Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Does This TSH Report Indicate?
Question: I was recently diagnosed with Hashimotos Disease, based on TPO antibodies, and am not sure what to do next. I will be seeing an Endocrinologist next month but from everything I have read, it seems as if they will treat this with synthetic hormones once my TSH levels go above the lab range. But what about all of the symptoms this is causing and may have caused going back many years:
SYMPTOMS:
- Epstein Barr antibodies
- IBS – since teens – bloating, gas, random runs
- Migraines – since teens – frequency has increased in past 3 months
- Anxiety/Depression: diagnosed Spring 2013 – 25 pound weight loss
- Major weight gain starting in 2014 (50 pounds!). no change in diet; exercise 4-6 times/week. Currently on very restricted diet and not losing any weight
- Excessive sweating – 2012, 2013, 2014 – night sweats; excessive sweating at parties, etc…
- Chronic pain – lower back – increase in discomfort in past 3-4 months - constant pain but shapr pain and dull ache that radiates up and around
- Achy joints
- Fatigue – 3-4 years
- Insomnia and night waking – years
- Thinning, brittle hair and hair loss – 2-3 years
- Thin brittle nails
- Mental fog – forgetting words, train of thought – not “Claritin clear’
- Heart PVCs – March 2011
- Thoracic outlet syndrome – 1 year – pain, pins & needles, right side. PT did not help
- Parasite (2006?)
- Intensely stressful youth
My labs have shown the following TSH levels:
6/20/07 2.54
1/7/11 2.13
2/9/12 2.43
9/19/12 2.27
6/5/13 3.27
8/12/13 2.04
11/8/13 2.26
10/7/14 3.96
8/15/15 2.84 -- with TPO ab at 435 (range 0-35)
How do I start the journey towards addressing the underlying causes and feeling better???
SYMPTOMS:
- Epstein Barr antibodies
- IBS – since teens – bloating, gas, random runs
- Migraines – since teens – frequency has increased in past 3 months
- Anxiety/Depression: diagnosed Spring 2013 – 25 pound weight loss
- Major weight gain starting in 2014 (50 pounds!). no change in diet; exercise 4-6 times/week. Currently on very restricted diet and not losing any weight
- Excessive sweating – 2012, 2013, 2014 – night sweats; excessive sweating at parties, etc…
- Chronic pain – lower back – increase in discomfort in past 3-4 months - constant pain but shapr pain and dull ache that radiates up and around
- Achy joints
- Fatigue – 3-4 years
- Insomnia and night waking – years
- Thinning, brittle hair and hair loss – 2-3 years
- Thin brittle nails
- Mental fog – forgetting words, train of thought – not “Claritin clear’
- Heart PVCs – March 2011
- Thoracic outlet syndrome – 1 year – pain, pins & needles, right side. PT did not help
- Parasite (2006?)
- Intensely stressful youth
My labs have shown the following TSH levels:
6/20/07 2.54
1/7/11 2.13
2/9/12 2.43
9/19/12 2.27
6/5/13 3.27
8/12/13 2.04
11/8/13 2.26
10/7/14 3.96
8/15/15 2.84 -- with TPO ab at 435 (range 0-35)
How do I start the journey towards addressing the underlying causes and feeling better???
Brief Answer:
Follow up of Hashimoto's thyroiditis
Detailed Answer:
Good day,
Welcome back . Noed the history. Agree that you have hashimoto's thyroiditis. But your TSH is remaining normal and at this point you may not require any treatment. There is even a possibility that TPO antiboy levels will drop down in the future.
I agree that, many people experience some physical symptoms when they have high antibody levels even if they have normal TSH. I had siggesed Selenium 200 mcg as a trial to reduce high antibody levels.
Some of the symptoms you mentioned may be associated with hypothyroidism. However, these can occur in depression itself. You may be have episodes of depresssion and feel down during those episodes.
Please try Selenium. Along with that, you may also need to do a bit of stretch exercise, meditation, yoga etc which help to beat depression. Check vitamin D and B12 levels and correct them if low. Take calcium every day.
Check TSH after 6 months intervals x 2 times and if normal, then yearly.
