Goitre and antibodies but bloods all fine - Thyroid UK

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Goitre and antibodies but bloods all fine

LibertyCake profile image
12 Replies

Hi,

I developed a fairly big lump in my neck in July 23. Did the 2 week wait thing and had an ultrasound and saw an ENT consultant. They diagnosed a thyroid nodule and said it looked normal with no need for FNA.

Consultant asked for endo to see me and I am still waiting for this or any acknowledgment that I have been referred. He assures me he sent the letter though.

Had bloods in September 23 via NHS

FSH 6.1

Free T3 4.98 range 2.6-5.7

TSH 2.92 range 0.35-4.94

I have just had a medichecks test done and these were my results:

TSH 3.07 range 0.27-4.2

Free T3 4.9 range 3.1-6.8

Free thyroxine 17 range 12-22

Thyroglobulin antibodies 411 range 0-115

Thyroid peroxide antibodies 61.9 range 0-34

CRP HS 4.15 range <3

Ferritin 53.1 range 30-207

B12 active 113 range 37.5-188

Vitamin D 97.6 range 50-250

Currently I am tired, constantly cold, have aching joints and generally feel a bit rubbish. I struggle to sleep beyond 5-6 hours a night but feel exhausted for it.

I am unsure about what the antibodies are showing if my actual thyroid results are in range?

For info: my dad had Graves’ disease

Is it worth letting my GP know?

The goitre is uncomfortable, causing pressure and a hoarse voice plus some swallowing issues but ENT said this was probably reflux based and not the goitre so they won’t do anything about that

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LibertyCake profile image
LibertyCake
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12 Replies
LibertyCake profile image
LibertyCake

sorry, forgot to say I had been taking vitamin D and B12 for around 6 months prior to these results but had stopped one week before in case that makes a difference.

Calceolaria profile image
Calceolaria

If your consultant referred you on in September or even October and no response, I suggest to ring the endocrinology secretary and ask her a) if they have the referral b) where are you on the list? c) does no harm to say you are struggling and explain what’s going on. Don’t underestimate the power of a medical secretary!

LibertyCake profile image
LibertyCake in reply to Calceolaria

I have chased now and they have received the referral in august and can’t advise on the wait other than to say it’s a long list

Calceolaria profile image
Calceolaria in reply to LibertyCake

Sorry to hear that. Always worth a try - and maybe consider persisting. We aren’t very good at pushing ourselves forward!

greygoose profile image
greygoose

Goitre + high antibodies = Hashimoto's Thyroiditis.

I am unsure about what the antibodies are showing if my actual thyroid results are in range?

Just being 'in-range' is not good enough. It's not necessarily the same as optimal. It depends where within the range the results fall:

TSH 3.07 (0.27-4.2)

Free T3 4.9 (3.1-6.8) 48.65%

Free thyroxine 17 (12-22) 50.00%

So, what have we got here? The TSH is too high. In a person with no thyroid problems (euthyroid), the TSH would be around 1. Never over 2 - that shows the thyroid is struggling. And, at 3, you are technically hypo.

Your FT4/3 results are good/'normal', but it's taking an abnormal amount of stimulation from the pituitary - Thyroid Stimulating Hormone (TSH) - to get them to that level.

And, as both your antibodies are high, your thyroid is not going to be able to maintain those levels for very long.

Therefore, in an ideal world, you would start thyroid hormone replacement now, before things get really bad. But, the NHS, in all it's wisdom, decrees that the TSH should be much higher - at least over-range, and better still over 10! - and the Frees should be lower, before it will admit there's a problem.

The goitre is uncomfortable, causing pressure and a hoarse voice plus some swallowing issues but ENT said this was probably reflux based and not the goitre

Well, a lot they know! Pretty certain it is the goitre causing your problems. But, in my experience ENT have little understanding of how these things work. Anything to do with the throat - persistant throaty cough, sore throat, loss of voice, trouble swallowing, etc. - can be, and often is, due to thyroid problems.

