Doctors Lounge - Rheumatology Answers
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Forum Name: Rheumatology Topics
|WatchTheWeatherChange22 - Sun Mar 04, 2007 10:27 am||
28 y/o female, 5'0, 150lbs. diagnosed with "hypothyroid" though "Hashimoto's" is the label frequently used in office by Endo and Rheumatologist. Recently diagnosed with Fibromyalgia after running tests to clear Lupus and other like autoimmune diseases. Not really feeling better yet. In fact, feeling worse.
Symptomatic Manifestations: Mitral Valve Prolapse, digestive symptoms, severe chronic symmetrical arthritis of metatarsal region in feet, chronic cystic acne (last ten years), headaches increased frequency and intensity, menstrual changes, severe anxiety attacks, waking up in the middle of the night for sugar, severe chronic fatigue, especially after eating, "brain fog," unrefreshing sleep, blurry vision without apparent physical cause, high cholesterol despite dietary restriction, and forty pound of weight gain in abdominal region (arms and legs have not shown proportionate gain). Family history of similar symptoms.
Medication: I have been on 75mcg of Levothyroxine, 5mcg of Cytomel and 1200 units of vitamin D per day for the last six months (previously just 50mcg of Levothyroxine).
Initial Diagnosis, 165 lbs.,
06/13/05: (TPOAb) 5908 H IU/ml (0-34 ref. interval), TSH 2.189 uIU/ml (.350-5.500 ref. interval), Total Cholesterol 233 H mg/dL (100-199 ref. interval) LDL 163 H mg/dL (0-99 ref. interval) I restrict foods high in animal fats, and had for the previous two years-- family history of high cholesterol and other symptoms.
Most recent test, 150 lbs.
02/06/07: 2141 IU/ml (0-34 ref. interval), TSH 4.157 uIU/mL (ref. interval .350-5.500), (No lipid panel for comparison)
I suspect that my problem is related to the pituitary, something like Cushing's. What exactly counts as "significantly elevated" for Thryoid Peroxidase (TPO) Ab? Should I be tested for Lyme's, Cushing's? What else should I be aware of? Where do I go next?
|Dr. Chan Lowe - Mon Mar 05, 2007 1:13 pm||
Specific numbers for reference ranges of your tests vary from lab to lab; however, a TPO antibody level in the thousands will be high for any lab. This is consistent with the diagnosis of Hashimoto's thyroiditis.
Hashimoto's thyroiditis can have various stages. Initially it may present as hyperthyroidism as the thyroid cells are killed by the antibodies causing them to leak their hormone into the blood. Overtime, essentially all Hashimoto's patients become hypothyroid. It appears that you are in this stage since you are taking thyroid hormone.
TSH should be followed and kept in the normal range for your lab. If TSH begins to rise it is an indication of a need for more thyroxine.
There is a saying that autoimmune diseases travel in packs, so since you have Hashimoto's thyroiditis you are at risk for developing other autoimmune diseases as well. Most of your symptoms are non-specific to any particular illness, making the diagnosis difficult. You may consider having your insulin levels checked. Insulin resistance can cause some of your symptoms.
Follow up with your doctor is important.
Hope this helps.
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