Hashimoto symptoms and conditions

I am a 48 year old woman, 5'1" (now 145 pounds). I had Mirena inserted almost exactly 5 years ago, and am scheduled to have it removed in 2 weeks. I gained 25 pounds over the course of the last three years; prior to that, my maximum weight for my whole (non pregnant) life was 123 (I was at 120 when Mirena was inserted, four years after the birth of my second child). I have always been very healthy, never abnormal blood tests except during my two pregnancies was tested as pre-gestational diabetic and had to watch my carbs.

I never put it together with Mirena until just recently, when I started doing research on hypothyroidism after a friend told me that my symptoms could be due to that problem. Depression, hair loss, acne on my back, and the terrible weight gain. I went to see my G.P. who referred me for blood work. I hoped to see evidence of low thyroid function (actual TSH value, 3.12 -- I was told this is normal on a range of .4 to 4.5). I also discovered that I now have high cholesterol (269 triglycerides, 251 total cholesterol, 46 HDL, and 151 LDL). My fasting (14 hours) glucose # is 99 (I was told this is normal on a range of 65-99 mg/dL), and my vitamin D, 25-OH is 21 (also was told this is still normal but low on a range of 20-100 ng/mL). I tried to give blood six months ago, and was turned down because of anemia, so I've been eating a lot of spinach, greens, and more red meat than I normally would, so I was interested to see if I am still anemic -- the red blood cell count is 3.8 (told it was normal on a range of 3.8-5.1 mill/uL). I mention these specific results because although I was told they were normal (except for cholesterol), when I physically went to the doctor's office and requested a copy of the results and did some research online I see that my thyroid IS actually low-functioning -- according to guidelines revised six years ago, anything over 3.0 is considered hypothyroid and should be treated. Plus, isn't a fasting glucose of 99 pretty high? Yet my doctor's only suggestion: diet and exercise. Good grief, I've been on a diet since I had my first child, 13 years ago. True, I don't exercise regularly (I'm a teacher and mom of 2; I never seem to have the me time.) I guess I have an excuse to get a gym membership now.

Also, for the last year I've had increasing pain in my shoulder (I couldn't lay on my side, for example, and lately I can't reach behind me or over my head). An x-ray turned up mild bone degeneration, but not enough to cause the pain I've been having. I was referred to an orthopedist, who today diagnosed a shoulder rotator cuff injury (I've had no injury; he says it is a common degenerative complaint in the over-40 crowd). He gave me a cortisone injection and I'll be on PT for a while to see if the pain goes away. If not, I'll have to have an MRI and surgery to correct the tear.

I'm posting all of this in case it might be useful to someone out there who might be going through the same thing. I had a thyroid test done about six years ago at my OB/GYN, and it was normal then (though I don't have the number; I'll get it in 2 weeks at the OB/GYN). It will be interesting to learn whether my thyroid level has gone up since Mirena. Also, although my research suggests that the effects of these synthetic hormones do not wear off for some time, possibly even years, I will finally feel like there may be hope if my symptoms improve over the next few months when Mirena is gone. If so, I will share it with you.

If you are reading this, perhaps you have a similar story. I wish I had been more aggressive about checking out the possible causes of my many symptoms, but I let them go for years because, I guess, I just figured I'm a healthy woman who is no longer young. (Oh, one more thing: for the first year or even two years that I had Mirena, I had incredibly heavy periods. The blood flow was similar to that during the day or two after the vaginal births of my daughters. Don't know if that's significant, but it took a couple of years for my periods to get fairly normal on Mirena.)

Hello... I started taking Levothyroxine last July for slight hypothyroidism. I felt great for the first 6-7 months, but then in January the problems started for me. I was getting severe anxiety which the doctor said was stress and he also thought I was depressed. I knew I wasn't, but he put me on Ativan and Prozac. The week I took prozac was the worst week of my life. I thought the effects I had were from the prozac, but now I know now it was my thyroid spiking, which the doctor never checked my levels during this period. My heart rate doubled, I had insomnia, was gagging, sick, felt like my body was on speed and wanted to die. I was prescribed a beta blocker for my anxiety previously which I had never taken, but decided to take when my heart was racing, which helped me feel a bit better for the week, but I knew something was wrong. I had this happen again recently for about a week (and I was on nothing but levothyroxine). I know what anxiety is and I have never had anxiety or depression my whole life until these episodes that happen when taking this medication. By the time I went to the doctor to get labs done, I had been feeling a bit better and he said my levels were fine. I am now wondering if it's side effects from the meds or if it is spikes in my levels making me hyperthyroid instead. All I know is that I cannot live like this!! I have a 3 yr old and I need to be happy and healthy like I used to be before this medication... no more heart racing, racing thoughts, anxiety, and insomnia. Please help!!

