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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What does "diffuse white matter signal abnormalities" mean in an MRI?

Answered by
Dr. Dariush Saghafi


Practicing since :1988

Answered : 1695 Questions

Posted on Tue, 2 Sep 2014 in Brain and Spine
Question: Had mri of brain 3 years ago showing diffuse white matter signal abnormalities noticeably confluent in frontalparietal region. Stated this is abnormal in this age group. Further testing only revealed very high antithyroid antibodys. Neurologist said isn't concerning unless have symptoms. Mri was for general feeling of unwellness. Repeated it one year later with no changes. Didn't get worse or better. So scared......
Answered by Dr. Dariush Saghafi 4 hours later
Brief Answer:
White matter abnormalities routinely found in MRI'

Detailed Answer:
Good afternoon. My name is Dr. Saghafi and I am a neurologist from XXXXXXX OH. I have a good deal of training in treating patients with the type of MRI picture that you describe.

I notice that your location of origin seems to be XXXXXXX OH as well.....Hey Neighbor!

I've read your summary of the problem as well as the responses from a number of other colleagues who have answered the question and reassured you of the more likely than not possibility of a benign or at least non-specific set of findings.

First of all, I do not see any attached MRI to look at or report so I'm not sure what the updated scans are saying compared to the first (your statement is that there is no change) but if I'm reading my colleagues' comments correctly there were less than 5 of these "white matter signal abnormalities" present in the first scan. Even if the "spots" were grouped in a similar location (confluence) it would not necessarily mean anything special UNLESS THE PATIENT HAD specific clinical complaints or a specific abnormal neurological finding upon examination. From what I'm gathering of the neurologist who is seeing you here in XXXXXXX your complaint is that of generally feeling unwell. And it would seem to me that the neurological examination was normal as to boot.

I understand you have a high titer of antithyroid antibodies. May I ask if you have other thyroid parameters available and what has been the follow-up with that result? If the antithyroid antibodies are significantly elevated then, I say there is reason to believe a thyroid problem MAY exist. This in turn MAY be associated with white matter lesions in the brain. If you in fact, do have a thyroid issue then, your symptom of "feeling unwell" can certainly be explained to some extent by that mechanism.

A potential autoimmune problem with your thyroid gland NEED NOT come with specific or classical symptoms and could very well be described as generally feeling "unwell", "crappy", "yukky" "Ewwwww"....whatever.....I disagree with the statement that there have to be manifestations and symptoms of hypothyroidism in order to go after the automimmune process. Whoever had the good idea of doing those tests should recognize their utility and go after the results either with an endocrinologist or by themselves. Another name for this condition if not manifesting classical symptoms of hypothyroidism would be Latent Hypothyroid state.

As an aside, I diagnosed my own mother with this problem many years ago when the endocrinologist actually missed it....she did not have MRI changes of any sort but she too had very nonspecific feelings of unwellness and occasional tiredness even though she was and still is a marathon runner at age we treated her and she has been feeling better ever since we made that diagnosis.

Furthermore, if a thyroid problem were revealed and corrected then, radiography studies have shown that white matter lesions of the brain are generally reversible. In other words, these little spots or ditzels or whatever you'd like to call them can potentially be erased. However, I caution this is IF AND ONLY IF we are talking about a true blue, bona fide, autoimmune process involving the thyroid gland.

Therefore, in conclusion, I believe that your finding of high antithyroid antibodies can potentially be run down to discover whether or not you possess an autoimmune thyroid problem (most commonly Hashimoto's thyroiditis) or Latent Hypothyroid State. Once that has been determined then, the next step to treat appropriately should be undertaken by someone knowledgeable in treating thyroid or autoimmune diseases. Final step would be to see what if any clinical manifestations you have after several months of treatment and then, the FINAL FINAL step would be to redo the MRI's of the brain and see what they look like.

Also, this condition is nothing to be scared of and is more common than people think simply because not many are looking for it and even when they find it they're not moving aggressively enough to see what can be done to fix it or link it to other clinical problems which to that point may have been looked at as either "trivial" by their doctors or otherwise unexplainable. Do you know what I mean? If you've got it then, I think it's a relatively easy fix and you stand a good chance of feeling better and looking better (at least in an MR scanner! HAHA!).

