Celiac testing and thyroid questions

[Guest guest]

Hi AllPatient is a 51 yo female who presented with long standing hypothyroidism, had never had her antibodies checked and had been on synthroid.  Since a bout with the flu in April she had extreme fatigue and muscle aches.  Switching from synthroid to armour made a small difference in her fatigue, but muscle aches persisted.  I saw her for the first time one month ago and suggested she eliminate gluten (among other recommendations) and see her MD for some labs.  (I'm in an unlicensed state)

She came back in yesterday and feels so much better already.  She's back to exercising and has no more muscle aches to speak of.Pertinent results:Low positive ANANegative RFPositive Thyroperoxidase Ab

Positive anti gliadin antibodiesNegative anti-enodomysial antibodiesNegative Western blot (for Lyme)She was told by her endocrinologist's staff person that she " has celiac disease " .  I explained to her that she would need further testing to determine if that were indeed the case and that her current test results indicate gluten intolerance. (I requested tissue-transglutaminase but they did not order it).  Her niece has frank celiac disease, so I recommended the genetic marker test (if she wants to know).  Having explained that she needs to avoid gluten no matter what, and that is the treatment for celiac, does she need to see a gastroenterologist for further testing?  Also, does she need to be taken off of Armour and switched back to synthroid (for the time being)...to avoid increasing her thyroperoxidase antibodies?  What is the standard when screening for thyroid antibodies anyway??  I thought it was anti-thyroglobulin and anti-TPO, but this endocrinologist ran " thyroid stimulating immunoglobulin " ...is this a moniker for something else?

thanks for your thoughts-- NDNorth field, RI

[Guest guest]

Hi ,

I am not totally sure and hope someone else chimes in. What I can see is that

she has hashi's with the positive TPO, gluten sensitity and likely leaky gut

with the positive antigliadin. Synthroid vs armour or naturethroid is very

individual and not set in stone. But since there is hashi's and possibly

celiacs, it is now an immune, not a thyroid issue.

It sounds like the endo also ran the test for graves. Not sure.

And I use Cryex labs now for all gluten, leaky gut and cross-reactive food

testing. They are superior. Though, the saliva screening test seems to be

inadequate.

BTW, most labs dont run lyme correctly or often miss it, as you likely know. Dr

Green out here in Redwood City does much more extensive testing if SSX are

there. She is the national expert now, I think.

Brad West, ND

Nor Cal

>

> Hi All

>

> Patient is a 51 yo female who presented with long standing hypothyroidism,

> had never had her antibodies checked and had been on synthroid. Since a

> bout with the flu in April she had extreme fatigue and muscle aches.

> Switching from synthroid to armour made a small difference in her fatigue,

> but muscle aches persisted. I saw her for the first time one month ago and

> suggested she eliminate gluten (among other recommendations) and see her MD

> for some labs. (I'm in an unlicensed state)

>

> She came back in yesterday and feels so much better already. She's back to

> exercising and has no more muscle aches to speak of.

>

> Pertinent results:

> Low positive ANA

> Negative RF

> Positive Thyroperoxidase Ab

> Positive anti gliadin antibodies

> Negative anti-enodomysial antibodies

> Negative Western blot (for Lyme)

>

> She was told by her endocrinologist's staff person that she " has celiac

> disease " . I explained to her that she would need further testing to

> determine if that were indeed the case and that her current test results

> indicate gluten intolerance. (I requested tissue-transglutaminase but they

> did not order it). Her niece has frank celiac disease, so I recommended the

> genetic marker test (if she wants to know). Having explained that she needs

> to avoid gluten no matter what, and that is the treatment for celiac, does

> she need to see a gastroenterologist for further testing? Also, does she

> need to be taken off of Armour and switched back to synthroid (for the time

> being)...to avoid increasing her thyroperoxidase antibodies? What is the

> standard when screening for thyroid antibodies anyway?? I thought it was

> anti-thyroglobulin and anti-TPO, but this endocrinologist ran " thyroid

> stimulating immunoglobulin " ...is this a moniker for something else?

