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Hello, For Months Now I Have Been Having Strong Fatigue,

Posted on Wed, 29 Jan 2020

Question: Hello, for months now I have been having strong fatigue, twitching both awake and asleep and just completely exhausted also random pains here and there throughout the body that come and go. I've had a variety of tests run and am looking for another opinion. I am wondering if my results point to anything specific such as Hashimotos or another autoimmune disease. As of my last blood test my T4 is high, TSI is normal, TSH is normal and Thyroid Peroxidase Antibodies are also normal. I am ANA positive with a titer of 1:80 and nuclear, dense, fine speckled pattern. My birthcontrol is currently SPRINTEC and in 2018 my Sex Horomone Binding Globulin was high at 195. If you were my doctor what would you be thinking? Hashimotos? Something else? What would your next steps be?

Answered by Dr. Mirjeta Guni (58 minutes later)

Brief Answer:
About hyperthyroidism;

Detailed Answer:
Hello and thank you for asking!
I have gone carefully through your concern.
Hashimoto thyroiditis is an autoimmune disease taht means that your body produces antibodies ( AntiTPO or AntiTg) that destroy the thyroid gland.
When more than 80% of the gland is destroyed, it does not produce enough hormones and is manifedted with high TSH and low Ft4 and Ft3.
In your case the antibodies are negative and Ft4 is high not low.
There are 2 main pathologies that cause high Ft4; Graves disease and nodular goiter.
Graves' disease is an autoimmune disease that means that your body produces antibodies ( TSi) that stimulate the thyroid gland to produce Ft4 and in your case these antibodies are negative.
So you need a thyroid ultrasound to confirm.the nodular goiter.
Hope the information will help.
Best wishes.
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Mirjeta Guni (1 hour later)

Thank you for your answer!
This would not explain my fatigue would it? So what comes next in terms of figuring out treatment or cause of fatigue (twitching at night I can live with)The fatigue is what concerns me the most and led to testing. It hasn’t resolved for months. Some days are great, others are horrible. Husband has noticed energy levels down and I sleep a lot more than ever.

Answered by Dr. Mirjeta Guni (22 hours later)

Brief Answer:
About thyroid hormone result;

Detailed Answer:
Hi again,

The thyroid hormone result does not explain your concerns.

Positive ANA antibodies suggest for a rheumatologic autoimmune disease but a detailed history and physical examination would be of help to interpret it.

Regards,
Dr.Mirjeta

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Above answer was peer-reviewed by : Dr. Arnab Banerjee