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Thyroid Problems/Hashimoto's disease + Lichen Sclerosis + breast enlargement?!

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QUESTION: I'm a 44 yr old woman who had a baby just before my 39th birthday. The pregnancy went fine however I did not go into labour naturally, was unable to breastfeed (no significant lactation) & suffered post partum depression. Since the birth of my son, I've gained 40+ pounds & my breasts have increased two cup sizes & they were already large to begin before & during pregnancy. I eat well however admit I don't exercise enough. In addition to the changes after pregnancy, I've been having additional problems over the last 3 yrs, most importantly being; difficulty sleeping, irritability, low libido, dramatic mood swings & extremely itchy anal area. After suffering for the last three years, I finally made an appointment to see my G.P. with a list of my complaints-most of which I determined were hormonally related. My test results came back with high TPO antibody levels but normal thyroid function & the beginning of a slight goiter but besides that, no further suspicious results. I have not seen a dermatologist to confirm the idea that I have Lichen Sclerosis but from what I've researched, this is most likely the problem. I'm wondering if there is a connection between all these issues & if there is any ONE thing I could do in order to relieve my symptoms as I really don't want to take multiple pills/creams. I thank you for your time & response.

ANSWER: Hello M,
Warm welcome to you!
After reading your question I think all your symptoms are because of hypothyroid/hashimoto's condition. Because patients with low thyroid hormone levels do show symptoms like breast enlargement, 'pruritis ani'/itchy anal region, weight gain, increased TPO.

But if the skin in the perineal/ anal region shows visible changes like white patches with/without itching, then you may consider seeing a dermatologist. A dermatologist will most probably be able to recognise it without any lab tests.

But I will be very greatful to you if you could post your thyroid results. Because I have got a doubt after seeing that there is mild goitre but thyroid function is normal!

Anyway if its not Lichen Sclerosus then all your problems should be relieved by taking thyroid supplements. Since Hashimotos has got autoimmune reaction involved and so do Lichen Sclerosus, both may show up in a single patient. But please know that Lichen sclerosus can also happen because of infection.

Take care. Have a great day. Bye.

---------- FOLLOW-UP ----------

QUESTION: Dear Dr. Kulkarni,
Thank you for your response & my apologies for not responding sooner. I'm not really sure what information you need to see precisely but here is the follow up of my most recent blood work which I believe includes the thyroid information you seek (some of it might be in Dutch as I live in the Netherlands however I've translated what I can & I believe the rest should be easy enough to figure out what it means).
BSE: 5
Hemoglobin (Hb): 8.8
Hematocriet (Ht): .42
M.C.V.: 89
Red bloodcell distribution: 11.1
Creatine: 72
Creatine clarification MDRD (GRF): >60
Thyroid stimulating hormone (TSH): 2.6
T4 thyroxine free: 13.7
Ferritin: 136
Iron: 15
Transferrin: 35
Vitamin B12: .3
Immunoglobin E (Ige tot): 30
Paul-Bunnell: NEGATIVE
Multi RAST (Phadiatop) New: N.AANT.
Epstein-Barr (IgG): POSITIVE
Epstein-Barr (IgM): NEGATIVE
Erythrocytes: 4.69
Vitamin D (250H): 40
In my paperwork, it says that my ANTI TPO levels are: 66 out of a range of 0-55. My Anti TSP: 0.4 out of a 0-1 range. Due to the low Vitamin D results, I was given a monthly vitamin D supplement however I know that will not relieve any of my other problems.
I also saw a endocrine specialist to rule out Cushing's Disease as I showed many symptoms associated with that however my results returned a LOW cortisol level-completely unexpected by myself & the doctor. This result put us back to square one. The specialist decided that perhaps my problems were a sign of early menopause however I disagree-there is no history of that in my family & I have no additional symptoms that would justify that diagnosis-menstral cycles, albeit short & light as is the case for the last ten years or so, have always maintained regularity.
I truly believe that my issues stem from some sort of hormonal imbalance which started aproximately ten years ago & has manifested itself in many different ways since then.
Believing me, my GP put me on .025mg of thyrax for a two week trial period to see if my symptoms were relieved any. This only made matters worse however-I became VERY confuses & disoriented. I felt like I was living in a fog. She also had me tested for allergies-no notable results. I also was sent for an echo of my thyroid gland-the results show some small nodules as well as slight goiter.
Getting anyone to take me seriously has been a challenge as it seems most doctors don't like people to "self diagnosis" however I'm a believer that WE know our bodies better than anyone else & would be the first to notice any differences. I'm not at all a hypochondriac nor do I normally take anything more than an mild pain reliever so, to suffer with these symptoms for years without any definitve answers has been difficult for me-I'm really just looking for a "reason" why these things are happening to me & possibly a way to ease the symptoms a bit & most importantly, to help avoid any additional problems in the future.
I look forward to hearing back from you with your thoughts on this subject.
Kind Regards, M

Answer
Hello M,
Nice to see you again!
Sorry for the late response, I was totally busy in hospital duty.
In your lab reports your hemoglobin, ferritin levels are low. So what your doctor has adviced you for that? Are you taking any iron and folic acid tablets? vitamin D is low but not too much.

After reading your mail completely and noting your case history, my probable diagnosis is you may have Hashimoto's Thyroiditis. The patients of Hashimoto often show low hemoglobin level, low vitamin D level, increased TPO antibodies, mood swings, weigth gain, breast enlargement(swelling), low libido etc. But some times its difficult for doctors to diagnose it because the thyroid hormone profile is normal. This is because hashimoto's patients swing between hypo-normal-hyper thyroid states continuously. So they sometimes show hypothyroid symptoms and sometimes hyperthyroid symptoms. This is due to the attack or TPO antibodies on thyroid gland.

So my suggestion is you get your thyroid tests done again after some weeks. And discuss with your doctor whether he knows that Hashimoto patients swing between hypo-hyper.  

What is your doctor's opinion on thyroid nodules and goitre? It could be 'Multinodular Colloid Adenomatous goitre'. It can some times cause deposition of fat on the back. This can be confused with cushing's disease.

I hope that helps.

Take care. Have a great day. Bye.  

Thyroid Problems

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Dr.Shrinidhi Kulkarni

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