Suggest Treatment For Thyroiditis And PCOD

Posted on Fri, 16 Jan 2015

Question: I have removed dairy from my diet. I have recently been told I have thyroiditis but haven't been told what sort. I have a long history. I have polycystitic overy syndrome and endometriosis as well. I also have a benign pulmonary murmer. I also suffer from migraine. I find it difficult to get to sleep and when I do sleep, no matter how long I sleep, I still feel really really tired. My body had also decided that it doesn't like dairy. 3 months ago I ended up with bad diarrhea and now whenever I eat dairy, within half an hour, I'm in the toilet with foul smelling bowl movements. I have always been very gasy. Also recently, whenever I seeat, it smells like rotten meat. Help me please

Test Results:

Anti-TPO (microsomal):699.1 IU/mL ( 0-9 ) H

Anti-Tg (thyroglobulin):234.2 IU/mL ( 0-4 ) H

Ordered by:PAUL XXXXXXX

Laboratory:pathlabs

Observation date:08-Dec-2014

Answered by Dr. Prasanna Heijebu (1 hour later)

Brief Answer:
Elevation of Anti TPO and Tg antibodies reflects Hashimotos Thyroiditis

Detailed Answer:
Hi Mam,

I understand your query and concern.

You seem to have Hashimoto's thyroiditis. This is reflected in the elevation of Anti TPO and Tg antibodies. This thyroiditis is reflected as hypo functioning of thyroid gland, causing many metabolic alterations.

Most of the bowel altered movements could be related this thyroiditis.

Since this thyroiditis is autoimmune in nature, there is high possibility of other auto immune diseases in you.

Hence I advise you to get a complete ANA profile.

Also a total colonoscopy of the bowel along with total ultrasound abdomen will help to rule out abdominal autoimmune pathologies.

Removal of dairy from your diet is a good move.

Polycystic ovary syndrome and endometriosis have to be treated separately with hormonal pills.

Migraine in your case needs special attention with drugs like triptans under expert medical care

Sleep disturbances in your case are directly related to hypothyrpidism and should be treated with drugs like clonazepam under expert medical care.

Post your further queries, if any.

Thank you.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Prasanna Heijebu (6 hours later)

Here are my last blood tests taken the same day as my antibodies where done;

HbA1c (IFCC):32 mmol/mol

(<41) If used as a screening test, diabetes is virtually

excluded. If diabetic and treated with insulin/sulphonylureas,

the risk for hypoglycemia is increased.

Ordered by:PAUL XXXXXXX

Laboratory:pathlabs

Observation date:08-Dec-2014

Sodium:140 mmol/L ( 135-145 )

Potassium:4.3 mmol/L ( 3.5-5.2 )

Creatinine:76 umol/L ( 45-90 )

eGFR:>90 mL/min ( >60 )

Glucose:5.2 mmol/L ( 3.0-7.8 )

Ordered by:PAUL XXXXXXX

Laboratory:pathlabs

Observation date:08-Dec-2014

Bilirubin total:7 umol/L ( 0-20 )

Alk phosphatase:80 U/L ( 40-100 )

GGT:31 U/L ( 0-50 )

ALT:20 U/L ( 0-40 )

Total Protein:81 g/L ( 60-80 ) H

Albumin:44 g/L ( 34-48 )

Globulin:37 g/L ( 25-35 ) H

Ordered by:PAUL XXXXXXX

Laboratory:pathlabs

Vitamin B12:273 pmol/L ( 140-650 )

Folate:29.9 nmol/L ( 7.0-45.0 )

Ordered by:PAUL XXXXXXX

Laboratory:pathlabs

Observation date:08-Dec-2014

Ferritin:99 ug/L ( 20-200 )

Ordered by:PAUL XXXXXXX

Laboratory:pathlabs

Observation date:08-Dec-2014

Free T4:11.0 pmol/L ( 7.0-16.0 )

TSH:4.05 mU/L ( 0.3-5.0 )

Ordered by:PAUL XXXXXXX

Laboratory:pathlabs

Observation date:08-Dec-2014

HAEMOGLOBIN:138 g/L ( 115-155 )

PCV:0.41 L/L ( 0.35-0.46 )

MCV:92 fL ( 80-99 )

MCH:31 pg ( 27-33 )

WBC:9.7 x10E9/L ( 4.0-11.0 )

Neut Seg:6.1 x10E9/L ( 1.9-7.5 )

Lymphocyte:2.7 x10E9/L ( 1.0-4.0 )

Monocyte:0.7 x10E9/L ( 0.2-1.0 )

Eosinophil:0.1 x10E9/L ( 0.0-0.5 )

Basophil:0.1 x10E9/L ( 0-0.2 )

PLATELET COUNT:319 x10E9/L ( 150-400 )

Ordered by:PAUL XXXXXXX

Laboratory:pathlabs

Observation date:08-Dec-2014.

My migrains are being treated with Amitriptyline 10mg and Metoprolol Succinate 47.5mg which I take daily and Naproxen 250mg for any breakthrough migrains. A neurologist prescribed me these. Im also on a contraceptive pill called Ava 20 ED. Shall I see my local GP to organize anymore tests to get referred for the colonoscopy and ultrasound? And how to I moniter the Hashimotos thyroiditis? I was told basically that I wait till my thyroid stops working then they put me on pills for it. Could it also be some thing called Graves disease?

Answered by Dr. Prasanna Heijebu (13 hours later)

Brief Answer:
Wait and watch is the right procedure adapted for thyroid

Detailed Answer:
Hi Mam,

I understand your query and concern.

I have gone through all your reports in detail.

All of which are pretty fine and well within the normal limits with no lab abnormality detected.

Your thyroid hormones are practically well within the normal range.

So you are currently in the euthyroid state. So you do not need any external thyroid supplementation as of now. So what your doctors said is pretty right. You should wait until the picture of hypothyroidism develops.

Graves’s disease is quite unlikely as it presents with antibodies to TSH-R which in your case is absent.

Also Anti TPO antibodies are quite specific to Hashimoto's thyroiditis.

Your Migraine is aptly treated at the moment. Of course Triptans can be added.
You can discuss this with your Neurologist.

You need to visit a Gastroenterologist for the Colonoscopy and Ultrasound but NOT a GP.

Post your further queries, if any.
Thank you.

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Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju