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What causes hashimoto's thyroiditis?

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Posted on Tue, 8 Jul 2014
Question: Hi, I am currently seeing a fertility doctor due to low testosterone. I am taking Chlomid to boost these levels whilst my wife and I try for a baby. Yesterday my fertility doctor told me that my blood work had shown I have Hashimotos Thyroiditis. The blood work results were as follows: t-3 Total 1.02 NG/ML, Anti Thyroglobulin AB 299 IU/mL, Thyroperoxidase AB 155 IU / mL, FSH 11.9 mlU/ml, TSH 3.61 mIU /ML (last blood check this was at 4.83), Free T4 1.10 ng/dL.

I am a fairly fit 37 year old that exercises frequently, albeit I have a stressful job. However, I have chronic carpal tunnel syndrome in one arm, I suffer regular small issues with joints and muscles (which i had previously assumed were from aging), I struggle to concentrate, i often feel fatigued despite regular exercise, have low libido, marginally high cholesterol (total 217) and have periodic bouts of mild depression – all of which I understand are symptoms of thyroiditis.

My fertility doctor has not suggested any medication for the time being, but will monitor my blood every three months. I am just confused by what these blood results mean? Should I go and see a specialist? Could it be a sign of cancer (you read lots of things on the internet), do I need to change my diet? How bad do those results look, or are they normal for someone with Hashimotos and should I just not worry about it for the time being? Any help would be much appreciated.
Thanks XXXXXXX
doctor
Answered by Dr. Monish De (15 minutes later)
Brief Answer:
antibodies against thyroid peroxidase

Detailed Answer:
Hi XXXXXXX
Hashimoto's Thyroiditis is a condition in which your immune system attacks your thyroid, a small gland at the base of your neck below your Adam's apple. The thyroid gland is part of your endocrine system, which produces hormones that coordinate many of your body's activities.
The resulting inflammation from Hashimoto's disease, also known as chronic lymphocytic thyroiditis, often leads to an underactive thyroid gland (hypothyroidism). Hashimoto's disease is the most common cause of hypothyroidism in the United States. It primarily affects middle-aged women but also can occur in men and women of any age and in children.
Doctors test your thyroid function to help detect Hashimoto's disease. Treatment of Hashimoto's disease with thyroid hormone replacement usually is simple and effective.
In general, your doctor may test for Hashimoto's disease if you're feeling increasingly tired or sluggish, have dry skin, constipation and a hoarse voice, or have had previous thyroid problems or goiter.
Diagnosis of Hashimoto's disease is based on your signs and symptoms and the results of blood tests that measure levels of thyroid hormone and thyroid-stimulating hormone (TSH) produced in the pituitary gland. These may include a hormone test. Blood tests can determine the amount of hormones produced by your thyroid and pituitary glands. If your thyroid is underactive, the level of thyroid hormone is low. At the same time, the level of TSH is elevated because your pituitary gland tries to stimulate your thyroid gland to produce more thyroid hormone
An antibody test. Because Hashimoto's disease is an autoimmune disorder, the cause involves production of abnormal antibodies. A blood test may confirm the presence of antibodies against thyroid peroxidase (TPO antibodies), an enzyme normally found in the thyroid gland that plays an important role in the production of thyroid hormones.
In the past, doctors weren't able to detect underactive thyroid (hypothyroidism), the main indicator of Hashimoto's disease, until symptoms were fairly advanced. But by using the sensitive TSH test, doctors can diagnose thyroid disorders much earlier, often before you experience symptoms.
Because the TSH test is the best screening test, your doctor will likely check TSH first and follow with a thyroid hormone test if needed. TSH tests also play an important role in managing hypothyroidism. These tests also help your doctor determine the right dosage of medication, both initially and over time.
Treatment for Hashimoto's disease may include observation and use of medications. If there's no evidence of hormone deficiency, and your thyroid is functioning normally, your doctor may suggest a wait-and-see approach. If you need medication, chances are you'll need it for the rest of your life.
If Hashimoto's disease causes thyroid hormone deficiency, you may need replacement therapy with thyroid hormone. This usually involves daily use of the synthetic thyroid hormone levothyroxine.
Synthetic levothyroxine is identical to thyroxine, the natural version of this hormone made by your thyroid gland. The oral medication restores adequate hormone levels and reverses all the symptoms of hypothyroidism.
Soon after starting treatment, you'll notice that you're feeling less fatigued. The medication also gradually lowers cholesterol levels elevated by the disease and may reverse weight gain.
Treatment with levothyroxine is usually lifelong, but because the dosage you need may change, your doctor is likely to check your TSH level every six to 12 months.
To determine the right dosage of levothyroxine initially, your doctor generally checks your level of TSH after a few weeks of treatment. Excessive amounts of thyroid hormone can accelerate bone loss, which may make osteoporosis worse or add to your risk of this disease. Overtreatment with levothyroxine also can cause heart rhythm disorders (arrhythmias).
If you have coronary artery disease or severe hypothyroidism, your doctor may start treatment with a smaller amount of medication and gradually increase the dosage. Progressive hormone replacement allows your heart to adjust to the increase in metabolism.
Levothyroxine causes virtually no side effects when used in the appropriate dose and is relatively inexpensive.
Hope i have answered your query
Regards
DR De


Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Monish De (17 minutes later)
Thanks for your reply. All of the tests you mentioned have been done and i put the results in my orginial query. i am keen to get some clarity on my specific results - my antibodies look really high and my TSH varies between 3.6 and 4.8. Do i need to see a specilaist now, could this be a sign of cancer, do i need to change my diet? given other symptoms, should i not start medication immediately? - and how high would the antibody reading need to be before immediate medication is required?

given my specific results does a wait and see approach make sense?

