Aa
Hashimoto's or Graves
Dr. Lupo,
I am a 24 yr old female who is confused about my diagnosis or lack of diagnosis.
Six months after giving birth to my son. I went for a routine checkup complaining of feeling tired and constipated. My physician did a thyroid workup since I have a family history of hypothyroidism. My TSH came back at 6.0 (normal 0.4-4.0) but everything else was in normal range. I retested a month later with a TSH of 2.6. My physician felt it was postpartum thyroiditis and it would resolve on its own.
A year later in Oct of this year, I was found to have an enlarged thyroid. An ultrasound was scheduled along with thyroid workup; results showed slightly hetergenous thyroid on ultrasound. My TSH was 0.02 and my free T4 was 2.55 (normal 0.71-1.51). It appeared that I was hyperthyroid. I actually was having some symptoms as well: Increased anxiety, tremors, increased bowel movements, and heart racing at times. I had a thyroid scan to confirm the diagnosis and it showed my thyroid to have a low uptake (about 0.4% of iodine uptake). My physician said it must be some form of thyroiditis not Graves and referred me to an endocrinologist.
The endo doctor saw me and ordered a series of thyroid antibodies as well as repeating thyroid series. He suspected Hashimoto's thyroditis. Results were: TSH 0.02, free T4 1.57, ESR 3 (normal 0-20), TSI less than 1.0 (normal 0-1.3), TPO 367.3 (normal 0-8.9), thyroglobulin 21 (normal 0-33), and negative for anti-thyroglobulin antibodies. My endocrinologist called me and said he still wasn't sure what it was and to repeat tests next month. I asked him why the thyroid scan wasn't enough for diagnosis and he responded that I should forget the scan. He did however feel that my hyperthyroidism was resolving since my labs were better and I was no longer feeling symptoms. He says I need no treatment now. Here are my questions.
When you have Hashimoto's is it possible to bounce between hypo and hyper? If so how long can this last? Is the thyroid scan or radioactive iodine uptake test really unreliable? What is your opinion of my labs? Finally, I would like to try to get pregnant some time next year...what are risks to the fetus with my condition? Any help would be appreciated.
I am a 24 yr old female who is confused about my diagnosis or lack of diagnosis.
Six months after giving birth to my son. I went for a routine checkup complaining of feeling tired and constipated. My physician did a thyroid workup since I have a family history of hypothyroidism. My TSH came back at 6.0 (normal 0.4-4.0) but everything else was in normal range. I retested a month later with a TSH of 2.6. My physician felt it was postpartum thyroiditis and it would resolve on its own.
A year later in Oct of this year, I was found to have an enlarged thyroid. An ultrasound was scheduled along with thyroid workup; results showed slightly hetergenous thyroid on ultrasound. My TSH was 0.02 and my free T4 was 2.55 (normal 0.71-1.51). It appeared that I was hyperthyroid. I actually was having some symptoms as well: Increased anxiety, tremors, increased bowel movements, and heart racing at times. I had a thyroid scan to confirm the diagnosis and it showed my thyroid to have a low uptake (about 0.4% of iodine uptake). My physician said it must be some form of thyroiditis not Graves and referred me to an endocrinologist.
The endo doctor saw me and ordered a series of thyroid antibodies as well as repeating thyroid series. He suspected Hashimoto's thyroditis. Results were: TSH 0.02, free T4 1.57, ESR 3 (normal 0-20), TSI less than 1.0 (normal 0-1.3), TPO 367.3 (normal 0-8.9), thyroglobulin 21 (normal 0-33), and negative for anti-thyroglobulin antibodies. My endocrinologist called me and said he still wasn't sure what it was and to repeat tests next month. I asked him why the thyroid scan wasn't enough for diagnosis and he responded that I should forget the scan. He did however feel that my hyperthyroidism was resolving since my labs were better and I was no longer feeling symptoms. He says I need no treatment now. Here are my questions.
When you have Hashimoto's is it possible to bounce between hypo and hyper? If so how long can this last? Is the thyroid scan or radioactive iodine uptake test really unreliable? What is your opinion of my labs? Finally, I would like to try to get pregnant some time next year...what are risks to the fetus with my condition? Any help would be appreciated.
Did you have a scan or uptake, or, both?
A scan may be done along with a radioactive iodine uptake test (RAIU).
Thyroid scan is done to evaluate thyroid nodules, determine the cause of an overactive thyroid gland (hyperthyroidism) and whether thyroid cancer has spread beyond the thyroid gland
A radioactive iodine uptake test (RAIU) to evaluate thyroid function.
A low uptake may mean hyperthyroidism caused by certain conditions as inflammation of the thyroid gland such as thyroiditis (Thyrotoxic phase of subacute thyroiditis, Hypothyroidism). Interpretation of the iodine uptake is usually done in conjunction with blood tests.
There is a hyper phase before going into full blown Hashi, however this should relate in your blood test. Without a F/T-3 done at the same blood draw as the other two, can't tell what might be going on, that is, if you are in the early Hashi/hyperthyroid stage.
You need this resolved and treated if warranted, before you become PG and TSH level kept at the appropriate range throughout pregnancy.
When you go for your next test have done, TSH, FT-4, FT-3 and for Graves';
TRAB = TSH receptor antibodies: TSI thyroid stimulating immunoglobulin (antibody).
TGI = thyroid growth immunoglobulins
For Hashi; TRAB = TSH receptor antibodies: Blocking TSH receptor antibodies.
The rest were already done. These antibodies are specific to Graves' and Hashi.
Good Luck.
A scan may be done along with a radioactive iodine uptake test (RAIU).
Thyroid scan is done to evaluate thyroid nodules, determine the cause of an overactive thyroid gland (hyperthyroidism) and whether thyroid cancer has spread beyond the thyroid gland
A radioactive iodine uptake test (RAIU) to evaluate thyroid function.
A low uptake may mean hyperthyroidism caused by certain conditions as inflammation of the thyroid gland such as thyroiditis (Thyrotoxic phase of subacute thyroiditis, Hypothyroidism). Interpretation of the iodine uptake is usually done in conjunction with blood tests.
There is a hyper phase before going into full blown Hashi, however this should relate in your blood test. Without a F/T-3 done at the same blood draw as the other two, can't tell what might be going on, that is, if you are in the early Hashi/hyperthyroid stage.
You need this resolved and treated if warranted, before you become PG and TSH level kept at the appropriate range throughout pregnancy.
When you go for your next test have done, TSH, FT-4, FT-3 and for Graves';
TRAB = TSH receptor antibodies: TSI thyroid stimulating immunoglobulin (antibody).
TGI = thyroid growth immunoglobulins
For Hashi; TRAB = TSH receptor antibodies: Blocking TSH receptor antibodies.
The rest were already done. These antibodies are specific to Graves' and Hashi.
Good Luck.
I have been trying to get into the doctor's forum but unable to get in. Does anyone on here have any advice for me? Any help appreciated.
you can reach the Doctor Thyroid Forum and ask Dr. Lupo at http://www.medhelp.org/forums/show/120 OR
at left of page almost top, under "Thyroid Disorders" in red click on "thyroid" it will take you to the forum.
If you have posted more than one post per the sites rules for doctors forums, you probably won't get answered. Or if the forum is full and not taking any more questions for the day, you can try another day.
Good luck and Best of health!
at left of page almost top, under "Thyroid Disorders" in red click on "thyroid" it will take you to the forum.
If you have posted more than one post per the sites rules for doctors forums, you probably won't get answered. Or if the forum is full and not taking any more questions for the day, you can try another day.
Good luck and Best of health!
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