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Forum Name: Endocrinology Topics

Question: Hashimoto's Thyroiditis: Skin Symptons, Sudden Throat Pain


 MandyR - Mon Nov 17, 2008 10:46 pm

In a recent blood test my T4 level was normal (1.2) but my TSH was increased (600 IU/mL). I was told that I had subclinical hypothyroidism. Also, I went to a dermatologist who believes my thick skin, with discolored velvety build-up, acne, yellow skin, and patches of white spots are symptoms of unbalanced thyroid levels. I was also recently diagnosed with a memory disability.

I've had these skin and memory issues since before I was nine years old. I've also had symptoms of depression and lethargy since the same time. Just recently my throat has begun to ache consistently for the last month. Is it possible that I've had hypothyroidism since I was young, or are these symptoms unrelated? Looking only at information on the internet, I also seem to have auxiliary symptoms of hypothyroidism, but I'm wary of information on the internet. My doctor believes that I'm just now experiencing Hashimoto's Hypothyroidism as my thyroid is abnormally large, but I'm disconcerted by what I've read about hypothyroidism recently.

I'm 19 years old, 5'5'', at 130 pounds.
 MandyR - Tue Nov 18, 2008 12:53 pm

Sorry, I mis-entered my blood test information: Thyroid Peroxidase Antibody greater than 600 IU/ml. TSH 7.4

Thank you for your time,

Mandy
 Dr. Safaa Mahmoud - Sat Nov 22, 2008 2:57 pm

User avatar Hello,

Your symptoms as well as the test results are suggestive of hypothyroidism mostly due to Hashimoto's thyroiditis.
Hashimoto's thyroiditis is an autoimmune disease in which the body immune cells attack cells of the thyroid. This is a common cause of thyroid hypofunction.

However, during the acute phase of the disease, thyroid hormones being released from the damaged thyroid gland result in an initial state of hyperthyroidism. So patients may present earlier with thyroid gland enlargement make them feel throat tightness and swallowing difficulty.

Patient then go into a phase of thyroid hypofunction, so patients may complain of fatigue, depression, difficulty in concentration, have dry skin and excessive sleepiness.

Diagnosis based on complete history, physical examination and investigations for exclusion of other causes of nodular goiter (benign or malignant).

Essential blood tests are thyroid function tests: T3, T4 and TSH.
Typically, there should be elevated TSH and low T3 and T4 (may be normal or high initially, as in your case).

Diagnosis of Hashimoto's thyroiditis is helped by the finidng of thyroid autoantibodies. Which are high in your blood test results.

Thyroid US and scan are recommended as needed, and US is also used to guide a FNAC. Histological studying of the thyroid tissue may be needed and diffuse infiltration of the thyroid gland with inflammatory cells is characteristic for Hashimoto thyroiditis.

Treatment is usually medical with hormone replacement according to symptoms and lab results. While surgery is kept for complicated cases.

Whether this was the cause of your early symptoms years before the diagnosis is made is a difficult question to be answered. But there are cases of chronic thyroiditis that may have subclinical hypothyroidism with constantly elevated TPO antibody.

Thyroid peroxidase (TPO) antibody is used to detect antibodies against the thyroid gland in conditions similar to Hashimoto's Thryoiditis. Most people with chronic thyroiditis (70%-90%) are positive for TPOAB test.

In any circumstances what is known is that serial follow up testing to keep your thyroid hormone level within the normal range (with replacement therapy when needed) would improve your symptoms.

I would advise you to follow up with your doctor and please keep us updated.

Best regards.
 MandyR - Fri Dec 05, 2008 9:19 pm

Thank you for your thorough reply! I met with an Endocrinologist last week, and she prescribed 50mg of Synthroid. However, she didn't comment on the cause of my hypothyroidism, so I'm assuming it's not relevant to the treatment.
 Dr. Safaa Mahmoud - Sat Dec 06, 2008 6:19 am

User avatar Hello,
Thank you for updating us.
Hypothyroidism is treated with thyroid hormone replacement regardless the cause.

So, I would advise you to continue your treatment on regular basis and to follow up with your doctor. She will recheck your thyroid hormone levels in the blood to make sure it is within the normal range otherwise dose adjustments will be needed.
Please keep us updated.
Best regards.

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