Regards
Binu
Follow up of Hashimoto's thyroiditis
Detailed Answer:
Good day,
Welcome back . Noed the history. Agree that you have hashimoto's thyroiditis. But your TSH is remaining normal and at this point you may not require any treatment. There is even a possibility that TPO antiboy levels will drop down in the future.
I agree that, many people experience some physical symptoms when they have high antibody levels even if they have normal TSH. I had siggesed Selenium 200 mcg as a trial to reduce high antibody levels.
Some of the symptoms you mentioned may be associated with hypothyroidism. However, these can occur in depression itself. You may be have episodes of depresssion and feel down during those episodes.
Please try Selenium. Along with that, you may also need to do a bit of stretch exercise, meditation, yoga etc which help to beat depression. Check vitamin D and B12 levels and correct them if low. Take calcium every day.
Check TSH after 6 months intervals x 2 times and if normal, then yearly.
Regards
Binu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
from everything I have read -- people suffer for years and years without ever detecting the underlying cause. I've been "warned" that traditional doctors use the TSH level as the main indicator for treatment. I have also read that in "normal" Americans with no thyroid issues -- the average TSH level is 1.5. Which make all of my readings "above average". I also read about the attempts to lower the high end of that TSH range for labs.
My frustration is that if I understand it correctly -- I have an autoimmune disease that may end up negatively affecting my thyroid -- which can be monitored by the TSH levels. But the thyroid is the casualty of war here --- and in he meantime, my body is and possibly has been at war with itself for years. So the concern isnt so much the TSH levels right now -- but what my body is doing to itself and how I can find the root cause to treat that, not just treat teh thyroid when the time comes.
I have read over and over peoples stories of this battle -- many of whom were told the same thing about it being depression and being medicated for that and getting those extra side effects thrown on top of the pile. I'm sure depression does come into play at some point -- especially when your body has been constantly attacked by itself -- making you feel ill, fatigued, in pain, etc... and sure -- the insane weight gain with no reason behind it, and the inability to drop weight no matter what you try will make anyone depressed too. BUT, again, the depression is a result of the cumulative effect of all of these things.
I want to know HOW i get to the root of the problem so I can make necessary life changes and start living a full life. I do continue to see a therapist to talk things through and I do exercise regularly (though not like I used to bc of pain).
The answer can not be simply in tracking TSH levels.
My frustration is that if I understand it correctly -- I have an autoimmune disease that may end up negatively affecting my thyroid -- which can be monitored by the TSH levels. But the thyroid is the casualty of war here --- and in he meantime, my body is and possibly has been at war with itself for years. So the concern isnt so much the TSH levels right now -- but what my body is doing to itself and how I can find the root cause to treat that, not just treat teh thyroid when the time comes.
I have read over and over peoples stories of this battle -- many of whom were told the same thing about it being depression and being medicated for that and getting those extra side effects thrown on top of the pile. I'm sure depression does come into play at some point -- especially when your body has been constantly attacked by itself -- making you feel ill, fatigued, in pain, etc... and sure -- the insane weight gain with no reason behind it, and the inability to drop weight no matter what you try will make anyone depressed too. BUT, again, the depression is a result of the cumulative effect of all of these things.
I want to know HOW i get to the root of the problem so I can make necessary life changes and start living a full life. I do continue to see a therapist to talk things through and I do exercise regularly (though not like I used to bc of pain).
The answer can not be simply in tracking TSH levels.
Brief Answer:
TSH is pulsatile
Detailed Answer:
Hashimotos's thyroiditis has a high chance of developing hypothyroidism in the future. However, totally disagree with that TSH cut off of 1.5. You have to understand the physiology of TSH secretion. It is a pulsatie hormone and levels can vary in a same person at different times of the same day. The normal range is usually between 0.3 to 4.5. It can fluctuate with in this value in a single day.
Your TSH level is perfectly normal at this point of time. Any attempt to bring it down by using thyroxine at this stage may cause development of palpitatations, and even osteoporosis ( bone loss).
No one knows exacty what triggers Hashimoto's thyroiditis. It is indeed an auto immune disease and immune dysregulation, +ve family history etc are big risk factors to develop this condition. Apart from this, viral infections also play a role in initiating this autoimmune process.
