Autoimmune Thyroiditis: Symptoms, Tests, and Treatment Options

Q: Autoimmune Thyroiditis: Symptoms, Tests, and Treatment Options

It is recommended that you visit a medical center to see an endocrinologist and check for TSH receptor antibodies, as this antibody is related to exophthalmos. <br>Thank you for your inquiry.

Autoimmune Thyroiditis

Hello, Doctor.
I have been tracking thyroid issues for many years.
In November of last year, my tests showed TSH 4.43, Free T4 0.84, and anti-TPO 9295, along with asymmetrical eyes, with the right eye protruding.
I have been experiencing chronic dryness in my eyes, and in November, my eyes were tearing and painful.
An ophthalmologist diagnosed me with dry eye syndrome, but the prescribed drops did not improve my condition.
I even experience pain within the eye socket, especially in the more severely protruding right eye, leading to concerns about possible involvement of the orbit.
I later visited a clinic and would like to confirm whether my thyroid inflammation and eye changes are indeed caused by an autoimmune condition.
What tests should I undergo? Previously, I had some tests done on January 3rd at the hospital, but I do not understand whether the results indicate any abnormalities: CRP 0.14, Rheumatoid Factor <10, C3 130.3, C4 27.3, WBC 7.00, RBC 4.31, Hb 14.1, HCT 41.8, MCV 97.0, MCH 32.7, MCHC 33.7, PLT 250.
Should I see an endocrinologist, or should I also consult a rheumatologist? The clinic prescribed me steroids (Compesolon 5mg, Plaquenil 200mg, Pentop S.R 400mg), and I would like to confirm if these medications are appropriate, especially since I have gastroesophageal reflux disease.
Additionally, what further tests should I undergo to determine if I have an autoimmune disease? Thank you.

Mu Mu, 50~59 year old female. Ask Date: 2023/05/11

Dr. Li Jian reply Internal Medicine

It is recommended that you visit a medical center to see an endocrinologist and check for TSH receptor antibodies, as this antibody is related to exophthalmos.
Thank you for your inquiry.

Reply Date: 2023/05/11

More Info

Autoimmune thyroiditis, commonly known as Hashimoto's thyroiditis, is a chronic autoimmune condition where the immune system attacks the thyroid gland, leading to inflammation and often resulting in hypothyroidism (underactive thyroid). Your symptoms, including fluctuating thyroid hormone levels, eye issues, and dry eyes, suggest that you may indeed be experiencing complications related to this condition.

Symptoms and Diagnosis
The symptoms of autoimmune thyroiditis can vary widely. Common symptoms include fatigue, weight gain, cold intolerance, and depression, but in your case, the eye symptoms are particularly concerning. The presence of proptosis (bulging eyes) and dry eyes can indicate a condition known as Graves' disease, which is another autoimmune disorder affecting the thyroid but typically leads to hyperthyroidism (overactive thyroid). However, it is also possible to have overlapping symptoms from both conditions, especially if you have been diagnosed with thyroiditis.

To confirm the diagnosis, several tests can be performed:
1. Thyroid Function Tests: These include measuring TSH (Thyroid Stimulating Hormone), Free T4, and Free T3 levels. Your TSH level of 4.43 and Free T4 of 0.84 suggest that you may be on the borderline of hypothyroidism.

2. Antibody Tests: High levels of anti-TPO antibodies (as you mentioned, 9295) indicate an autoimmune response against the thyroid. This is a strong marker for Hashimoto's thyroiditis.

3. Imaging Studies: A thyroid ultrasound can help assess the structure of the thyroid gland and identify any nodules or changes consistent with autoimmune thyroiditis.

4. Thyroid Scan: This can help determine how well the thyroid is functioning and whether there are areas of overactivity or underactivity.

Eye Symptoms and Management
The eye symptoms you describe, particularly the pain and dryness, may be related to thyroid eye disease (TED), which is often associated with Graves' disease but can occur in other thyroid conditions as well. It is crucial to have these symptoms evaluated by an ophthalmologist who specializes in thyroid eye disease. They may recommend imaging studies such as a CT scan of the orbits to assess the extent of any inflammation or swelling.

Treatment Options
Regarding your current medications, the use of corticosteroids (like Compesolon) and Plaquenil (hydroxychloroquine) can be appropriate for managing inflammation associated with autoimmune conditions. However, given your history of gastroesophageal reflux disease (GERD), it is essential to monitor for any potential side effects, as corticosteroids can exacerbate GERD symptoms. You should discuss any concerns about these medications with your healthcare provider.

Specialist Referrals
Given the complexity of your symptoms, it would be advisable to consult both an endocrinologist (for your thyroid issues) and a rheumatologist (for the autoimmune aspect). The endocrinologist can help manage your thyroid hormone levels and adjust your treatment as necessary, while the rheumatologist can address any systemic autoimmune issues and help manage your eye symptoms.

Conclusion
In summary, your symptoms and test results suggest a significant autoimmune process affecting your thyroid, possibly leading to both hypothyroidism and thyroid eye disease. It is crucial to have a comprehensive evaluation and management plan that includes both endocrinology and rheumatology specialists. Regular monitoring of your thyroid function and symptoms will be essential in managing your condition effectively. Please ensure you have open communication with your healthcare providers about your symptoms and any concerns regarding your treatment plan.

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