My entire life I've been very sickly many doctors thought thyroid but I guess my numbers always came back normal and test never lie right... My levels were finally abnormal at age 21 and I was diagnoised with Hashimoto's Thyroiditis last week. Just started Synthroid right away and my breathing is better then it has been in a few years. Doctors had no idea why my breathing was so horrible in the first place since I only have mild asthma. They just heard the wheezing in my throat and in my chest and knew something was wrong. They knew I needed an amount of breathing medication that was pretty much killing me and the E.R gave me even more then I'd take at home. Only a week of being on synthroid I'm now only taking what a severe asthmatic would take daily. Thats going to be like 100 vials less then what I was on by the end of the month!!! I don't know if I will stay on Synthroid because of the side effects I'm having that maybe I won't have on another type of medicine. We'll see I guess. But I Thank god for Synthroid without it I wouldn't be here right now. We had no idea it would even do anything for my breathing...I wasn't even prescribed it for that. I've learned now though to do my own research because doctors don't know it all especially General Doctors. Sometimes it's correct to raise the dose to get past the hyper swings of hypo sometimes it's an overdoes causing it....it's crazy. Anyway I wish all others with thyroid problems good luck your not alone.

I'm 23 years old and had the Mirena put in 6 weeks after our first daughter was born. The first 2 weeks of having it were fine... other than a little struggle implanting it all was going well. Exactly at the 2 week mark I wound up in the ER with what I thought were a bladder infection, hemorrhoids, and swollen lymph nodes in my hip-flexors. Now none of this has been linked to the Mirena, so it could be a fluke, but none of the doctors could figure anything out! My urine sample was clean, my pap was normal, they couldn't find hemorrhoids, and it was a frustrating un-diagnosis. The doc sent me home with pain meds and a local numbing cream, but using the bathroom hurt so bad I had to bite down on a towel to pee! Taking a poop... HA... I've been putting it off for days because I feel like my rectum will tear open! Has anyone else had any of these things? Maybe I'm just ill with a strange disease, but this site has me curious if it isn't the Mirena!

I am a female and was diagnosed with Hashimoto's three years ago (looking at old childhood photos I've probably had this all my life) and have taken Levoxyl and Synthroid in escalating doses over time. Initially 25mcg for about a year and that was the endo plan until bloodwork indicated a need for more. I quit taking it after a year as it seemed I was gaining weight. After a few months went to a different endo and he started the treatment again with 25 (I weighed 160 at the time) and now has worked it to 100mcg (I now weigh 178!!!). I thought that with the higher dose I would have more of a weight loss effect (definitely not weight gain) and thought I'd have more energy, better brain function and happier outlook. I am experiencing the complete opposite. The last time I visited the endo and he looked at my weight gain he just said to "stop it". I work out almost every day for 45 minutes to 2 hours, have a job that at times requires arduous work, I eat a very healthy diet full of fiber, low in fat, low in carbs. I'm always hungry and feel like eating to make up for a lack of energy. I come home from work exhausted. This isn't living. I've had it with the Synthroid and any form of T-4 alone. I'm going to see a natural healthcare professional to try Armour because none of the medical doctors I've seen will prescribe it or synthetic T-3.

My mother and I have both been diagnosed with Hashimoto's Thyroiditis and we both take levothyroxine. We both experience extreme pain and she has been diagnosed with fibromyalgia. I have not been diagnosed with fibromyalgia but I experience the pain body also. Another thing. I have been losing my hair. No reason, it's falling out from the root and I have some serious thinning. Memory...what memory. I can't remember anything. Has anyone received advise from a MD? Thanks