I hope this information has been of value to you and if so, please do me the favor of leaving some written feedback and a STAR RATING so that I can tell how much I hit the mark on your questions and concerns.

Also, if there are no further questions to ask would you also do me the favor of CLOSING THE QUERY on your end. That way the network can file the case and shut 'er down for archival and educational purposes in the future. I actually, think this would turn out to be a wonderful teaching case (if you'd agree) and you should be given Kudos if this all pans out to be true since you stayed persistent with things in not just accepting easy answers that have little importance (at least as far as others are concerned).

We'll see which way it all goes shortly, right?

This query required 58 minutes of physician specific time to review, research, and consolidate final documentation of the envoy draft to the patient.


Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
Follow up: Dr. Dariush Saghafi 17 minutes later
Actually there were more than 5 lesions found and the report states clearly abnormal in this age grourp. They named everything from ms to leukoencephelopathy to prior brain insult. I'm lost. I don't physically have symptoms right now. I had the mri repeated one year from each other with no changes. I'm so scared. Do I have dementia at 30??
Answered by Dr. Dariush Saghafi 22 minutes later
Brief Answer:
Do not get hung up on big words

Detailed Answer:
Hello. You've got to take a couple of deep breaths first and then Read on.

Remember, the radiologist reads the reports and only reads what he sees and rarely has access to clinical information. If he does have access such as in this case where antithyroid antibodies have been discovered, he may not put that together with the radiographic findings.

Furthermore, the term leukoencephalopathy is just another word for white matter changes which we have already admitted you have.

The word should not be as important compared to what you need to do which is follow up on the antithyroid antibodies. You can't possibly have dementia at the age of 30 since you do not have any clinical symptoms. That is by your own admission and by your neurologist's admission.

Aside from that there's also the fact that dementia such as Alzheimer's disease is primarily a disease of the cortex in the brain which is not white matter but rather gray matter.

The MRI changes are white matter changes and they do not involve the cortex. If you let your imagination run away with a lot of terminology and other things and lose focus of what I spoke about having to do about a possible thyroid condition then, you will remain "scared."

Let's just focus on the important things. Whoever ordered the antithyroid antibodies needs to either run a full panel set of tests in order to fully describe the state of your thyroid gland or needs to send you for a consultation with an endocrinologist of reputation.

The rest of the plan is laid out in my previous note to you and should be followed as it says, one step at a time.

Hope you are breathing nice and slowly and relaxed. :)

Once again, if this information has given you more insight to your condition, would you do me the favor of putting inbsome written feedback and a star rating of our conversation?

If you have further questions i'd be happy to answer them otherwise, I would also appreciate your closing the query so that the network can appropriately file and archive our conversation.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
Follow up: Dr. Dariush Saghafi 10 minutes later
Thank u so much!! you actually made sense!! I will def be giving you a wonderful rating!! just an aside I also had very high thyroglobulin levels but normal tsh. had it removed but mri of brain taken after and it remained same as before
Answered by Dr. Dariush Saghafi 22 minutes later
Brief Answer:
One step at a time

Detailed Answer:
Good stuff. Let's just clarify a couple of things. I read that you also had high Antithyroglobulin antibody levels as well. Is that true? You then said you had them "removed" so I would like to know what that exactly means. Did they put you on thyroid medication? As far as the reversibility on MR is concerned of the white matter lesions or if we now want to use our newly discovered "word of the day", Leukoencephalopathy--that can take an undetermined amount of time. In several studies that were looked at, those changes (after correction of thyroid status) was from months two years.

Not only that but we must also factor in some of the things which have already been said by other neurologists who have given opinions on your case on this network which is there are other reasons to look for white matter lesions on an MRI.

for example, patients may have a history of smoking, high cholesterol, high blood pressure, diabetes, B12 deficiency, vitamin D deficiency, and the list can go on and on and on may all show white matter lesions on an MRI scan.

Patients over age 35 can also show lesions on an MR scan which are believed to simply be part of the aging process. and also, there is an important group of individuals who suffer with migraine headaches and may have the types of lesions that you show on your scan. These are referred to as an identified bright objects or (UBO's).