I don't doubt you have acid reflux, because being hypo, you will probably have low stomach acid (symptoms are the same as high acid) but very much doubt if it's causing your throat symptoms. That's just another way of passing the buck! Not my problem, squire, see and gastro! They just love to pass hypo patients from speciality to speciality in the hope it will let them off the hook!

Yes, take these results to your doctor. But don't allow yourself to be fobbed off with spurious excuses about acid reflux, etc. And don't allow them to prescribe PPIs, or any other of their rubbish without first addressing the root cause: Hashi's/hypo! :)

LibertyCake profile image
LibertyCake in reply to greygoose

Really appreciate the time taken to reply. This is useful stuff to know.

greygoose profile image
greygoose in reply to LibertyCake

You're welcome. :)

SlowDragon profile image
SlowDragonAdministrator

CRP is slightly raised - indicating inflammation

Ferritin rises with inflammation. So in reality ferritin may be lower than it appears

You need full iron panel test

Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test

Medichecks iron panel test

medichecks.com/products/iro...

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

You also need coeliac blood test

High thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s

nice.org.uk/guidance/ng20/c...

1.1 Recognition of coeliac disease

1.1.1 Offer serological testing for coeliac disease to:

people with any of the following:

persistent unexplained abdominal or gastrointestinal symptoms

faltering growth

prolonged fatigue

unexpected weight loss

severe or persistent mouth ulcers

unexplained iron, vitamin B12 or folate deficiency

type 1 diabetes, at diagnosis

autoimmune thyroid disease, at diagnosis

irritable bowel syndrome (in adults)

first‑degree relatives of people with coeliac disease.

No folate result?

LibertyCake profile image
LibertyCake in reply to SlowDragon

Thanks for this info. Really appreciate it.

I have just done the econsult with my gp and just plainly explained that I need a full iron panel and coeliac blood test and they immediately sent me a link to book one so that is set for 8am in two weeks. Utterly shocked at the ease of that as I thought I’d have to fight or go private but credit where it is due!

pennyannie profile image
pennyannie

Hello LibertyCake and welcome to the forum :

A TSH over 2 and especially over 3 is an indication that you will be suffering symptoms of hypothyroidism and which can be all those symptoms your have describe.

Your T3 is at 48% and T4 is at 50% and both in their ranges - but obviously not at a high enough level that gives you enough T3 to successfully run your body without suffering symptoms of hypothyroidism.

Your inflammation is high as are both your TPO and TgAb thyroid antibodies showing you dealing with Hashimoto's Auto Immune disease as well the visual, physical symptoms and inconvenience of having this goitre.

I would strongly suggest you ask your doctor to chase the endo team as your symptoms are likely to get worse with time.

When metabolism is not running as ' normal ' either too fast as in true hyperthyroidism or too slow as in hypothyroidism the body struggles to extract key nutrients through food no matter how well and clan you eat -

Whilst your active B12 and vitamin D are just about ok and optimum - your ferritin could do with tipping up over 70 ++ and I aim for around 20 ;

There is generally a genetic predisposition to thyroid health issues - did your Dad get treatment and have a surgery or RAI thyroid ablation. ?

LibertyCake profile image
LibertyCake

Thanks for all the replies. I will chase the endo referral and speak with my gp about the results.

It was a while ago now but my dad had some radioactive treatment to kill the thyroid and then took levo to replace it all. He suffered badly with his eyes due to it.

I’m so frustrated that people are brushed off and kicked between teams with this sort of thing but sadly it looks like I will need to get used to this from here on in!

pennyannie profile image
pennyannie in reply to LibertyCake

If you wish to reply to someone you need to ensure you reply with their reply to you - as then they get notified there is a message - or you could type in @with their name directly alongside and a panel pops up with all forum members name options and the name is then highlight in blue - sorry probably confusing you !!

I too have Graves and had RAI treatment back in 2005 and deeply regret this treatment option - but knew no different at the time and simply followed the advice offered.

Yes, I'm afraid you'll have to keep pestering the relevant people - especially now as I read the O/P waiting lists continue to grow.

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