Hashitoxicosis

[ASUTodd]

after doing a lot o reading my symptoms lean towards hashitoxicosis
I've been diagnosed with hashimotos and obviously hypothyroid but I have anxiety, tremors, and feel
Hot at times on top of cold every morning. The endo says I've got a leaky thyroid and suggests I get a TT.
Any wisdom you guys have about hashitoxicosis?

[Red_Star]

Lowrance is stating what is mentioned in medical literature (as posted from The Medical Journal Of European Endocrinology above).

[Barb135]

From the research I've done, I'd have to disagree with Mr Lowrance, because what he's referring to is not Hashitoxicosis.  If one has antibodies for, both, Graves Disease and Hashimoto's, then one has the 2 separate  autoimmune diseases, which is entirely possible.  Once a person has, either, Hashimoto's or Graves disease, they have it for life, though one or the other will be dominant at a given time.

Simply put, Hashitoxicosis is a hyper phase of Hashimoto's... It's not unusual for persons to alternate periods of hyperthyroidism with periods of hypothyroidism in the early stages of Hashimoto's, nor is it unusual to have nodules that leak hormones on their own, independently of the thyroid.  

Hashitoxicosis "does" resolve on its own, because the person will, typically, swing to the hypo side and while they may alternate hyper and hypo, they will eventually end up permanently hypo.

A leaky nodule is, often cause to have the thyroid removed, because there is no way to control hormone output from it. Have you had an ultrasound to determine if you might have a nodule that is leaking hormones independently of the thyroid?  Or an uptake scan?

All of that said, what are your actual thyroid hormone levels?  Please post them, along with reference ranges, so we can get a better idea of where you actually are in the ranges.  Be sure to include reference ranges for comparison, since ranges vary lab to lab.

Some symptoms can apply to either/both hyper and hypo.

[Red_Star]

Here is some information on Hashitoxicosis...

Excerpt from the article: The Medical Journal Of European Endocrinology - Hashitoxicosis – Three Cases and a Review of the Literature...

"It should be pointed out that, especially in the US literature, the term ‘hashitoxicosis’ is sometimes used to describe an autoimmune thyroid disease overlap syndrome of Graves’ and Hashimoto’s disease.  In this article the term is strictly limited to the ‘leakage’ symptoms of active Hashimoto’s disease."

***

Excerpts from the book: Thyroid Disorders and Related Health Conditions by James M. Lowrance...

"Some Hashimoto's Hypothyroid Patients Experience 'Hashitoxicosis'

While Hashimoto's typically causes hypothyroidism (low thyroid hormone levels) some patients can have fluctuations in their thyroid hormones, that go from hypothyroid to hyperthyroid (from abnormally-low to abnormally-high thyroid hormone) and this can be due to them having high levels of a certain type of thyroid antibody. The condition I refer to is "Hashitoxicosis".

The antibodies that are blood tested for, when Hashimoto's is being determined/diagnosed, are the anti-TPO (anti-thyroidperoxidase) and the anti-TG (anti-thyroglobulin) antibodies (also referred to as "autoantibodies"). Either or both of these testing positive helps to confirm presence of this hypothyroid disease.

However some Hashimoto's patients can also test positive for autoimmunity cells called "TSI" antibodies (Thyroid Stimulating Immunoglobulin). This antibody is what usually contributes to Grave's Disease or "autoimmune hyperthyroidism" however, some Hashimoto's patients have these antibodies at high levels, as well as having the TPO and or TG ones, that typically cause Hashimoto's.  

You could say they are suffering from Grave's and Hashimoto's, simultaneously, usually for a limited period of time. This phenomenon is most prominent during the early stage of Hashimoto's and for many patients, the hyperthyroid phases will diminish over time."

'Block and Replace' Treatment for Non-Resolving Hashitoxicosis

Even without having TSI antibodies present, Hashimoto's thyroiditis patients can potentially experience flares of thyroiditis, which can also cause mild hyperthyroid type symptoms that are not as severe as those caused by Hashitoxicosis, if phases of hyperthyroidism symptoms are severe.  Some patients who have both Hashimoto's thyroiditis and Grave's antibodies that cause continually unstable thyroid hormone levels and that do not resolve over time, are sometimes placed on a treatment called "block and replace".

This is a treatment in which they will block the hyper-stimulation of the thyroid with an anti thyroid drug (the medication slows hormone production) and afterward, at the appropriate timing, they will give the patient thyroid hormone therapy (replacing the diminished thyroid hormone levels).  This is an alternative treatment to thyroid removal (thyroidectomy and ablation), however, if the treatment fails, once given an ample trial, thyroid removal might be recommended as a follow up treatment."

For Most Hashimoto's Patients - Hashitoxicosis Resolves on Its Own

Some Hashimoto's patients have been known to actually transition over to Graves Disease over time, when having both types of antibodies (those that destroy thyroid cells and those that stimulate thyroid hormone production) and they become progressively hyperthyroid (not common).

Most Hashimoto's thyroiditis patients who experience Hashitoxicosis however, will have intermittent hyperthyroid phase for periods of weeks or months but they will still become progressively hypothyroid afterwards and there comes a point at which the Hashitoxicosis resolves and never returns."