Graves/Hashi's

[Kelly091903]

Hi....I'm new here. I have some questions that I really would like some feedback on.  I'll start with my background.  I've have a history of depression and anxiety.  4 years ago, a doctor tested me for Hashi's antibodies and it came back positive; however, I wasn't experiencing any "thyroid" symptoms (besides the emotional issues), so she said to just see what happened in the future. Even though I had the antibodies, my TSH and T4/T3 were all within range.  Over the past two years, I've become symptomatic (lethargy, anxiety, depression, tired, weight gain/loss, no sex drive, loss of memory, extreme extended menses, irritability, headache, brain fog, etc.).  I went to the gyno for the heavy periods, and she sent me for an ultrasound of my thyroid.  She said that she felt goiter.  The ultrasound revealed gointer and nodule.  She then sent me to an endo.  Endo did an RAU iodine test.  The test came back hot all over.  She told me that I had Graves.....based on those results and the goiter.  Then she looked at my TSH and T4/T3 (both of which were normal).  I explained about the previous Hashi's diagnosis (because, honestly.....it had slipped my mind).  So she sent me out or more labs.  The results came back as follows:

TSH            1.4
FREE T4    1.0
FREE T3     2.79

ANTI-TPO   115.8 VH
Thyroglobulin  >3000

So....I'm concerned with these results.  My interpretation is that the thyroid levels are "normal", right; however, the antibody levels are high.  Add to this the goiter, nodule, and hot (overall the entire thyroid) Radioactive Iodine Uptake Test, and I think I have some real issues.  Does anyone have any advice on what my options are, and what I should be doing.  I'm not sure the endo wants to do anything right now, since the thyroid levels are "normal".  I believe she wants to wait until the levels are abnormal, and then treat.  I think this is strange, because I feel like crap now and don't understand why we have to wait until I feel even worse before we do something about it.  ANY advice would be greatly appreciated!

Thanks,

Kelly

[goolarra]

First your current labs:  FT4 is at only 20% of range.  Many of us find that it has to be around 50% before our hypo symptoms are relieved.  Your FT3 is at 26% of range, and many of us aren't comfortable until FT3 is in the upper third (67%+).  So, it's no wonder you are having hypo symptoms.

TPOab and TGab are both elevated, so Hashi's is confirmed.

Usually, the hyper (Graves') phase comes first, and the hypo (Hashi's) phase comes later.  However, a diagnosis of both Graves' and Hashi's can get tricky because early stages of Hashi's can also include swings from hypo to hyper and back.

Your TSH level is pretty much flat out "normal".  A better range for TSH is 0.3-3.0, and that puts you just about smack dab in the middle.  With your low FT3 and FT4, I'd expect your TSH to be higher.  TSH is a pituitary hormone.  All it does is stimulate your thyroid to produce T4 and T3.  So, when T4 and T3 are low, TSH should be high and vice versa.  What happens with Graves' is that antibodies attach to the TSH receptors in the thyroid and stimulate it to produce (usually too much) T4 and T3, so TSH goes way down (close to zero) since the antibodies have taken over its function.

Has your doctor tested TSI (thyroid stimulating immunoglobulin)?  That's the antibody test for Graves'.

Yes, it's obvious you have issues.  Regardless of whether you have both Graves' and Hashi's or not, the fact of the matter is that you are hypo at the moment and you need treatment.  Of course, it's ridiculous for your doctor to ignore your symptoms.  Something is definitely not right.  You can try discussing your labs with her in more depth, and you can try impressing upon her just how bad you feel.  Be sure to make a list of symptoms so you don't forget anything while in the office.  If she's not willing to treat based on symptoms, you may have to find a new doctor.  

DON'T just put up with this.  Some doctors believe Hashi's patients should be treated early (before labs go out of range and/or before symptoms appear), others want you to get good and sick before they do anything.  If this doctor won't help you, find one that will.  It's not going to get any better until you do.        

[Kelly091903]

I posted my reference range in a separate post. Thanks so much for your response!  Dr. said (in her words), that my thyroid looked "ratty".  She hasn't thrown out the Graves diagnosis, as my radioactive iodine scan showed that my thyroid sucked up all the iodine.  So I am dealing with both Graves and Hashi's, I believe.  Or maybe I'm just Hashi's, but am going into Graves.....since my TSH levels seem to be on the low side.  Does that sound right?

[Kelly091903]

Thanks......here's the info:
TSH - 1.4 MIU/ML (Ref Range 0.4-4.2)
FREE T4 - 1.0 NG/DL (Ref Range 0.8 - 1.8)
FREE T3 - 2.79 IU/ML (Ref Range 2.30-4.20)

Anti-TPO - 115.8 IU/ML (Ref Range 0 - 60.0)
Thyroglobulin Ab >3000 H (Ref Range Less than 20 IU/L)

Does that help?

[goolarra]

Please post the reference ranges for your labs.  Ranges vary lab to lab, so you have to rreport range with result.  Your TGab (thyroglobulin antibody) test was > 3,000, correct?

Has she backed off her diagnosis of Graves' yet?