TSH is pulsatile
Detailed Answer:
Hashimotos's thyroiditis has a high chance of developing hypothyroidism in the future. However, totally disagree with that TSH cut off of 1.5. You have to understand the physiology of TSH secretion. It is a pulsatie hormone and levels can vary in a same person at different times of the same day. The normal range is usually between 0.3 to 4.5. It can fluctuate with in this value in a single day.
Your TSH level is perfectly normal at this point of time. Any attempt to bring it down by using thyroxine at this stage may cause development of palpitatations, and even osteoporosis ( bone loss).
No one knows exacty what triggers Hashimoto's thyroiditis. It is indeed an auto immune disease and immune dysregulation, +ve family history etc are big risk factors to develop this condition. Apart from this, viral infections also play a role in initiating this autoimmune process.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your answers.
But again, I am not concentrating on the TSH level and I have no desire to go on nor have I even asked about going on thyroxine at this point.
I am trying to understand what patients should do to try to get to and treat the root problem.
Are you saying that until the Hashimotos leads to hypothyroidism (if it does) -- I would have no symptoms from the Hashimotos itself? And that all of the health issues I have had to date are unrelated to the Hashimotos? This is what I am trying to understand -- the connections between my health history and Hashimotos and whether there is a link that would explain much of the health history.
thanks if you have any opinion/insights on that
But again, I am not concentrating on the TSH level and I have no desire to go on nor have I even asked about going on thyroxine at this point.
I am trying to understand what patients should do to try to get to and treat the root problem.
Are you saying that until the Hashimotos leads to hypothyroidism (if it does) -- I would have no symptoms from the Hashimotos itself? And that all of the health issues I have had to date are unrelated to the Hashimotos? This is what I am trying to understand -- the connections between my health history and Hashimotos and whether there is a link that would explain much of the health history.
thanks if you have any opinion/insights on that
Brief Answer:
Screen for Vitamin D and B12 deficiency
Detailed Answer:
Sometimes, many diseases do not behave the same way how it is described in textbooks. One of my old professor used to say " no one become patient after reading text books". So typical text book description may not always be there in many diseases.
Even before hypothyroidism stage, when the antibody levels are high, many patients complaint of various symptoms. I do have to admit that. I have seen young kids and older adults developing encephalopathy ( clouding of conscious levels) when antibody levels are too high ( usually more than 1000). Many of them have perfectly normal TSH. So there is a link between anti TPO and symptoms.
Steroids are recommended during encephalopathy. It is a harmful medication when used for long term and is not routinely recommended just to reduce Anti TPO antibody ( other than encephalopathy setting).
SELENIUM has been tried and found useful in many patinets.
I must also say that, hashimoto's being an autoimmune disease, many other autoimmune diseases may be going on along with hashimoto's in a patent. Not all them may be evident. Hence it may be prudent to check an 8 AM serum cortisol, vitami B12 and vitamin D, ESR, etc.
Other than this, there are limitations in what modern medicine can offer in hashimoto's disease when thyroid bllod profile ( TSH and Free t4) are normal.
Screen for Vitamin D and B12 deficiency
Detailed Answer:
Sometimes, many diseases do not behave the same way how it is described in textbooks. One of my old professor used to say " no one become patient after reading text books". So typical text book description may not always be there in many diseases.
Even before hypothyroidism stage, when the antibody levels are high, many patients complaint of various symptoms. I do have to admit that. I have seen young kids and older adults developing encephalopathy ( clouding of conscious levels) when antibody levels are too high ( usually more than 1000). Many of them have perfectly normal TSH. So there is a link between anti TPO and symptoms.
Steroids are recommended during encephalopathy. It is a harmful medication when used for long term and is not routinely recommended just to reduce Anti TPO antibody ( other than encephalopathy setting).
SELENIUM has been tried and found useful in many patinets.
I must also say that, hashimoto's being an autoimmune disease, many other autoimmune diseases may be going on along with hashimoto's in a patent. Not all them may be evident. Hence it may be prudent to check an 8 AM serum cortisol, vitami B12 and vitamin D, ESR, etc.
Other than this, there are limitations in what modern medicine can offer in hashimoto's disease when thyroid bllod profile ( TSH and Free t4) are normal.
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
