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Subacute Thyroiditis with low levels of antibodies?
Last Post 15 Dec 2014 10:51 PM by Elaine Moore. 1 Replies.
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zHuntUser is Offline New Member New Member Posts:
11 Dec 2014 02:07 PM
    Hi everyone! I was urged to come here from another person who told me that Elaine might be able to help me! My case is a little perplexing to me.

    28/female. In September my anxiety issues had hit a new high, by October I was in a near thyroid storm. I made it to a gastroenterologist because I was so nauseous with constant bowel movements and diarrhea along with my anxiety, tacycardia (170 BPM) and everything else that goes with hyperthyroidism. At the time, my thyroid felt a little tender to the touch for a few days, and I mentioned it, and he ordered a TSH along with a bunch of stool tests and GI tests. I thought it was a GI issue because I'd had a fecal transplant in May 2014 for recurrent c. difficile infections of my gut. A whole other story!

    Anyway, my TSH came back at 0.019, so while waiting to see a doctor about it, I was so dehydrated that I just went to the ER, where they run a bunch of thyroid tests and admitted me because of how high the results were and how high my heart rate was. They diagnosed Graves, but I didn't have an RAIU or TSI test, so they were just guessing. Started me on 50mg Atenolol and 20mg Methimazole, and released me soon after because they were afraid I'd catch c. diff there since my history of it was so messy, they didn't want to risk me being exposed to it again. They set me up with an endocrinologist.

    While on Methimazole for about 4 days, I had an extreme headache, pain behind my eyes, pain in my skin and bones... so I was switched to PTU for a couple of weeks. I stopped the PTU for 14 days to prepare for an RAIU and scan because my TSI came back "within range" (see test results below).

    Ultimately my endocrinologist diagnosed me with Subacute Thyroiditis, but I didn't have a preceding virus, I didn't have a fever-- maybe one degree above normal, I didn't have a sore throat or pain in my thyroid (just a few days worth of tenderness), my ESR was never tested, I wasn't pregnant, and my hyper symptoms are really lingering. My last labs were 11/18 and my next round of them are 12/18.

    Another thing I should mention is that ever since I was a child my thyroid actually ran on the low end of normal, with my TSH being about 3.8 most of the time, and my Free T3 being just a smidge below normal. Yet I have always been underweight and anxious.

    I seemed to feel a lot of improvement in the hyper symptoms for a few weeks, then my period came about 13 days ago and I feel all thyrotoxic again with rapid heartbeat and tremors and diarrhea. Am wondering if my period could have caused my thyroid to act up again? How long might this toxic phase last? and why do I have antibodies (even tho they are within range)? Can subacute thyroiditis cause you to go hyper more than once? Should I look into Hashi? Also when my TSI test was done I had been on antithyroid meds for a week.

    The symptoms I had while in thyrotoxicosis:
    all day long panic attacks that never abated
    adrenaline rushes all day long
    tacycardia (170 BPM)
    waking every few hours during sleep
    frequent bowel movements, including diarrhea and cramping
    unrelenting nausea / inability to eat or keep myself hydrated
    oily skin and increased acne
    hair falling out in huge clumps, like alarming clumps in the shower
    finger nails growing weird
    pain underneath thumb nails
    elevated temperature
    high blood pressure
    rapid weight loss
    Broken capillaries in eyes

    Here are my labs:

    Labs 6.13.14
    Thyroid Meds: none
    TSH: 3.6 (Ref: 0.3 - 3.6)

    Labs 10.27.2014
    Thyroid Meds: none

    TSH: 0.011 (Ref: 0.36-3.74 uIU/mL) L

    Free T3: 9.88 (Ref: 2.18-3.98 pg/mL) H

    Free T4 2.92 (Ref: 0.76-1.46 ng/dL) H

    Total T3: 321 (Ref: 76-181) H

    Reverse T3: 50 (Ref: 8-25) H

    Thyroglobulin: 80.6 (Ref: 2.8-40.9) H

    Thyroglobulin antibodies: <1 (Ref: <OR=1 )

    Thyroid Peroxidase Antibodies: 2 (Ref: <9)

    WBC: 8 (Ref: <10)

    Labs 11.12.14
    Thyroid Meds: Atenolol 50mg PTU 100mg x3/day

    Thyroid Stimulating Immunoglobulin Antibodies (TSI): 32 (Ref: <140)

    Labs 11.18.14
    Thyroid Meds: Atenolol 50mg, stopped PTU for RAIU scan scheduled 11.20.14

    Ultrasound: normal

    Free T4: 1.96 (Ref: 0.76 - 1.46) H
    Total T3: 276 (Ref: 176 - 181) H

    RAIU & scan 11.25.14 Meds: Atenolol 50mg

    RAI-u & Scan: 2% at 6 hr, 1% at 24 hr - scan pictures undetectable due to low uptake.

    Next labs (TT3 and FT4 - 12.18.14)
    Do not restart PTU
    Diagnosed with Subacute Thyroiditis
    Still feeling hyper but not nearly as bad.
    Elaine MooreUser is Offline Veteran Member Veteran Member Posts:3836
    15 Dec 2014 10:51 PM
    Your normal levels of thyroid antibodies and your low uptake strongly suggest thyroiditis. There are several different kinds of thyroiditis, including subacute, silent, postpartum (after any cessation of pregnancy) and several others. You wouldn't necessarily have developed thyroiditis after an infection depending n the type of thyroiditis you have.
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