I suggest to anyone that has Hashimoto's Thyroiditis (type of Hypothyroidism) to have a blood test done for Celiac Disease. There has been research done linking Celiac Disease and Hashimoto's Thyroiditis. Celiac Disease can be controlled by a gluten-free diet (wheat, rye, and barley free). In the US, not many doctors recognize/know of this link. I have been hypothyroid for 20 years (had Hodgkin's Disease (cancer) - radiation/chemo at age 16) I have 2 sisters with Hashimoto's Thyroiditis and were iron and B12 deficient. I was diagnosed with Hashimoto's Thyroiditis 3 months ago with iron and B12 deficiency. I have been on a gluten-free diet for 2 months now. My dosage of synthroid (levothyroxine) was 175 mcg and now is down to 137 mcg. I hope that I am one of the lucky ones that will have their antibodies to their thyroid normalized (no more synthroid!) I have a couple of days left before my next blood test and I hope that it goes down more. I am feeling better now than I have in a very long time. I have attached a link for those of you interested. It is an endocrine article from Finland outling the link between Celiac Disease and Hashimoto's Thyroiditis (among other things). I hope that this helps some of you. http://edrv.endojournals.org/cgi/content/full/23/4/464

I have been on synthroid for about 6 months now. Some of the side effects I have been experiencing are numerous.I have hair loss, sometimes I get so ill that no one can stand to be around me, my weight has gone up about 30 pounds, my cholesterol levels went sky high so now I'm taking Crestor, I'm bloated most times, I have episodes where my face flushes and gets so red that it feels like its on fire, and now I've just started experiencing burning and aching of the legs, I'm tired a lot too! My doctor said I would lose the weight but every time I go for check ups and get on the scale it just keeps going up. I would like to know if anyone else out there is experiencing the burning and achy legs because I have been tested for everything and they can't find out what is going on. They of course say it's not the medication.It seems to never be. Does anyone feel me??

Fluoroquinolones interfere with thyroid hormones. IMany of us (from another site) have found that we have Hashimoto's, which is that our autoimmune systems are attacking our thyroids. Also, there's a possibility that your adrenals are shot too. Now that I am on Armour (pig thyroid) all of the horrible tendon issues, anxiety, fibromyalgia and chronic-fatigue-like symptoms have abated. I am walking long distances again. Suggest that you all have these tests done: FREE T3, FREE T4, and thyroid antibodies test in addition to the TSH test that they will always do. Also, be aware that your TSH test score should NOT be above 2.0. Your docs will erroneously insist that anything under 5.0 is ok. WRONG. My scores were in the 3's before being floxed and in the 4's after. I also take tiny amounts of Cortef for my adrenal fatigue.

hello everyone
i am a full time college student and I believe that i have some side effects from synthroid. As i was reading everyones blog i notice that some people feel the same way that i do. At times i feel that i'm normal but if something upsetting happens i get really tired, depress, and I have a never time concentrating at school and home. My body hurts all the time. especially my joints and i feel that i don't want to do anything. I have about a year left until i graduate and its the going to be hard. I cry sometimes for no reason. help! i'm going to talk to my doctor but if any body else feels the same way please reply.

I was prescribed 25 MCG tabs of levothyroxine (generic for Levoxyl) by my MD for my hypothyroid. (I was tested at a 4.5 reading -- just below a normal 5 reading). After 60 days of taking levothyroxine EXACTLY as prescribed (i.e.; on an empty stomach, 1st thing in the morning with a glass of water; no vitamins for at least 4 hrs afterward), I started to have symptoms that I've never experienced before: my hands began hurting so bad with joint pain; my lips felt numb; and I was sweating more than I ever had in my life. I decided to stop taking the medication due to these symptoms, and in about 7-10 days from stopping, ALL these symptoms had disappeared and have not returned to date. I relayed this information to my MD who told me that my symptoms had nothing to do with Levothyroxine and that I needed to continue taking the drug. It's more than strange to me how some MDs will not listen to his/her patient -- even more so now that I've read other info on the internet where many other people have had these same side effects taking levothyroxine!! On my own, I am now looking into taking an all natural alternative that I found on wellness resources called "Thyroid helper". I will not take Levothyroxine again if I can avoid it by taking an alternative. Has anyone else out there had success taking "Thyroid Helper"?

I am so glad I found this site. I have been experiencing severe joint pain and constant edema. I never even thought it could possibly be the toprol xl 50 mg I have been on for over a year now. I have had extensive blood work to find out why I have such joint pain and everything has been coming out normal! I am in pain EVERY day...and it has been getting worse. I do have a thyroid condition (which was also recently checked and all the blood work was fine), because I got terrible joint pain as a symptom of Hashimoto's thyroiditis (an auto-immune disorder) way back in 1999 when I was first diagnosed. So, when this terrible joint pain returned, I was sure it was the thyroid and that my medication for THAT would have to be adjusted. Needless to say, I was shocked and concerned that my thyroid numbers are all normal.
I cried today over this pain...I am only 44 years old and I feel like I'm 90 years old. Maybe fate led me here tonight. It may or may not be the toprol causing all of this pain, but at least I have some hope now. I am scared because since I do have an "auto-immune" disease, I am apparantly at a much higher risk of developing other auto-immune diseases....so perhaps it is not the toprol. I HOPE IT IS THOUGH...

Hi bitter RN!! Hope you read my last posts... (I fear they were displaced in the meantime to site 2 or 3).

Just had a phone talk with my doc's office. They didn't tell me every result of the bloodwork but I asked them especially for those here:

TSH (Thyroid) 4,1 (!!) --> the highest it has ever been...

Transferrin: 340 (within the normal range but at the upper end of them; so it seems to be a bit high, which could show, that my iron storages are a bit low........

Iron: 76 (which is also still within the normal range but at the lower end of the normal ranges!!)

I have an appointment with my doc to talk about all the results on tuesday next week in the afternoon...

I hope they can finally help me somehow.......

Flowerbabies:

As you told, you have hashimoto's... do you know or could you tell me, how your TSH is??

Thank you both in advance!!

Best wishes
Silke

Hi there. I take 88 mcg of levoxyl and since being on it I have this desire to constantly eat food. I eat when I am not hungry and when I am already full. I do not sleep well anymore and wake up often in the night. I am extremely depressed and very emotional. I think I was better off when I wasn't taking medication. I tried to take my body off of it, and I felt very weak. I was recently diagnosed with Hashimoto's disease and I am scared that eventually i will lose my thyroid. Has anyone else felt like this?

hi sophie,
sorry to hear you are still suffering so badly,were you on yasmin for long? i was on it for 1.5 years and have been off now for nearly 6 months like you. i think it depends how long you took yasmin and how badly messed up your hormones have become. i'm not sure if i have replied to you before (i think i have ) have you had your thyroid checked? i ask this question of most people who are still feeling bad. your thyroid levels (tsh) should be in between 0.3 - 3.0 .most people feel best around 1 - 1.5. my thyroid was out of whack whilst on yasmin so i had a dose increase (i have hashimoto's) when i had my test 1 month ago it showed that i needed my dose reduced again so bcp's definately can effect thyroid function. thyroxine is afterall a hormone so it is quite likely that it has been effected too. Your periods could be an indication that all is not right with the thyroid. underactive tends to cause depressive feelings,muscle pain and heavy periods and also headaches. yours may be fine but it is worth ruling it out. the previous poster recomended prozac..i know nothing about it or any other anti-depressants as i never took them (apart from a short time on diazepam for my anxiety/panic attacks) but as she says if you are still not finding any relief from your symptoms it might be a route to consider (do rule out the thyroid 1st though). i read many helpful books that helped me learn to handle my anxiety/panic attacks and that has done wonders for me,even if i have a few bad days i KNOW they will get better and i just use what i have learned to work through it,it's not easy, some times are worse than others but i know i am getting better slowly. i hope this will be the case for you and that you will start to see some improvement in your symptoms. with regards to your periods it may be a sign that they are trying to regulate themselves again.mine were 28 days for the 1st 2 cycles but now can be anything up to 38 days apart and are so light they are gone within a day or 2. my periods were always regular as clockwork before i went on yasmin. even after i had my last child and breastfed for a year. as soon as i stopped feeding her my periods came back at 28 days on the dot,then i started taking this rubbish.

best wishes to you sophie.