Thanks
doctor
Answered by Dr. Monish De (1 hour later)
Brief Answer:
Observation

Detailed Answer:
Hi
Though the upper limit of TPO antibodies is 34 international units per ml and in your case it is very high with values reading 155 IU / mL.That is high because of your Hashimoto's Thyroiditis disease and it is very normal to have high elevated levels.
But since your TSH level is still normal as upper normal limit of TSH is 5 miu/l and in your case it varies beteween 3.6 and 4.8 which means it is yet to cause thyroid hormone deficiency.So my advise is to be on observation and repeat the blood tests after 3 months.
If after 3 months TSH level crosses 10 miu/l then you may need replacement therapy with thyroid hormone like levothyroxine.
Hashimoto's thyroiditis is definitely associated with an increased risk of developing papillary thyroid cancer. The risk is greatest for women: female patients with Hashimoto's thyroiditis who undergo thyroidectomy are 30% more likely to have papillary thyroid cancer.
Once a diagnosis of Hashimoto’s is obtained, the dietary goals are to cool the inflammation, work to balance all hormones, and help the thyroid gland produce hormones and the body to convert them properly.
Adopting a diet rich in high-quality proteins and fats, with lots of fresh, seasonal, and organic vegetables, fruits, nuts, seeds, whole grains and nutrient-dense booster foods is the shortest, straightest path to nutritional thyroid support. An emphasis on building, through an increased amount of protein, is recommended, since lowered thyroid function reduces the body’s ability to benefit fully from the protein foods. Also consider eating three meals and two to three snacks per day to keep energy levels more even throughout the day.
If you do not have any clarifications, you can close the discussion and rate the answer. Wish you good health.


Regards
DR De


Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Answered by
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Dr. Monish De

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Practicing since :2004

Answered : 2233 Questions

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What causes hashimoto's thyroiditis?

Brief Answer: antibodies against thyroid peroxidase Detailed Answer: Hi XXXXXXX Hashimoto's Thyroiditis is a condition in which your immune system attacks your thyroid, a small gland at the base of your neck below your Adam's apple. The thyroid gland is part of your endocrine system, which produces hormones that coordinate many of your body's activities. The resulting inflammation from Hashimoto's disease, also known as chronic lymphocytic thyroiditis, often leads to an underactive thyroid gland (hypothyroidism). Hashimoto's disease is the most common cause of hypothyroidism in the United States. It primarily affects middle-aged women but also can occur in men and women of any age and in children. Doctors test your thyroid function to help detect Hashimoto's disease. Treatment of Hashimoto's disease with thyroid hormone replacement usually is simple and effective. In general, your doctor may test for Hashimoto's disease if you're feeling increasingly tired or sluggish, have dry skin, constipation and a hoarse voice, or have had previous thyroid problems or goiter. Diagnosis of Hashimoto's disease is based on your signs and symptoms and the results of blood tests that measure levels of thyroid hormone and thyroid-stimulating hormone (TSH) produced in the pituitary gland. These may include a hormone test. Blood tests can determine the amount of hormones produced by your thyroid and pituitary glands. If your thyroid is underactive, the level of thyroid hormone is low. At the same time, the level of TSH is elevated because your pituitary gland tries to stimulate your thyroid gland to produce more thyroid hormone An antibody test. Because Hashimoto's disease is an autoimmune disorder, the cause involves production of abnormal antibodies. A blood test may confirm the presence of antibodies against thyroid peroxidase (TPO antibodies), an enzyme normally found in the thyroid gland that plays an important role in the production of thyroid hormones. In the past, doctors weren't able to detect underactive thyroid (hypothyroidism), the main indicator of Hashimoto's disease, until symptoms were fairly advanced. But by using the sensitive TSH test, doctors can diagnose thyroid disorders much earlier, often before you experience symptoms. Because the TSH test is the best screening test, your doctor will likely check TSH first and follow with a thyroid hormone test if needed. TSH tests also play an important role in managing hypothyroidism. These tests also help your doctor determine the right dosage of medication, both initially and over time. Treatment for Hashimoto's disease may include observation and use of medications. If there's no evidence of hormone deficiency, and your thyroid is functioning normally, your doctor may suggest a wait-and-see approach. If you need medication, chances are you'll need it for the rest of your life. If Hashimoto's disease causes thyroid hormone deficiency, you may need replacement therapy with thyroid hormone. This usually involves daily use of the synthetic thyroid hormone levothyroxine. Synthetic levothyroxine is identical to thyroxine, the natural version of this hormone made by your thyroid gland. The oral medication restores adequate hormone levels and reverses all the symptoms of hypothyroidism. Soon after starting treatment, you'll notice that you're feeling less fatigued. The medication also gradually lowers cholesterol levels elevated by the disease and may reverse weight gain. Treatment with levothyroxine is usually lifelong, but because the dosage you need may change, your doctor is likely to check your TSH level every six to 12 months. To determine the right dosage of levothyroxine initially, your doctor generally checks your level of TSH after a few weeks of treatment. Excessive amounts of thyroid hormone can accelerate bone loss, which may make osteoporosis worse or add to your risk of this disease. Overtreatment with levothyroxine also can cause heart rhythm disorders (arrhythmias). If you have coronary artery disease or severe hypothyroidism, your doctor may start treatment with a smaller amount of medication and gradually increase the dosage. Progressive hormone replacement allows your heart to adjust to the increase in metabolism. Levothyroxine causes virtually no side effects when used in the appropriate dose and is relatively inexpensive. Hope i have answered your query Regards DR De