TPOab reading and Graves disease past.

[stella5349]

Dr. Lupo

If you can - I have mixed information on my autoimmune disease.

6 years ago I was diagnoised with Graves Disease off a TSI lab and an uptake scan indicating autoimmune Graves.

I had RAI done 6 weeks after the DX due to a thyroid storm.  In the years after RAI I was very hypothyroid but no other autoimmune tests were done and I gradually became extremely ill.

I recently have found two wonderful doctors who have helped me in switching my medication and running appropriate lab work.

I requested to run a TPOab lab test on my last check to see if I also had these antibodies as well. The test came out with a positive reading of over 600.

My doctor viewed the lab and said I have Hashimoto thyroiditis.

( I have swelling in my neck for years as a major symptom after RAI )

Does this mean that I "have or had"  both Graves and Hashimoto disease - since my last lab indicates a high TPOab?

Did I develop the TPO antibodies after the RAI? or was this mostly likely just overlooked?

Does having Graves disease cancel out the fact of Hashimoto's even if the TPOab testing is positive?

and lastly - since RAI - I am obviously hypothyroid and require meds to stay optimal. Can you develop antibodies for Hashimoto's disease  because of  remaining hypothyroid for so long without proper treatment?

Do you think I need any additional tests to confirm this diagnoises?

Thanks ahead for your reply.

[stella5349]

So to clear this question up on my situation.

Can a person that was DX with Graves also be diagnoised later as Hashi also?

[Mark Lupo, M.D.]

The nodule can be FNAd with ultrasound guidance (unless it is directly behind the carotid - then this is harder).....

in some cases there can be thyroid tissue that "survives" the ablation -- this could potentially swell.

[Mark Lupo, M.D.]

You had autoimmune thyroid disease -- Graves -- which has both TSH-receptor antibodies and often TPO & Tg antibodies.  These will persist often after RAI but the main issue at this point is post-RAI hypothyroidism with antibodies to the thyroid due to the autoimmune thyroid history.  This does not change the treatment plan.

[stella5349]

If the dx of Hashimoto's thyroiditis is correct - how can my thyroid swell since it is ablated?

New tissue perhaps?

I have grown a nodule too. A US scan confirmed this too. Is this a higher risk of having cancer? A year ago it measured 1cm.

The nodule itself was FNA'd and it was unsuccesful to biopsy due to its deep posterior location on the ablated gland too close to the cartiod artery.

What should be done now?