>

> thanks for your thoughts

>

> --

> ND

> North field, RI

>

>

[Guest guest]

Hi ,I just finished taking Datis Kharrazian's Mastering the Thyroid seminar with Apex Energetics last weekend. (www.thyroid360.com is his website)My responses to your questions are based off of what I learned at this seminar. It complements quite well with Dr. Thom's Autoimmune seminar.A) Having explained that she needs to avoid gluten no matter what, and that is the treatment for celiac, does she need to see a gastroenterologist for further testing?-It seems the choice is hers - depending on the degree of information she wants/needs.-If she does not need the confirmation of the tissue biopsy to say she officially has or does not have Celiac Disease, and you and she are aware that it is not going to change the treatment plan, then it seems that the invasive procedure is unnecessary-If she wants to have that concrete information from the tissue biopsy, then it makes sense to refer to the gastroenterologist. Does she need to be taken off of Armour and switched back to Synthroid (for the time being)...to avoid increasing her thyroperoxidase antibodies?-Armour (bioidentical fixed ratio of T3 and T4 combination)-Synthroid (synthetic T4)-Some components of Sythroid which have the potential to be problematic for some patients - which may be the case for your patient, at least in regard to the confectioner sugar: 1) Confectioner's sugar which has corn starch in it. Datis explained that in Hashimoto's patients who are gluten-sensitive (most, if not all) or have Celiac disease, this corn starch can be a source of sensitivity2) Acacia, which is a Th2 stimulator and may cause an immune response in Hashimoto's patients who are TH2 dominant3) Lactose, which also is a common sensitivity for patients - especially gluten sensitive ones due to cross-reactivity with casein-Datis said the biggest clue that there is a filler medication problem if when the patient has a break (whether accidental or intentional) from the medication and feels better-I do not think this patient needs to switch back to Synthroid, based on the noted improvement of some of the symptoms. I would not worry about increasing the TPO Abs, as much as continuing to modulate her autoimmune response. Gluten free diet is a huge huge start. -Based on her imrpoved response to Armour, it seems like she has a conversion problem (unable/insufficient conversion of T4 --> T3). If she did, her labs may show elevated reverse T3, and possible high Total T4, low TT3 and FT3. -Treatment Datis recommended in order to address Conversion problems:Find the stress and inflammation sources and address these.Support glutathione.If the only abnormal labs are Elevated reverse T3 with High total T4, Low TT3 and Low FT3, no thyroid replacement is needed. (Obviously, this is not the case for your patient, who has positive Abs.)A conversion problem is not a problem at the level of the thyroid. Treatment Datis recommended to address autoimmune thyroid problems:Find the triggers for that patient and have her avoid them. (What makes your symptoms worse?) Address blood sugar imbalances (many patients are insulin resistant or hypoglycemic - both of these processes cause insulin surges which greatly impact the autoimmune process)Avoid gluten to remove gluten's cross-reactivity with the thyroid hormone and reduce the inflammatory load. (Cross-reactivity is when two substances have an identical 3 amino acid sequence, and then cross react.) Consider avoiding other foods that commonly cross-react with gluten - such as casein. Avoid supplements/ food that contain gluten, intrinsic factor, and other ingredients that may be amplifying the patient's immune responseModulate the autoimmunity: The specifics on this are complicated. Some ways include increasing Th3 cellular activity, supplementing vitamin D, and a diet for leaky gut. Datis showed that leaky gut occurs in Hashimoto's because of the pathophysiology of the disease, not solely due to GI inflammation.Datis explained that after the autoimmunity is addressed, look for other tissues that have been attacked and support them. Often it is the brain, but may include muscle, skin, GI, pancreas, reproductive organs, etc. He explained that based on research and clinical observation, when a patient develops Hashimoto's thyroiditis - they are often susceptible to developing other autoimmune tissue reactions and diseases. One of the reasons for this is because multiple tissue antibodies develop in many Hashimoto's patients. For example, cerebellum and myelin Abs affecting brain function, parietal cell Abs affecting GI absorption, etc. , your patient may have developed muscle Abs - based on where she is experiencing the symptoms. C) What is the standard when screening for thyroid antibodies anyway?? I thought it was anti-thyroglobulin and anti-TPO, but this endocrinologist ran "thyroid stimulating immunoglobulin"...is this a moniker for something else?