Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
How can you have both hypo and hyperthyroidism
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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How can you have both hypo and hyperthyroidism

I am very confused. I went to an endocrinologist yesterday because I have hypothyroidism. I've had an ultrasound as well as a radioactive scan to look at a goiter. When I went to the doctor, he said he had never seen anything like my results. I have Hashimoto's and Graves Disease. I'm swollen and miserable, but the swelling doesn't go down. No energy! And I have symptoms of both hypo and hyperthyroidism. Have you heard of this, or how it may be treated. My legs are so swollen I look like I have tree trunks on my body and the swelling makes my toes turn blue. I also have PBC and Raynauds's Phen. Lupus, Rheumatoid, and MS have been ruled out. I do have a positive RA and ANA. My TSH was 55 in Jan.,  after 50 mcg of synthroid it was normal (.7 in March)  In June it was 32 and I've been on 100 mcgs since. I have searched the internet for anything. Thank you for your advice.
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There are people who have antibodies for both hashimoto's (TPO and Tg) and Graves (TBII and TSI -- but in graves we also see TPO and Tg) ---- occassionally they swing between hypo and hyper (aka Hashitoxicosis), but so far you have no definite evidence of this (despite the swing in TSH on synthroid).

Most likely the scan showed increase uptake which caused the confusion.  I could be wrong, but my guess is that you were off meds for the scan and had an elevated TSH which would cause a scan/uptake that actually looks like Graves Hyper but it's not.

If this is hashitoxicosis, then I often wait until the patient is hyper off meds and consider I-131 to eliminate the gland's ability to over-produce thyroid hormone.
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