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Lab Results - Graves AND Hashimotos? Looking for recommendations
Hi all, I am brand new to Thyroid issues - told my PCP about a month ago that I have been exhausted and am gaining weight, and just don't think it is "normal" since I'm 28, no kids, finally out of school (I'm a RN) and working a 9-5 job - I feel like I should be full of energy but could just sleep all the time.
I had never had bloodwork done, and so they checked some values, my TSH came back < 0.3 so they referred me to an Endocrinologist.
So two weeks ago the Endocrinologist checked my labs - I told her I felt Hypo but my TSH showed Hyper (confusing already) - so she called me yesterday with my lab results and they are as follows:
TSH = 0.00 LOW (normal range 0.35-4.94)
T4 Free = 0.86 (in normal range)
T3 Free = 2.64 (in normal range)
Thyroid Peroxidase AB = 5.17 (in normal range)
Thyroglobulin AB = 422.27 HIGH (range 0.00-4.11)
TSI = 243% HIGH (normal range <140)
Basically, the Endocrinologist told me my results mean I have both Graves Disease and Hashimotos. She is sending me for a uptake/scan and ultrasound of my Thyroid in a month and then I follow up with her in a month and a half. In the meantime I am trying to research these autoimmune disorders and feel overwhelmed. I am confused that I have BOTH, and that I feel lethargic and am experiencing weight gain with a TSH level of 0.00. I have gained 20-25 pounds since October 2013 so that's just over 6 months (I'm female, 5'8" and went from about 144 up to 166). I haven't been dieting, but I haven't been overeating either, and already don't eat barely any dairy and try to watch my gluten intake and avoid fast food. I am considering trying the Paleo diet, but it is so difficult to follow strictly, and I guess I am having a hard time coming to terms with it needing to be a life-long change that I may need to follow. (But it sounds like I am facing life long medication anyways....?)
My Endocrinologist has already mentioned RAI as a possible route of treatment, and I feel like it just sounds quite drastic. However, I don't want to minimize the seriousness of problems that can result from Graves. I already feel like I have digestive issues, possible gluten intolerance, have some hair loss, lethargy, menstrual cramps and irregularity, weight gain, have been noticing an increase in depression and anxiety lately.....I am starting to realize these could all be tied to my thyroid and just feel at a loss of which direction to go to next. Can anyone offer suggestions, support, answers to how I can have both Graves and Hashimotos?
Thanks in advance, I will take all the help I can get!
I had never had bloodwork done, and so they checked some values, my TSH came back < 0.3 so they referred me to an Endocrinologist.
So two weeks ago the Endocrinologist checked my labs - I told her I felt Hypo but my TSH showed Hyper (confusing already) - so she called me yesterday with my lab results and they are as follows:
TSH = 0.00 LOW (normal range 0.35-4.94)
T4 Free = 0.86 (in normal range)
T3 Free = 2.64 (in normal range)
Thyroid Peroxidase AB = 5.17 (in normal range)
Thyroglobulin AB = 422.27 HIGH (range 0.00-4.11)
TSI = 243% HIGH (normal range <140)
Basically, the Endocrinologist told me my results mean I have both Graves Disease and Hashimotos. She is sending me for a uptake/scan and ultrasound of my Thyroid in a month and then I follow up with her in a month and a half. In the meantime I am trying to research these autoimmune disorders and feel overwhelmed. I am confused that I have BOTH, and that I feel lethargic and am experiencing weight gain with a TSH level of 0.00. I have gained 20-25 pounds since October 2013 so that's just over 6 months (I'm female, 5'8" and went from about 144 up to 166). I haven't been dieting, but I haven't been overeating either, and already don't eat barely any dairy and try to watch my gluten intake and avoid fast food. I am considering trying the Paleo diet, but it is so difficult to follow strictly, and I guess I am having a hard time coming to terms with it needing to be a life-long change that I may need to follow. (But it sounds like I am facing life long medication anyways....?)
My Endocrinologist has already mentioned RAI as a possible route of treatment, and I feel like it just sounds quite drastic. However, I don't want to minimize the seriousness of problems that can result from Graves. I already feel like I have digestive issues, possible gluten intolerance, have some hair loss, lethargy, menstrual cramps and irregularity, weight gain, have been noticing an increase in depression and anxiety lately.....I am starting to realize these could all be tied to my thyroid and just feel at a loss of which direction to go to next. Can anyone offer suggestions, support, answers to how I can have both Graves and Hashimotos?
Thanks in advance, I will take all the help I can get!
Thank you so much goolarra, that makes so much more sense and helps me identifying why I feel hypo - I didn't realize FT3 and FT4 factored in quite like that. I really appreciate that thorough explanation!
Also, I haven't tried any diet changes as I just received the diagnosis information yesterday - definitely an approach I am researching as I would like to take care of my health issues as naturally as possible. Any direction on where to find the best dietary information and recommendations would be appreciated as well. I am able to find stuff on Graves OR Hashimoto's - and what to eat for Hypo OR Hyper - but if I have both I feel confused as to which treatment approaches to follow...
Thank you for the responses. I appreciate the feedback. I didn't realize the ranges vary for FT3 and FT4. Here are mine:
T4 Free = 0.86 (range 0.70-1.48)
T3 Free = 2.64 (range 1.71-3.71)
So it sounds like it is possible for Graves to reverse, and or disappear on it's own? I guess from reading online so far, I was thinking once you have it, you are stuck with the diagnosis for life...I have definitely had stress: Divorce, moving across country, job changes, etc... but have just started settling into a comfortable routine with much less stress - so maybe with some diet adjustments I can avoid RAI?
