3 to suddenly go sky high, and therefore the TSH to drop. As that is happening, a little Thyroid Peroxidase and a little Thyroglobuline - proteins contained in the cells of the thyroid, necessary for producing thyroid hormone - also leak into the blood, where it shouldn't be. So, the TPO and Tg antibodies come rushing along to clean it up.
So, if you had a blood test at that point, the TSH would probably be suppressed and the FT4 and FT3 would be high, and your doctor would freak out that you'e 'gone hyper' or accuse you of 'abusing' your thyroid hormone. Doubtful he would even test the antibodies a second time, but if he did, they would be over-range at that point. And things would stay that way for quite a while, They don't go back to 'normal' instantly, so you would have a good chance of catching the abnormal results during the aftermath of the attack - or Hashi's 'hyper' swing, as it is sometimes known.
That said, antibodies fluctuate all the time, Less dramatically when there isn't an attack going on, but they do fluctuate.
What's more 20% of Hashi's people never even have over-range antibodies, but it could be picked up on by a knowledgeable person on seeing that the Frees suddenly go very high without a change of dose (that does not include the majority of doctors!). Or, if you suspect you have Hashi's for some other reason, an ultra-sound of the thyroid would show if any Hashi's damage had been done to it. So, there are ways of knowing.
But, whether you have Hashi's or not, the treatment is the same because there is no treatment for the Hashi's itself, just replacement of the missing hormones as the thyroid becomes too damaged to work properly.
When I asked my endo if I had Hashi's, he told me that all people with hypothyroidism do. He said that Hashi's is just another word for hypothyroidism. I know that isn't true, so since he won't diagnose me properly, I was hoping that I could find a way to do so myself. I guess that I can't though, since I would have to be having my blood done at roughly the same time as an attack for the antibodies to be high? I had a thyroid ultrasound last year (shortly after my referral to an endo) and it came back as normal - no nodules, everything regular in shape, etc.
Silly man! lol My goodness, the do come out with some rubbish at times!
How long since you were diagnosed? And, do you know what your blood test results were on diagnosis? It could be that at the time of your ultrasound, there wasn't enough damage to be noticable. And, you don't have to have nodules to have Hashi's. However, it is sounding more and more like you don't have it. So, the chances of you ever finding out what caused your hypo are pretty low. Does it really matter?
The first image shows the numbers when I was diagnosed, before I started on Synthroid. I was on Synthroid only for the first couple of years (2017 - 2019), and then after educating myself, I requested the Cytomel (unbelievably, I lucked into an endo who agreed with using it!). I went up from 25 to 50 to 75 Synthroid and from an original dose of 5 mcg's of Cytomel up to 10. I guess that it doesn't matter if I have the diagnosis or not, since treatment is the same. I am still titrating, but almost all of my original symptoms are now gone, so this might be my final dose. I have also overcome many issues that I had no idea were even related to hypothyroidism (acid reflux, sore muscles, restless legs, and sore ear cartilage(!)).
OK, so your TSH wasn't very high, so even if you did have Hashi's,t here wasn't an awful lot of damage done, so might not have shown up in an ultersound.
That said, your Free T4 was pretty low, and that wasn't reflected in the level of your TSH. So, there's a possibility that your hypothyroidism stems from your pituitary or your hypothalamus (Central Hypo), rather than the thyroid itself, and that's why the thyroid looked good in the ultrasound. But, even if it is CH, the treatment is still the same.
Have you ever had your cortisol tested, or any other hormones?
First image is when I was diagnosed as subclinical by my GP. Second image is my latest results. The last bloodwork was done while I was on 50 mcg's of Synthroid and 10 mcg's of Cytomel. I take my Synthroid and 5 mcg's of Cytomel in the morning, and the other 5 mcg's of Cytomel late in the day. I left 14 hours between last Cytomel and bloodwork, and did not take my morning meds until I returned home. And based on those last numbers, I convinced my endo (who was reluctant) to up my Synthroid to 75.
Guidelines on dose levothyroxine by weight when on JUST levothyroxine ONLY is 1.6mcg levothyroxine per kilo
standard starter dose of 50mcg
Dose levothyroxine is typically increased slowly upwards in 25mcg steps (retesting 6-8 weeks after each dose increase) until near full replacement dose, before considering adding T3
If Ft3 remains low once on or near full replacement dose, then typically dose levothyroxine is reduced by 25mcg and 2 x 5mcg T3 added
Taking almost any dose of T3 will result in very low TSH when adequately treated
It can be hard to persuade endo to increase levothyroxine dose in face of low TSH
If Ft4 remains low, or especially if drops further you may need to increase levothyroxine at next test
You need vitamin D, folate, ferritin and B12 tested
I weigh about 85 kilos. Most of my symptoms have diminished or disappeared completely with my last dose increase, so I'm not sure if I need much more (maybe a bump up to 100?) I had a B12 deficiency when originally diagnosed (the symptom that sent me to my GP in the first place was full-body neuropathy, and he then tested my thyroid and B12) and my endo later tested for vitamin D which was low too. I've been supplementing with B12 since the beginning (2017) and am now consistently over range. I only found out about the vitamin D deficiency about 6 months ago though, and haven't had another test done on that. I may have to go private for that though, because it's like pulling teeth to even get the endo to increase anything. The last thing I want to do when I finally get him to agree to a bump, is then ask him to put vitamins on the recquistion too. I live in Canada and our bread has been infused with folic acid for decades now, and low folate is almost never encountered here at all. I don't have any low iron symptoms, but have been meaning to see if I could get those tests done anyway, but would have to go private for that too, I think. Cholesterol is good.
I had an ultrasound. Then many yrs later a CT scan which showed there was no thyroid left- total absence. This 1 of the NICE criteria for prescription of Liothyronine.
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