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Treating Hashi's with normal hormone levels? Dangerous?
An_251952 posted:
Hi everyone,
I am interested in other people's experiences with treating thyroid problems- in general but especially when TSH levels are in the normal range.

here's my situation....After a long battle with severe constipation & fatigue and many, many trips to my general MD (and despite a "whole foods diet", cutting out diary, alcohol, and coffee) i finally sought out a Naturopath who tested my thyroid only to find I have Hashimoto's disease. I had not heard of this disease before so I was shocked to find I had every symptom associated with the disease. Although my hormone levels were consistently normal, due to the presence of the symptoms and antibodies, the Naturopath suggested I go on Nature-Throid (32 mg/day). I have been on this now for two months and I feel so much better. I am still tired (I have two kids under 4!) but much more functional. I feel human.

Fast forward to last week when I went to an endocrinologist... just to cover my bases. This MD seems completely uninterested in my symptoms and how I was feeling and instead looked only at my hormone levels. She basically said i didn't really need to be treated and that I was probably "just" depressed. However, since I'm already on the meds (and would like to someday try for another baby- though I'm not sure why this matters) she said we might as well keep me on them and check my TSH regularly.

Here were my initial levels in February:
thyroid perioxidase antibodies=147
thyroglobulin antibodies=55
T3 Reverse=21
T3 Uptake=36
T4, free=1.2
TSH= 1.52 (although has been up in the 4s previously)

From what I've been reading it does seem controversial to treat Hashi's with thyroid meds if TSH is normal- is it? Has anyone had success with an Endocrinologist who treats symptoms not just numbers? And is it risky to take the meds if I am otherwise healthy and the TSH levels remian "normal"?

Any advice or thoughts from anyone would be appreciated. thanks.
An_250567 responded:
With Hashi, your thyroid may present within normal limits, but at some point, function will begin to decline at an unpredictable rate, thus the reason for regular testing.

As far as treating when levels are WNL, some docs treat, some wait. My doc began treating me when my levels presented just barely out of normal limits. I was dx'd with hypothyroidism years after having my kids, but had I been, I would have definitely made sure my levels were WNL for awhile before I even began trying to become pregnant.

My internist monitors me, not an endo. Internists or a family practitioner can treat Hashi unless you don't respond to treatment or perhaps if you become pregnant at which point you'd want to see either an endo or gyno/endo.

Background on hypothyroidism, In the US and other developed countries, hypothyroidism is typically due to autoimmune disease because we have iodine in our diets (iodized salt, for example). In underdeveloped countries, where lack of iodine in diet is present, hypothyroidism is diet related. With autoimmune hypo, you may get the dx because your antibodies show Hashi, but you've yet to present clinically and therefore, treatment isn't warranted until the thyroid function begins to decline. So, most people in the US with hypo most likely have Hashi. Other tests you might ask for at some point is a thyroid ultrasound to check for nodules, DEXA scan to measure bone density as Hashi untreated can lead to bone thinning, check Vit D levels.

Oh, about treating when you present WNL? Yes, if you add too much thyroid hormone and become over medicated, you'll have symptoms of hyperthyroid, not good either and in fact can be quite dangerous. Its important to have blood work regularly, especially if you add medicines such as BCP which can alter thyroid levels.

Hope this helps prod some thoughts for you to take to your doctor and see what treatment is best for you. Good luck.

PS, don't wait for thyroid treatment to address constipation. Get on a protocol to treat that. Don't rule out being somewhat stressed/depressed given where you are in life. Young children zap our energy. Whether it is called depression or stress or whatever, take steps to combat that through a good diet, regular exercise, sunshine (need that Vit D), having a strong social network, etc.

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