So you see, simply correcting one factor such as thyroid parameters may or may not be at the heart of these white matter lesions.

However, to my way of thinking if it is really true that there is a latent hypothyroid state or Hashimoto's thyroiditis, why not fix it? It's easy to do, makes a lot of sense, and certainly if we know that problem has been solved and we are still interested in discovering the cause of the white matter lesions we know for sure we can't blame that one anymore.

i'm sure your neurologist probably ordered other blood work and tests to include some if not all of the other things I mentioned.

But the point is we go one step at a time and we don't think about those nasty little "lesions" anymore. You are otherwise normal. you think normally and you walk normally and you talk normally and that is plenty good for me at this point.

so we agree then that going after the thyroid problem will be for two reasons and two reasons only:

1. we need to discover whether or not you truly have an underlying low thyroid state
2. correction of the same so that we can optimize you from a hormonal point of view without any expectation that in doing so we will affect the lesions in the brain. We may but we also may not.
3. If we get to that point where we have in fact optimized you with your thyroid situation and we feel that it is clinically warranted to be more aggressive with a work up to find out what exactly is at the heart of these lesions then, we will cross that bridge when we get to it.


Tallyho young lady!
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
Follow up: Dr. Dariush Saghafi 22 minutes later
deal! but I am very healthy and exercise daily. marathon runner and everything. The only thing discovered was hashimotos disease with antithyroid antibodies at 976. Neurologist referred me to endo and he examined and had thyroid removed for suspicois nodules which were cancerous. have been fine. No reoccurance. just worried I'm developing a dementia. I have 2 small kids and I worry! The neurologist did ask if I ever did any serious drugs in past or if any disorders run in my family. That scared me bc what on earth did he see! but he was baffled that I'm asymptomatic so he said not to worry. He checked all of the things u mentioned but nothing other than the thyroud. He mentioned ADEM but wasn't convinced.
Answered by Dr. Dariush Saghafi 55 minutes later
Brief Answer:
I think your neurologist is right on target

Detailed Answer:
So, now the story becomes even a bit more clear and in fact you were felt to have Hashimoto's thyroiditis and treated for it, correct?

And then your neurologist went ahead and ruled out all of the other usual suspects in a case like this and basically came up with no other ideas because in fact, there probably aren't any. even went so far as to consider something crazy like ADEM but then, correctly discarded that idea. But he was trying to think outside the box!

So, now you're concerned that there may be a dementing illness afoot because other things just haven't been found.

But, on the other hand you have two small children, you are a marathon runner, you stay physically fit, you are probably an intelligent and hard-working individual, so with all of that on your plate don't you think you deserve to be a little forgetful at times? LOL

We have four kids and have had them for the past 21 years, of course not all of them at the same time, but every time I want to call someone, I have to go through four different names and sometimes I even call the same one twice!

I would love to trade war stories with you sometime about our respective sporting passions. I continue to be in competitive collegiate and Olympic style wrestling and for that I need to run at least 3 to 4 miles daily. I don't always do it but I certainly preached at the XXXXXXX XXXXXXX wrestlers that I coach and do my best to keep up with that schedule. my last running adventure was a half marathon down in XXXXXXX at the beginning of the summer. My daughter invited me to run it with her and of course, she being a crossFit maniac (which I do not approve of necessarily) put me in a position where I had no choice but to say "of course.". Mind you, I do not like running distances anymore than I absolutely have to for wrestling training.

he beat me by 10 minutes and I told him that I would never run anything greater than a 10K and I would probably never run anything with him again anyways!
and the race that I had done before the half was a 10K which was at the behest of one of my fellow assistant coaches, nearly 25 years younger than me, who put the same challenge out there and said that if I were really somebody who thought they were in shape I'd run this thing with him. Haha!

anyways, I guess I'm trying to make a point out of all of this and I'm not sure where it's going but to say that we all do the very very best we have with everything we have at the moment. Then, when the moment changes and even if it turns out to be something that we weren't particularly expecting or wanting we simply need to deal with it the best way we can.

So to bring this full-serve go with your situation I would say the same thing that there has been an exhaustive search set out to discover the reason for the white matter lesions. In the meantime, a condition of Hashimoto's thyroiditis was discovered and addressed which is a very good thing especially for your level of competition and physical activity but the white matter lesions still seem to persist.

