I need Medicine's advice on Hashimoto's!

[Foxxy Cleopatra]

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Hi-

It's one of my first posts on the medicine board (I will be starting surgery internship next month) and I have a question that I was wondering if you could help me out with, being that you all are the experts on this! 🙂

I have a friend (31 y.o. male) who was training for a marathon a few months ago and noticed excessive tiredness and unusual weight gain. He was evaluated and diagnosed with Hashimoto's. I thought that was unusual for a male. He's pretty symptomatic- fatigue, muscle pain, and ~ 30 lb weight gain in the last 8 weeks. He was started on Synthroid and has some trouble getting the dose adjusted (recently developed tachycardia ~170 bpm.)

When he told me about this, my familiarity with Hashimoto's was really what I learned in pathology and my 3rd year medicine rotation. I knew the basics of the disease and that the treatment is typically synthroid, but I don't know what would be next if things do not improve. I'm assuming that surgical therapy is typically aimed for poorly responding goiters, which, oddly enough, he does not have. His weight gaining features to me almost look Cushing-like (mild face swelling, significant truncal weight gain.)

Are you familiar with any other treatments for this? How successful are they? I really appreciate any advice- I'm wishing that I did an endocrinology rotation during 4th year now!

thanks,
-f.c.

 

[ckent]

It sounds like your friend is just having difficulty finding the right dosage of synthroid. It can take several months to find the right dosage of synthroid in the beginning. After your friend finds the right dose, he will need to be on synthroid and need regular dosage readjustments for the rest of his life. Since your friend is a guy, he should ask for antibodies to be drawn in him to confirm the diagnosis. There are diseases other then hashimoto's that can elevate TSH in people. It's funny that you should mention cushing's features, because Hashimotos is sometimes associated with adrenal insufficiency, but not hypercortisolism to the best of my knowledge. I've always thought that Hashimoto's was one of the better diseases to have, it doesn't effect your lifespan or your life activities, you just have to take this medicine for the rest of your life. Just make sure that your friend is being followed by an internist or endocrinologist, and not just a family practioner. My friend went to a family practioner for hypothyroid symptoms, and after he found a high TSH, he wanted to look for Grave's disease antibodies in her. 🙄

 

[Foxxy Cleopatra]

Thanks ckent- luckily, he is going to an endocrinologist today. I was baffled by it, because I thought Hashimoto's was like 20:1 ratio female/male, so I was kind of apprehensive about the diagnosis. Plus, like you said, I thought Hashimoto's was associated with adrenal insufficiency (not hypercortisolism) and this poor guy looks like he has been on high doses of prednisone. Though maybe it is just a manifestation of the low thyroid hormone.

Hopefully, if it really ends up being Hashimoto's, the synthroid will eventually work. He has not yet had a biopsy of the thyroid- he said he was diagnosed based on the antibodies found.

Thanks again!

-f.c.

 

[DR]

High TSH would indicate HYPOthyroid.