Can you have thyroiditis with normal lab results?

[Julietilly22]

I started getting a very painful front of neck about 7 weeks ago that was affecting one side but now has spread to the other side. It's not particularly visable but feels swollen to touch. During this time I started with palpitations that seem to get worse during the night and affect my sleep. I have started to feel very achy the last 2 weeks and have particularly stiff achilles and ankles in the morning. I have also started to get chills and sweats that are worse at night and early morning. My doctor has suspected thyroiditis but my bloods have come back satisfactory. My ecg showed sinus tachycardia. Could I still have this condition? I'm worried now if it's not thyroiditis what is causing the awful pain. Currently taking Ibuprofen that does help alot .

[SlowDragon Administrator]

Welcome to the forum

what time of day was test done

Can you add actual results and ranges

You are legally entitled to printed copies of your blood test results and ranges.

Important to see exactly what has been tested and equally important what hasn’t been tested yet

 

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Very important to test vitamin D, folate, ferritin and B12 as well

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies 

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. 

Both are autoimmune and generally called Hashimoto’s.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis 

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended on here that all thyroid blood tests early morning, ideally just before 9am

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning. 

Watch out for postal strikes, probably want to pay for guaranteed 24 hours delivery 

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism 

thyroiduk.org/wp-content/up...

[Julietilly22 in reply to SlowDragon]

Thank you for your reply. The test was done at 10am. I'm not sure of the results just that it was satisfactory. I think it was only tsh that was tested. I will ask for the actual results tomorrow. My doctor is referring me for a scan and said it would be to either the thyroid clinic or ultrasound dependant on my blood results so I presume it will now be ultrasound.

[humanbean]

During this time I started with palpitations that seem to get worse during the night and affect my sleep.

There are several possible causes of palpitations and/or tachycardia (fast heart rate). (I don't have a full list.)

Some examples that are fairly common on the forum :

1) High blood sugar. Could be caused by ice cream, cakes, chocolate, processed food diet which is heavy on the carbs. Could be diabetes.

2) Low iron and/or ferritin (iron stores). These may cause palpitations and/or tachycardia, and if iron and/or ferritin gets really, really low it can cause chest pain.

3) Low or high Free T3.

4) Low or high Free T4.

5) Note - TSH doesn't make you feel anything. It is just a marker used to aid diagnosis of some thyroid diseases.

stiff achilles and ankles in the morning

This is also common on the forum - do a search for it. It is called "plantar fasciitis" and is often caused by low Free T3. I had it for many years, and it disappeared very quickly as soon as I started taking T3. It hasn't returned. Note that standard medical treatment for plantar fasciitis is usually exercise or steroid injections or surgery into the soles of the feet. I never had any treatment and my recovery with T3 was a happy accident for me. I'm glad I found the treatment that worked for me - the medical options sound awful to me.

Doctors are usually completely unaware of the relationship between hypothyroidism and plantar fasciitis. At least one member has been laughed at when they mentioned it to their doctor. It might have been SlowDragon but I could be wrong.

I have also started to get chills and sweats that are worse at night

This could be an indication that you have

1) a cortisol issue, or

2) an infection or inflammation.

Is your temperature normal for you? It is best to test before getting out of bed after waking up in the morning.

My ecg showed sinus tachycardia.

There are lots of types of tachycardia, and sinus tachycardia is just one of them.

en.wikipedia.org/wiki/Tachy...

en.wikipedia.org/wiki/Sinus...

The speed up of the heart that occurs when people exercise is called sinus tachycardia, but it isn't always so innocuous. If it becomes a problem and no cause can be identified you might be prescribed beta blockers to slow down your heart.

Some common causes to look out for are low iron and/or ferritin, or anaemia, or low/high blood sugar, or dehydration, or the wrong dose of thyroid hormones for hypothyroidism (underactive thyroid), or finally it could occur with hyperthyroidism (overactive thyroid).

This list is not complete.

[humanbean in reply to humanbean]

I've just had another thought...

You might have De Quervain's Thyroiditis - something I know nothing about :

en.wikipedia.org/wiki/De_Qu...

There are other forms of thyroiditis that might or might not be relevant :

en.wikipedia.org/wiki/Subac...

[SlowDragon Administrator in reply to humanbean]

Yes…it was with with plantar fasciitis and my (ex) GP who thought I was completely mad to say plantar fasciitis was linked to low thyroid levels, especially low Ft3 ….he nearly fell off his laughing

Like humanbean my plantar fasciitis disappeared once correctly treated for thyroid…..and improving low vitamin D

[Imaaan]

Another area to explore is sleep apnea. It can cause tachycardia.