-All three thyroid Abs are often run - anti-thyroglobulin, anti-TPO, and Thyroid Stimulating Immunoglobulin (TSI)-When TSI is positive - 80% of the time it is due to Grave's, 20% of the time it is due to Hashimoto's.-As a side note, with positive TSI, Low TSH, and hyperthyroid symptoms (whether it is Grave's or Hashimoto's) - Datis recommended getting an endocrinologist involved (due to stroke risk)-Below is a more detailed summary of interpreting lab results in regards to thyroid Abs, TSH, and symptoms:High TSH, hypothyroid and/or hyperthyroid sxs, no thyroid Abs --> may in fact be Hashimoto's thyroiditis (Ab levels fluctuate, and at that 'snapshot' of the blood - they were not visible); other less common possibilities may be iodine deficiency hypothyroidism and goitrogenic influenced hypothyroidismHigh TSH, hypothyroid and/or hyperthyroid sxs, and thyroid Abs --> picture perfect Hashimoto's thyroiditisNormal TSH, hypothyroid/hyperthyroid sxs, (+) TPO Ab --> Hashimoto's auto-immune reaction (patient has developed the self-Abs to the thyroid; the thyroid tissue has not been attacked enough to cause a lowering of TSH; without intervention, the patient will continue on to develop Hashimoto's thyroiditis)Low TSH, hyperthyroid sxs, (+) TPO Abs and/or (+) thyroglobulin Abs --> Hashimoto's thyroiditis in a hyperthyroid state (in Hyper state, consider getting a referral such as endocrinologist involved dt stroke risk)Low TSH, hyperthyroid sxs, (+) TSI (TSH Receptor) Abs --> (+) TSI Abs is Grave's disease 80% of the time, Hashimoto's 20% of the time (URGENT referral dt stroke risk)I hope this information was helpful.Say hi to Li'l Rhodey for me. :)Take care,MarcyMarcy Feibelman, NDPortland, ORAnd the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom. -Anais Nin Keep a green tree in your heart and perhaps a songbird will come. — Chinese proverbP Celiac testing and thyroid questionsPosted by: "" drcp10101@... CP10101Thu Oct 27, 2011 9:19 am (PDT)Hi AllPatient is a 51 yo female who presented with long standing hypothyroidism,had never had her antibodies checked and had been on synthroid. Since about with the flu in April she had extreme fatigue and muscle aches.Switching from synthroid to armour made a small difference in her fatigue,but muscle aches persisted. I saw her for the first time one month ago andsuggested she eliminate gluten (among other recommendations) and see her MDfor some labs. (I'm in an unlicensed state)She came back in yesterday and feels so much better already. She's back toexercising and has no more muscle aches to speak of.Pertinent results:Low positive ANANegative RFPositive Thyroperoxidase AbPositive anti gliadin antibodiesNegative anti-enodomysial antibodiesNegative Western blot (for Lyme)She was told by her endocrinologist's staff person that she "has celiacdisease". I explained to her that she would need further testing todetermine if that were indeed the case and that her current test resultsindicate gluten intolerance. (I requested tissue-transglutaminase but theydid not order it). Her niece has frank celiac disease, so I recommended thegenetic marker test (if she wants to know). Having explained that she needsto avoid gluten no matter what, and that is the treatment for celiac, doesshe need to see a gastroenterologist for further testing? Also, does sheneed to be taken off of Armour and switched back to synthroid (for the timebeing)...to avoid increasing her thyroperoxidase antibodies? What is thestandard when screening for thyroid antibodies anyway?? I thought it wasanti-thyroglobulin and anti-TPO, but this endocrinologist ran "thyroidstimulating immunoglobulin"...is this a moniker for something else?thanks for your thoughts-- NDNorth field, RIBack to topReply to sender | Reply to group | Reply via web post Messages in this topic (1)RECENT ACTIVITYVisit Your GroupMeditation andLovingkindnessA Yahoo! Groupto share and learn.Sell OnlineStart selling withour award-winninge-commerce tools.Yahoo! HealthAsthma TriggersHow you canidentify them.Need to Reply?Click one of the "Reply" links to respond to a specific message in the Daily Digest.Create New Topic | Visit Your Group on the WebMessages | Files | Photos | Links | Database | Polls | Members | CalendarMARKETPLACEStay on top of your group activity without leaving the page you're on - Get the Yahoo! Toolbar now. Change settings via the Web (Yahoo! ID required) Change settings via email: Switch delivery to Individual | Switch format to Traditional Visit Your Group | Yahoo! 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