Graves vs. Hashitoxicosis

[powergrrrl29]

I am very confused about what's wrong with me.  I am a runner and noticed about 2 weeks ago that my heart rate was super high when I was running and my resting heart rate was also incredibly high.  I ran a marathon about 5 weeks ago and didn't have any problem.  This is what prompted me to go to the dr.  My primary care suspects hashitoxicosis based on the following labs...TSH 0.01 mIU/L (norm 0.4-4.5), T3 Uptake 34 (norm 22-35%), Thyroxine, free, direct 2.01 ng/dl (norm 0.8-1.8), Thyroid Peroxidase (TPO) 485 IU/ml (norm ), Thyroglobulin AB 28 IU/ml (norm less than 20).  My ultrasound showed a thyroid at the upper limits of normal in size with heterogeneous echogenic texture.  Also, my WBC's are very low 1.7 Thousand/ul (norm 3.8-10.8).
Again the main symptom has been low excercise tolerance....because my heart rate goes through the roof when I try to run or lift weights.   I also found myself feeling short of breath on stairs.  I've have had some other symptoms of hyperthyroidism, but the increased heart rate is what's been bugging me.
I'm just wondering if these are enough tests to diagnose hashitoxicosis.  What about Graves disease?

[powergrrrl29]

Thanks for your advice.  I have an appt with an endocrinologist in 2 weeks.

[Mark Lupo, M.D.]

This sounds like graves which can also have positive TPO antibodies.  Hashitoxicosis is not nearly as common.  In either case, the immune system is attacking your thyroid causing a release of thyroid hormone and hyperthyroidism.  Treatment should be considered -- would work with an endocrinologist to treat hyperthyroidism.

TSI and TBII are additional blood tests that may be helpful.  An I-123 uptake would show elevated iodine uptake in Graves.

[powergrrrl29]

Thanks for the info.  I was thinking the same thing about getting a free T3 because I heard the same thing about the T3 uptake being outdated.  I am being referred to an endocrinologist and I will definitely ask for a TSI and Free T3.  I just started on a beta blocker...I don't really like the way it makes me feel and it doesn't really bring my heart rate down that much.  Maybe the endocrinologist will prescribe anti-thyroid meds.
Interesting that women who excercise a lot come down with graves.  I never knew that.

[GravesGirl]

Hi! It does sound like Graves, but you need a free t-3 test, not uptake. I think that might be outdated. He might be saying hashitoxicosis because of your antibodies. I had these higher than yours at diagnosis and my doc said t-3 toxicosis (early manifestation of Graves) Still don't have an answer to this antibody issue as I dropped my endo last year. He never explained it to me.  Thought at first I had sub acute thyroiditis Five months later he put me on meds..I am still on anti thyroid meds for two years. My Ft4 levels weren't as high as yours either. Mine were like 1.65. The definitive test for Graves is the TSI. Thyroid stimulating immunoglobulins. Mine was 109. Still considered normal but normal people don't have these! I've heard many times of women who exercise a lot coming down with Graves. Some athletes have had it. I would ask for the TSI test and also the FT3 test. I had the same heart issues. Only when I started meds did it get better.Did they put you on a beta blocker? I wasn't put on one cause my bp was too low.