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Hashinoto's thyroiditis. No treatment given. Huge differences in blood tests.

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Practicing since : 2001
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I would like to have an Endogrinoligist answer this question and very happy to pay for that only?

I have been diagnosed with hashimotto's, with all the symptoms of Hpyerthyroidism? I have huge nodules in one side of my thyroid and the endo here in Aus has put me on NO treatment. Each time I go to the Endo after a Test the TSH is high... I am so confused as each blood test I have show huge differences in TSH - i.e No1. - 1.01, No 2. - 3.35, No 3. - 1.3, No. 4 - 3.05, No. 5 - 1.61, No 7, 3.92 Range ( .30 - 4.0 )
FT4 No 1 7.2, (low) No 2, - 8.8, No 3. - 10.5, No 4. - 10.8, No 5. - 12.6 ( Range 8.0 - 18.00 )
FT 3 No 1 5.1, No 2. - 6.0, No 3. - 5.6 No. 4. - 4.1 No 5 - 3.92 ( Range 3.8 - 6.0 )

Since these tests have been done the "lab" they are using has said they are using new calibration method - that means that if taken on one of the days above i would be "normal".......

I know I am one but i think that it is a little cryptic the way the doctor is reading the tests.

Antithyroglobulin and Antiperoxidase over 600
Posted Sun, 22 Apr 2012 in Thyroid Problem and Hormonal Problems
Answered by Dr. V. Kumaravel 17 hours later

I do understand that you had been evaluated for probable hyperthyroidism and diagnosed to have hashimoto’s thyroiditis with nodular goiter. Your concern now seems to be related to thyroid function testing and further treatment.

You can have 2 issues with thyroid.
1. Problem in thyroid functions as reflected by the blood results.
2. Problem with thyroid structure (whether you have nodule or enlarged thyroid gland).

Though your TSH (Thyroid Stimulating Hormone) levels may vary between 1.01 to 3.92, all of them are within laboratory reference range 0.3 to 4.0. Similarly most of your FT3 and FT4 are within the reference range. In such case you may not require any thyroid medication as there may not be any clinical improvement by taking thyroxine.

Your Antithyroglobulin and Antiperoxidase over 600 suggests that you have hashimoto’s thyroiditis. We treat in such case only when you have associated thyroid function abnormality.

Since your Antithyroglobulin and Antiperoxidase over 600, you would require periodic monitoring of thyroid functions and treatment when required.

In view of nodule in thyroid, I would like to know the size of the nodule and you may require a needle biopsy from the thyroid nodule.

Above answer was peer-reviewed by
Follow-up: Hashinoto's thyroiditis. No treatment given. Huge differences in blood tests. 4 hours later
Thanks for the information to date. i am still wondering WHY am I having all the symptoms of Hyper when Hashi's is the diagnosis?

With the antibodies so high, I understand i obviously have a problem, and the Nodule is 2.5cm x 1.8cm x 2.0 cm.

You claim that the other problem is the blood tests? I do not understand? I am assuming that the erratic behaviour of low end and high end for FT4 and Ft3 and the TSh is inconsistent too.

What treatment should be taken?

The Nodule has been FNA and is all clear? but very large?
Follow-up: Hashinoto's thyroiditis. No treatment given. Huge differences in blood tests. 3 hours later
Just because you have both Antibodies does that confirm you have have hashitmotto's when all the symptoms are hyperthyroid.

I believe the problem is from the large nodule Excreting hormones into my system? I have XXXXXXX smaller ones too all FNA clear........

I have also read many articles and Medical journals which indicate that not necessarily do you "fit the mould " just because you are within the range. That now is proven by the lab who did the calibration changing the figures - some figure changing quite dramatically. If you sit on the low end or high end, it can cause many problems but a lot of Doctors who do not deal with Thyroid specific understand that the patient has a their OWN ideal range......Is this true?
Answered by Dr. V. Kumaravel 19 hours later
Thanks for reverting.
Hashimoto’s thyroiditis is an autoimmune disease (Where you have antibody production against your own thyroid tissue). Hashimoto’s thyroiditis usually present with hypothyroidism or with hyperthyroidism or with normal thyroid functions.

When you are antithyroglobulin and antiperoxidase antibody positive, it does not necessarily mean your thyroid functioning has been affected, but the chance of abnormal thyroid functioning is high and there is 4 to 10% chance you may develop thyroid dysfunction and periodic Free Thryoxine levels (FT4), Free tri-iodothyronine levels (FT3) and Thyroid stimulating hormone (TSH) assessment is mandatory.

Another aspect that has to be remembered is that thyroid hormones are secreted in pulses and can slightly vary and that's why you are given a normal range between 0.3 to 4 in case of TSH and the same holds for T3 and T4. Any value within the range, whether lower side or upper side is considered normal. In your case thyroid function tests are normal, I would prefer not to start treatment.

You have multiple thyroid nodules and your Fine needle aspiration cytology (FNAC) is normal and nothing to be worried about. We will have to follow-up the nodule and consider surgery if the nodule is growing or if your FNA biopsy is abnormal.

Your symptoms may not be related to thyroid and needs further evaluation.
I hope I have answered your queries. Please accept my answer if you have no further queries.
Above answer was peer-reviewed by
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