Could Hashimoto's Disease Display A Normal TSH Level?

Posted on Fri, 5 Sep 2014

Question: Could hashimotos disease display a normal tsh level

Answered by Dr. Binu Parameswaran Pillai (46 minutes later)

Brief Answer:
yes

Detailed Answer:
Hello
Good day.
Hashimotos disease initially present as thyroiditis with low TSH and raised free T4.

After the inflammation is settled ,Free T4 and TSH returns to normal. However, later in around 30 to 40 % patients, hypothyroidism develops and TSH rises.

Hence In the natural course of hashinotos disrase , you may get a stage where TSH can be normal. But the Anti TPO antibodies remain raised and there us always a risk of developing future hypothyroidism

Regards
Binu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (3 hours later)

I had a brain scan that showed diffuse white matter changes confluent in frontalparietal region. it's more than expected for my age. many things out ruled and the only thing found in bloodwork was high antithyroid antidody (974). could I have suffered an encephalopathy e thus??

Answered by Dr. Binu Parameswaran Pillai (7 hours later)

Brief Answer:
Hi

Detailed Answer:
I have seen 2-3 cases of hashimoto's encephalitis where anto TPO antibody was more than 1000. This is more common in children than in adults. However, it is possible in adults too. Did you ever suffer an altered sensorium or coma or headaches ?

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (13 minutes later)

I did experience a week long migraine like headache for few days which was absolutely horrible and I don't get migraines. I also experienced extreme sleepiness following what I can best describe as hot flashes?? Not sure if they were small seizures or not. Just my thinking. Mri of brain sshows diffuse white matter changes confluent in frontalparietal regions bilaterally. The lesions they claim are nonspecific. We're more than 5 though but neurologist didn't seem too concerned since I felt better after thyroid removed for a thyroid carcinoma

Answered by Dr. Binu Parameswaran Pillai (4 minutes later)

Brief Answer:
Hi

Detailed Answer:
Your symptoms doesnt seems to be related to encephalitis. Migraine itself can cause signal changes in MRI scan. Many a times, we see this kind of descriptions in MRI report and if your Neurologist is not really concerned much, it is unlikely to be significant. Please do not worry.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Binu Parameswaran Pillai (2 hours later)

Can u have symptoms of hashimotos disease w a normal tsh?? My antithyroid antibodies were 997 but tsh normal. At the timw I felt extreme fatigue and periods of overwhelming sleepiness. Anxiety w panic attacks and depression. Cold sweats or hot sweats...any of these hashis??

Answered by Dr. Binu Parameswaran Pillai (15 minutes later)

Brief Answer:
Hi

Detailed Answer:
Symptoms of hypothyroidism will not occur with a normal Free T4 and TSH. However, i have seen few patients with hair fall and fatigue who have a normal TSH with elevated anti TPO antibody. This shows that, there may be some relation with an elevated antibody and some of these symptoms. However, this has not been extensively studied. But there are clear evidence that elevated TPO antibody is associated with abortions, fetal loss and infertility independent of TSH levels.

Depression is associated with hypothyroidism ( elevated TSH), but not with elevated antibody alone.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar