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COVID, Epstein Barr Virus, and Hashimoto’s Thyroiditis

re: Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation
re: Hashimoto’s Thyroiditis
re: auto immune disease

Here follows an anecdotal and personal report on the auto-immune disease Hashimoto’s Thyroiditis, a disease 7X more common in women than men.

I repeat my advice here to anyone who is infected by COVID: minimize physical and other stresses for at least 3 months following recovery from COVID. For athletes who wish to train this will totally suck, but if you’re unlucky after infection like me, it’s a trivial inconvenience in the scope of life. And without any evidence, I would also say the same of COVID vaccination—treat it like a COVID infection.

Following my April 2020 apparent COVID infection which then caused a reactivation* of Epstein Barr Virus and HHV-6 six weeks later, I plunged into an oscillating fatigue cycle following my ascent of White Mountain Peak—could hardly walk 50 feet the next day. I had no inkling of what was to come.

And yet there were warning signs a week prior which I had shrugged off— an inexplicable day of extreme fatigue the day before I did a 5000' ascent + descent hike (felt great!). In retrospect, I ignored warning signs. Don’t be like me—pay close attention to such signs! Back off and take it easy for a good while, if you can.

Maybe the outcome would have changed had I followed my own advice above, but wisdom often is sold at a high price you learn only later—life gives the test, then the lesson. And maybe it would have only deferred the onset.

* Reactivation of viruses is a well-known side-effect of COVID. Epstein Barr Virus is very common (about 95% of adults), and associated with Hashimoto’s Thyroiditis as well as cancer and other issues.

Auto antibodies to thyroid — Thyroid Peroxidase (TPO) test

The chart below shows my history of Thyroid Peroxidase AB (TPO) test results.

My TPO antibody levels first popped up after the onset of fatigue in June 2020 as discussed above, then held fairly steady. No data for 2018 and 2019 and early 2020, when I was still strong.

Dec 31 to Feb 25 2022, TPO level soared by 3.5X, from 250 to 877*.

Free T3: 2.33 pg/mL range 2.3 - 4.2 pg/mL
Free T4: 0.82 ng/dL range 0.59 - 1.61 ng/dL
    TSH: 1.36 uIU/mL range 0.34 - 4.82 uIU/mL
    TPO: 877 IU/mL range 60 or less (was 250 as of 2021-12-31)
    TBG: 16.1 ug/mL rane 12.7-25.1
Ferritin: 68 ng/mL range 20-388
Homocysteine: 8.1 umol/L range 3.7-13.9
Uric acid: 5.5 mg/dL range 2.6-7.2
Sedimentation rate: 2 mm/hr range 0-20.0
PSA: 0.73 ng/mL range 0.00-4.00
Testosterone: 450 ng/dL range 87-780 (2021-12-31)
VitD25-Hydroxy: 26 ng/mL range 20-80 (2021-12-31, no supplementation)

...

There is no known treatment for auto-immune diseases like this; the body sees its own tissues in the thyroid as an invader, and attacks them, taking energy both to attack and to repair, and disrupting normal functions in the process. Hormone levels can be treated but that is only a bandaid over the effects, doing nothing to address the cause. And in my case, the hormone levels are still within range, though barely for T3. Attention to diet matters, but I have been eating only whole unprocessed foods and avoiding gluten and grains for some time.

As I had a pretty good January in gaining fitness and dropping 3 pounds of body fat in 3 weeks, I am guessing that a trigger caused these values to soar in only ~3 weeks. Because it was around early February that fatigue and weakness came on strong again. The exercise? Maybe, but I was feeling better from it, and I find that hard to equate that to Badness. And living in fear of doing exercise that feels good did not seem like a good plan ever, nor does it now.

In early February the fatigue came on strong again, and sleep needs rose again to 12 hours a day, plus resting in the daytime. Having to sleep 10-12 hours a day and then waking up more tired than at bedtime and then having to rest half the waking time is no good for much of anything. A double century is (was) a relaxing picnic by comparison. I had hoped that my 20-month fatigue ordeal would come to and end, but now all signs point to it being permanent. But I am not giving up hope just yet.

Thyroid Peroxidase antibody level (TPO)
Thyroid Peroxidase antibody level (TPO)

Assembly line medicine doctor, 7 weeks prior

I don't think reordering the thyroid peroxidase antibody test gives us any additional clinically useful information. If you are feeling fatigued though we can repeat the TSH test with a reflex to check Free thyroxine if the TSH is abnormal. I think this would be a more useful test. Since the thyroid peroxidase test was already positive it means you could have an increased possibility of developing hypothyroidism in the future. Many individuals also with normal thyroid function can have positive thyroid peroxidase antibodies

WIND: a test value that surges by 3.5X in 7 weeks (probably 3 weeks) is not clinically useful? On the contrary, it shows that my intuition was spot-on. And that it is almost certainly the root cause of the issue. And how can anyone possibly think that a few hormone numbers are all that’s needed to understand a rapidly developing problem in a highly complex biological system? Or that ignoring root cause ever makes any sense? Classic “wait and sick” approach: apply bandaids once the body is broken, while ignoring the underlying issue. Poor reasoning, IMO. Assembly line medicine in action.

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