Yet, from a clinical point of you you are functioning at a high and quite adequate level for your lifestyle and your families needs. I think that's where things should be at about now and if the situation were to change in the future for any reason then, you and anyone else will deal with it in the most logical and efficient manner possible. That could mean an additional MRI scan of the brain or more blood tests or who knows what might be available in several years from now to continue the investigation for this type of problem.

I hope that makes sense.

In closing, it was a pleasure to transact back-and-forth with you. Feel free to look me up directly with any other questions you may have. If you had copies of your MRI scans, I would be happy to look at them. You can always look me up directly on this network or we could potentially WebCam conference at which is yet another similar type to this network where I am present at very strange hours, usually 3 AM to 7 AM on Wednesdays, Thursdays, Fridays, and Saturdays. I am also on that network from 11 PM to 3 AM on Sunday evening.

Now, if you do for some reason or chance forget to either rate or provide written feedback about our conversation or you forget to close this query (assuming you don't have any further questions or comments which I would love to read) then, I may change my mind and say that in fact you are suffering from dementia and we should call the dementia police out right away in order to snare you and take you to some kind of a funny farm! ROFL

Be well and keep pounding that pavement! Somebody has to and I am just glad that it's not me!
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
Follow up: Dr. Dariush Saghafi 56 minutes later
Thank u so much for your kindness understanding and words of wisdom. Just to clarify I don't know how it got misconstrued but I'm from pa not Ohio but do have many relatives in ohio. XXXXXXX area. Anyway I plan to run XXXXXXX again and will run a few miles for u! Lol. Just one last clinical question I do plan to provide u a copy of my mri reports but the only thing I have noticed different with my cognitive abilities is that I always had a god awful sense of direction and am poor with remembering people's names. Unless I continuously see them and repeat the name to myself.these things aren't new just a little worse than before. Worry or don't worry?? And lastly could I have been born with the white matter on the brain maybe that could explain my poor direction and name recall my entire life. Possible????
Answered by Dr. Dariush Saghafi 5 hours later
Brief Answer:
Are you kidding? You'd run a few miles for me?

Detailed Answer:
Holy smoke....that would be be able to tell people that I've got someone running a few miles for me at the XXXXXXX since that would be the absolute closest I'll ever get to the BM! HA! Maybe I'll take the family up there when you go and we'll cheer you on...that would be very cool. Interesting on why I thought you were from OH. There is a link that shows us when we are answering questions for patients from where their question is originating based on an Internet localizer and when I clicked your link it showed me somewhere in downtown XXXXXXX I kind of wondered if you were from XXXXXXX you were telling me that you were told by your neurologist that you could go to get a 2nd opinion in XXXXXXX

By all means send me your MR's to look at or if you would like to webconference then, try and find out how to specifically hook up with me when I am on shift. I will be on tonight at 3a as well as tomorrow at 3a and then, Sunday at 11p. The website is With respect to your sense of direction it's well known by psychologists and forensic anthropologists that women are worse in direction than men and a full 10% of women are so bad--- that for them, following CARDINAL DIRECTIONS means that some red colored bird is telling them how to go South for the winter......but seriously, if you feel that sense is worse along with names...I don't think that's clinically significant enough to do anything with at this point.

Having said that, I wouldn't necessarily try and dissuade you from an indepth neuropsychological exam if it could help allay some of your fears right now. My guess (just from knowing you today briefly) is that neither of those items is of clinical relevance right now....but maybe a neuropsych battery could better ferret that out for us. White matter degeneration as a congenital or inborn error of metabolism is also not possible since many of those types of problems either end in catastrophe (i.e. early death...or at least severe cognitive disabilities at young ages).

Send me your MR's if you'd like and I'd certainly be appreciative for not only a few miles in XXXXXXX but a little written feedback to show the higher ups that we're doing our best helping you understand your concerns. Could you also CLOSE THE QUERY if you have no further questions.

Please stay in touch and all the best in your training and eventual got people in XXXXXXX rooting for you....AND COLUMBUS!
Above answer was peer-reviewed by : Dr. Shanthi.E

The User accepted the expert's answer

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