I would love to learn more about the process of "burning out" as my Endocrinologist mentioned this may be happening before she ran any labs (and only knew it was hyper from first lab).
T4 Free = 0.86 (range 0.70-1.48)
T3 Free = 2.64 (range 1.71-3.71)
So it sounds like it is possible for Graves to reverse, and or disappear on it's own? I guess from reading online so far, I was thinking once you have it, you are stuck with the diagnosis for life...I have definitely had stress: Divorce, moving across country, job changes, etc... but have just started settling into a comfortable routine with much less stress - so maybe with some diet adjustments I can avoid RAI?
I would love to learn more about the process of "burning out" as my Endocrinologist mentioned this may be happening before she ran any labs (and only knew it was hyper from first lab).
Please post the reference ranges for your FT3 and FT4. Ranges vary lab to lab and have to come from your own lab report.
TSH is a pituitary hormone and nothing but a messenger from your pituitary to your thyroid to tell it to produce more hormone. TSH, per se, causes NO symptoms. If TSH is accurately reflecting your FT3 and FT4 levels, i.e. it's high when FT3 and FT4 are low and vice versa, then it can be a useful test, but many other factors can influence TSH.
You will most likely be on meds for the rest of your life, for certain after RAI.
I know it sounds like a contradiction in terms to have both Hashi's (ultimately hypo) and Graves' (hyper), but it is possible to have both antibodies, as you have. One or the other disease is usually dominant, most often Graves' first.
TSI (thyroid stimulating immunoglobulin) is the antibody that indicates Graves'. TSI can dock at TSH receptors on the thyroid and stimulate the thyroid to produce hormone. However, unlike TSH, which is under pituitary control, TSI is indiscriminate (it just keeps calling for more and more hormone).
It looks like your thyroid might be in the process of burning out, but I can comment more on that once you post FT3 and FT4 ranges.
TSH is a pituitary hormone and nothing but a messenger from your pituitary to your thyroid to tell it to produce more hormone. TSH, per se, causes NO symptoms. If TSH is accurately reflecting your FT3 and FT4 levels, i.e. it's high when FT3 and FT4 are low and vice versa, then it can be a useful test, but many other factors can influence TSH.
You will most likely be on meds for the rest of your life, for certain after RAI.
I know it sounds like a contradiction in terms to have both Hashi's (ultimately hypo) and Graves' (hyper), but it is possible to have both antibodies, as you have. One or the other disease is usually dominant, most often Graves' first.
TSI (thyroid stimulating immunoglobulin) is the antibody that indicates Graves'. TSI can dock at TSH receptors on the thyroid and stimulate the thyroid to produce hormone. However, unlike TSH, which is under pituitary control, TSI is indiscriminate (it just keeps calling for more and more hormone).
It looks like your thyroid might be in the process of burning out, but I can comment more on that once you post FT3 and FT4 ranges.
Block and replace therapy is used for Hashitoxicosis: blocking the stimulation of the thyroid with an anti-thyroid medication and then replacing with thyroid hormones.
I was highly contemplating this treatment but my hyperthyroid symptoms went away after two months although it took a year for my pretibal myxedema to go away. I
was under tremendous stress when those Graves antibodies appeared so that looks to be the trigger. My stress levels dropped drastically over those months.
I was highly contemplating this treatment but my hyperthyroid symptoms went away after two months although it took a year for my pretibal myxedema to go away. I
was under tremendous stress when those Graves antibodies appeared so that looks to be the trigger. My stress levels dropped drastically over those months.
Hypothyroid exhibits both Grave and hashimoto symptoms. Have you tried the nutritional and anti- inflammatory diet and supplements. My wife was given the same diagnosis and we fought it off with the natural approach. Stay away from sugar, carbs, GMOs, milk and add green drink and supplements to your diet. Don't give up hope. you can reverse this disease IA.
I already had Hashimoto's thyroiditis and Graves antibodies showed up causing hyper symptoms, thyroid eye disease and pretibal myxedema while my labs showed hypothyroidism. Both autoimmune diseases together mess up the labs.
Hashitoxicosis goes by two definitions: Transient episodes of hyperthyroidism caused by inflammation associated with Hashimoto's thyroiditis; Graves' disease and Hashimoto's thyroiditis concurrently.
Hashitoxicosis goes by two definitions: Transient episodes of hyperthyroidism caused by inflammation associated with Hashimoto's thyroiditis; Graves' disease and Hashimoto's thyroiditis concurrently.
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Often, Graves' will dominate in the early stages of the disease, but having elevated TPOab and/or TGab increases the odds that you will eventually become hypo. You are not hyper. Hyper is when your FT3 and/or FT4 are high. Yours are both low. You have a suppressed TSH due to the Graves' antibodies, but your FT3 and FT4 are low enough for you to be considered hypo. With your TSI so high, your FT3 and FT4 should be through the roof. So, we have to assume that the TGab antibodies are at work destroying your thyroid.
Little can be done from a dietary standpoint. Of course, a healthy diet is important regardless of thyroid issues. Iodine rich foods can exacerbate Hashi's autoimmune response, and since iodine is a building block of T4, iodine rich foods are to be avoided when hyper. Goitrogens (you can google a list) can negatively impact the production of thyroid hormones. However, they are only important as long as you still have thyroid function left.