Hashimoto's Thyroiditis - Diagnosis

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How is Hashimoto's thyroiditis diagnosed?

TTo diagnose Hashimoto's thyroiditis, a physician should assess symptoms and complaints commonly seen in hypothyroidism, carefully examine the neck to look for enlargement of the thyroid gland, and take a detailed history of family members. Blood tests are essential to diagnose Hashimoto's thyroiditis. Specific blood tests determine the level of thyroid function.

During the early stage of thyroiditis, the levels of thyroid hormones (T3 and T4) may be normal. With chronic hypothyroidism, the thyroid hormone levels fall, and the level of thyroid stimulating hormone (TSH) becomes high. The most useful assay for determining thyroid status is measurement of TSH in the blood. As mentioned earlier, TSH is secreted by the pituitary gland. As the level of thyroid hormone falls, the pituitary gland responds by releasing more thyroid stimulating hormone (TSH). The increase in TSH can actually precede the fall of thyroid hormone to low levels by months or years, so the first sign of hypothyroidism may be an elevated TSH level even when levels of thyroid hormones are normal.

The blood work mentioned above confirms the diagnosis of hypothyroidism, but does not point to an underlying cause. The combination of the patient's clinical history, antibody screening (as mentioned above), and a thyroid scan can help diagnose the precise underlying thyroid problem. If a pituitary or hypothalamic cause is suspected, MRI of the brain and other studies may be warranted. These investigations should be made on a case-by-case basis.

Illustration of the Pituitary Gland
Illustration of the Pituitary Gland

The blood tests also usually include an analysis of antibodies (anti-thyroperoxidase antibodies) to aid diagnosis. If the anti-TPO antibodies are elevated at all, the diagnosis is made. Early on in the course of the disease, however, the patient may have negative antibodies.

If the gland is large, or there are symptoms of esophageal compression, an ultrasound may be performed to see if the gland is compressing either the esophagus (the food tube) or the trachea (the airway).

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See what others are saying

Comment from: LisaG, 45-54 Female (Patient) Published: January 29

I was just diagnosed with Hashimoto's this week however I suspect this has been a problem for years, but undiagnosed. I go to a family practice where I see a different doctor or nurse practitioner every time and finally I got one who tested for something different. After reading my chart and my current symptoms, he went immediately for thyroid issues, even though my last blood test showed my T4 staying in the good range. He ordered different blood tests than anyone had before. Most recently I've suffered with tinnitus (ear ringing) for weeks and what feels like mild hearing loss. This followed a string of other ailments with my digestive system over the last 6 months. I have also suffered from severe allergies for the last 7 years. The last two weeks I have been extremely tired and have had a hard time staying awake in the evenings, been extremely sluggish at work and had major brain fog. Other doctors have just dismissed everything as menopausal symptoms. I feel like finally we're on the right track. I have a thyroid ultra sound scheduled for next week. Hopefully forward progress from there.

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Comment from: Kat, 45-54 Female (Patient) Published: April 01

I have been fighting an uphill battle with my "former" family doctor for years. I knew something was wrong, I had anxiety, depression, rashes, hair falling out, weight loss, weight gain, lethargy, extreme fatigue, and those were the mild symptoms. Then came the Vitamin D deficiency, the B12 deficiency, I knew I had a multi-nodular goiter, but according to my doctor, if it wasn"t causing issues and my hormone levels were normal, then I didn"t need to have any additional tests run. Finally, this past year, after being officially diagnosed as Type 2 diabetic and dramatically altering my diet, and really changing my lifestyle, you would think, she must feel a lot better, nope, it made it worse. So, I started researching, basically self-diagnosed, and then changed doctors. Now I'm officially diagnosed with Hashimoto"s thyroiditis, but according to my current endocrinologist, I don"t need treatment, because even though my antibodies are outrageously high, my other levels are normal, so I should just live with all the other symptoms. So now I have a name for what's wrong with me, but still no treatment. Hard to find good health care, it's pretty bad when you have to diagnose yourself, then just get a doctor to confirm it.

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