sarah

hi silke,
i'm so glad to hear that you still look in on us everyday,i think yours were some of the earliest post i came across on this site and you seemed to be the one to ask all the questions. i am glad that your cycles are beginning to return,i am also 32,mine came back at 28 days for the 1st to post yasmin cycles but now can be anywhere between 32 and 40 days (pre yasmin you could have set your watch by my cycles,i was 28 days without fail and always between 5 and 6 o'clock in the evening!) when you mentioned the anti anxiety drugs making you worse that really struck a cord with me,i was on diazepam for about 2 months and they were among my worst times,i never realised that they could have made me worse,i had really scary vivid dreams on it,i stopped taking diazepam and i started improve a little,when i stopped taking the yasmin too i improved a lot! like you ,silke, i am still suffering the mid cycle anxiety although not at extreme levels like on yasmin,i also have monthly cystic acne and hair loss,while all these things are upsetting they are preferable to the yasmin nightmare symptoms. talking of thyroids,i have an underactive thyroid (hashimoto's) and whilst on yasmin i became more hypothyroid and had to have my dose doubled! now i have been off yasmin for 6 months my levels have come down again so i have now had my dose reduced to avoid becaoming hyperthyroid. i still take the b-complex and b6 as well as magnesium and zinc but like you i have also stayed off all kinds of medication to treat the symtoms that yasmin caused. one of my doctors even suggested going back on the pill to sort out my hormone chaos (good way to describe it silke!) i won't tell you what my response was to that,but be assure my doctor got the message that i will not be putting that rubbish in my body ever again! i will let my body heal itself and let nature do it's thing from now on,i am through messing with my hormones,if i had found this site sooner i never would have let my doctor put me on yasmin in the 1st place,he sold it as the new wonder pill to cure acne,water retention and would help me loose my baby weight...ha! i would rather be fat,spotty and bloated than a skinny ,mental & physical wreck! just out of interest silke how did the b-complex make you feel worse? i take it everday and have not had any problems that i know of but it is useful to know what the symptoms were just in case!
best wishes to you silke

sarah

The chronicles of my nightmare:

First of all.... I have been on Yasmin about 3 years... I have been batttles for "3 YEARS" with being dizzy, fatigue, vaginal dryness, chronic yeast infections, chronic discharge, mood swings, panic attacks, anger issues, anxiety and stress, trouble sleeping at night, loss in sexual desire, depression, constint fluctuations in my weight (I swing 13 pounds), and gastrointestinal problems.... I have been to every doctor and tried every medication known to man.... (Well almost).... I started testing for thyroid disease cuz my mother has grave's disease... At first I test for hyper (Got put on meds), then went to hypo, then they thought it was hashimoto's thyroid disease, until I tested back to normal and have been normal for about 2 years now even though I have been feel all wacked out. But, during this wholefiasco I had been making regular visits to my OBGYN to see why I am in so much pain from sex and why I have cronic yeast infections.. (Visited two to three times a month to be exact)... I've takin dyflucan (yeast infection pill)... no less than 24 times... Never helping me, so I became immune to that, then we trying creams, which gave me an even worse yeast infection, then we tried a homopathic approach ("biotic acid sappasitories")... Which made me so inflamed and in pain tha I have had the same irritaion/ yeast infection for the past 6 months.... Where no one could help me and the most the Gyno could tell me to do was don't have sex or use tampons for a whole month, which I did... and it didn't help one bit... I tried everything from eating large amounts of yogurt (Which is quite painful cuz Im lactosintolerant).... I tried not shaving my gential area, shaving my genital area, changing body wash, changing detergent, not having sex, and changing lube.. Literally have tried everything... Then, they start sending me to different doctors.. They want to send me to an internal medicine doctor which told me the route of my problems was sleep and that would make everything better... SO, he gave me Xanax.. Which turned out to make me very angry, verbally abusive, and still could not get a good nights rest... Then, he told me I have to go to a physiatrist... Which I am still waiting on to see next month.... I thought all was lost and I would permanently be in pain forever until I thought I would give the practice of gynocology one more chance. Before my visit I decide to do some research on the one medicaton I take..."YASMIN".... I came to this very site and the testimonials blew me away. The side effects that many women were complaining about, were the same exact things that I was going through. I read every single page and went off to a new gyno doctor to explain my situation. She was the best doctor I have ever had.... She immediately said stop taking birth control! She also recommended taking a large about of vitiamins ( like calcium, vit. B complete, and vit. c)... She also said to take warm salt and olive oil baths to overall bring back the nature anatomy of my vagina. She also could'nt stress enough.... DON'T SHAVE! She said that the hair is there for a reason and shaving brings all sort of bacterialinto the fragile vagina... On other thing she said was to use a condom made out of something else, not rubber, latex, or goat skin... I forget what it's called... So, now that I have the knowledge from the doctor and this web site, hopefully my nightmare wll be over soon... I finish my birth control pack in a matter of days and I can't wait to start feeling better after 3 years!!!!!! I never knew that something as simple as a little pill can turn your life upside down and have your dragging for years.... Thank you so much ladies for all your help.... I really could have never found this out without you guys.... I hope I helped someone out there with my story... Has anyone else experienced this kind of horrific nightmare?