[Habibi87]

Hi Julietilly22, I had pain that moved to the left and right of my neck for weeks and I was convinced it was a thyroid issue. I had two different set of blood tests done and they both came within ‘normal’ range though I knew that the value were different from my previous ones (I had IVF and so had thyroid bloods every few months ). Anyway, I got a private ultrasound done and the doctor said I most likely had De Quervain thyroiditis. By the next day I had another set of blood tests done and all my values were completely off and the thyroditis had caused thyroxicosis. The hospital tested all antibodies to ensure it wasn’t an autoimmune issue with the thyroid and then confirmed the diagnosis of sub acute (or de Quervain ) thyroditis. One thing that all tests showed, even when the thyroid values were normal was a raised CRP level which is a marker of inflammation. Most forms of thyroid issues don’t trigger high CRP. Let me know if you have any other questions x

[Habibi87 in reply to Habibi87]

I forgot to say that by the time I had the diagnosis , I had very strong pain in my neck, jaws, and ears with it extending to my head from time to time. I also had a high temperature, my heart rate was about 145 at rest, I was hungry all the time but couldn’t eat much as I would get too tired, I was loosing wait and was generally exhausted.

[Dizzy444]

I had subacute thyroditis two years ago, apparently the thyroid releases too much hormone to start with, this causes hyper symptoms. Afterwards the hormone output is reduced leading to hypo symptoms. It then mainly reverts back to normal after a period of weeks to months, I believe 90% of people get back to normal.

It’s worth having regular blood tests to see where you’re at, I only discovered my tsh was in the high 70s after doing a private test.

[Julietilly22]

Hi Habibi87, I am getting very similar symptoms to what you experienced. Extreme pain on my left side then now to my right this week with ear and occipital pain. My symptoms started about 8 weeks ago when I went to A &E with palpitations and chest pains. I had a bp of 200/116. I have been put on Ramipril but I don't think I'm on proper treatment as it's not made a huge amount of difference. I don't think I've had a temperature but have been getting chills and then hot flashes for weeks. My GP now suspects it to be thyroiditis and is referring me for a scan but needed the results to decide which department to send me to ( ultrasound or thyroid) It's reassuring to know that you had normal bloods and then they changed . I was convinced it was subacute thyroiditis but the results threw a curve ball. I'm thinking of going private as I feel so unwell and the palpitations are exhausting.

[Litatamon]

Hi,

I always had normal labs, and had a total thryoidectomy due to swallowing and breathing issues -from multinodular goitre.

When the thyroid was removed the pathology listed lympocytic thyroiditis. Chronic lympocytic thyroiditis is Hashimoto's. But I have no clue if mine was chronic due to it being found at a point when it needed to be removed, and not sooner.

Just minutes before I saw your post I read this informative overview of the different types of thyroiditis -

aafp.org/pubs/afp/issues/20...

It is the second time this week that I have been reading a random article, finished and then seconds later I am on a post asking all about it. May beloved synchronicity rule on in this forum.

All the best to you

[Julietilly22]

Thank you all for your replies. You are a such lovely bunch. So it turns out the receptionist got it wrong about my bloods after speaking to the doctor today. I do have an overactive thyroid. It's a big relief as I honestly thought I was going mad. He's not sure yet if its subacute thyroiditis but I'm being sent for a scan to find out. I've finally been given beta blockers for the palpitations! I honestly felt I couldn't go another single day with them. I will let you know how I get on here so it can help another person in the future.

[Julietilly22]

Hello again. I just thought I'd give an update - I've been diagnosed with sub acute thyroiditis with thyrotoxicosis which has been managed with beta blockers for the palpitations and ibuprofen for the thyroid pain. I also developed fevers and sweating and just generally feeling really unwell. I turned a corner last Monday and the pain just stopped after 2 months of misery. The endo believes my thyroid will heal now but I may develop hypothyroid symptoms before I return back to normal. My bloods taken from Friday are -

TSH 0.01 mU/L ( 0.3-4.40)

LT4 20.2 pmol/L (8.9- 17.3)

T3 6.1 pmol/L (2.4- 6.0)

Anti TPO Antibodies 38.0 U/ml ( <6 )

I'm not sure what they were when I was in really acute stage. I wasn't expecting to show positive for antibodies but I believe that level is low am I right?

I'm just suffering from dizziness and milder palpitations now. My heart rate is now dropping quite low sometimes too.

I will also add that I went to A&E in October with a v high bp and heart rate but they never tested my thyroid! My doctor didn't think to investigate either. My GP friend thinks this was negligent. So anyone else out there suffering with a racing heart I'd push for a thyroid test and not let them put it down to peri menopause, anxiety, age etc.