After taking Levoxyl, I am no longer fatigued, decreased vegetative symptoms of depression that go with lethargy, however, I came to this site as I have noticed memory problems, despite all other symptoms being relieved from Hashimoto's Thyroiditis.

I have Hashimoto's thyroiditis. Since I started taking Levoxyl I am no longer fatigued or cold. My TSH levels stay between 2 and 3. However, I seem to be having memory problems that are getting worse. Also I have pain in my hands and feet and sometimes wrists and ankles. I have been tested for everything in the world and they have found nothing. I did not have this pain before the levoxyl, so I assume it is a side effect.

My 16 year old son has been on prednisone for 7 years for Hashimoto's Thyroiditis, Asthma, and Idiopathic Angio-Edema (deep tissue swelling/hives) with Chronic Uriticaria (Hives). He started on massive doses but in the last year decreased to 10mg every other day. 3 weeks ago we discovered he has developed scoliosis due to the long term use of prednisone. They tapered him off in 2 weeks. Now 1 week later he is having a type of withdrawl from it... weakness and no energy, nausea and headaches. He is never allowed to take prednisone again, and now the doctors are talking about putting him on cyclosporine. Has anyone experienced this too?

Good God! What does all of this mean?! Is ANYBODY paying any attention to this, or do we all need to get together and petition the FDA?

Just the fact that presumably all of these folk writing in were in enough pain and turmoil to seek answers through the internet speaks volumes, doesn't it?

Anyhow, let me add my two cents' worth: I'm living in Greece so taking a European version of synthetic T4 (called, creatively enough, "T4"!) (Novartis is the manufacturer) and I'm finally so screwed up and concerned that I'm looking here there and everywhere else for answers. I was a pretty damned healthy 40-ish woman and suddenly I feel, as so many others have said, 100 years old ...

FYI, I'm on the lowest dose available, i.e. 50 mg/day. In the beginning I felt better because my periodic feelings of extreme fatigue went away, but the heart problems are making me a nervous, frightened wreck! I begin to prefer just plain ol' Hashimoto's thyroiditis with a slow dip toward hypothyroidism rather than this nonsense. At least then I didn't feel like I was on death's door!

The mail from the woman who woke up with pounding, racing heart struck me the most, as it's the pulsating and skipped beats and the rest that are driving me to distraction. I've worn a holter monitor for 24 hours and discovered that I "only" now have tachycardia, but suddenly I'm on TWO meds for the rest of my life (when I was never on any previously, short of a tylenol for an occasional headache ... quite a change, and not a very welcome one!) one for HEART problems! AND I'm still relatively young AND I now officially feel like s**t?!

Amazing, all of this. Drug companies pleasing their stockholders while a huge number of us go slowly crazy?

Would appreciate it if people who've succesfully gone off synthetic T4 would write and tell me their stories, particularly their experience with the Armour alternative (not that I know if it's available over here, but at this point, I'd happily fly over to the States a couple times a year to get it if it would end this misery!!)

Thanks to all and COURAGE!

I am a 19yr old female athlete w/Hashimoto's. When .1synthroid did not seem to be controlling my hypothyroid symptoms (hair loss, wt gain, fatigue), my dr. tried 5mcg of Cytomel twice/day. At first I didn't notice much of a change...slowly side effects appeared. I developed rashes and itchy hands, especially after exercise...finally got heart palpitations and ended up in the hospital with anaphalactic shock (probably due to these effects combined with mono -undiagnosed at the time). I am now off of Cytomel, and dr is changing me from Synthroid to Levoxyl thinking that I might have an allergic reaction to something in the Synthroid also, as I have been breaking out in hives after exercise,since I started taking it. Has anyone else experienced these symptoms? Anyone had success with Levoxyl? VERY FRUSTRATED!!!

Allergic reaction with Hashimoto's