Hyper and Hypo at the same time?

[criswatk]

I was diagnosed with Hashi and have blood tests to support with antibodies anywhere from 1500 to 300 (both globin and peroxidase) depending on the day of the test.  Also have TSH levels between 4.3-5. Symptoms cover both hypo and hyper.  Weight gain, fatigue, heavy periods, intolerance to cold, but also infrequent heart palpitations, tremors(mostly in left hand), dry skin, hair loss, insomnia just to name a few.  Doctor (GP) ordered a thyroid uptake test to rule out Graves and get a better picture of what was happening.  Test came back normal for the scan but Hyper for the uptake test.  So now I'm really confused.  The blood test taken the same day showed my TSH at 4.8.  Antibodies consistant with Hashimoto's. The doctor recommended that I get Radioactive Iodine Therapy to zap my thyroid because he says it will give us a level playing field to start medication and will get rid of swings from hyper to hypo due to Hashimotos.  I haven't been able to find anything that supports this treatment.  I can only find RAI for treatment of Graves.  Does this seem to be the right approach or should I consider something else?  I've had untreated Hashi for probably 10 years and had definite swings between hyper and hypo.  Just didn't know it at the time and have never been on thyroid meds.  These recent seemingly conflicting tests though have perplexed me.  I also have quite a bit of memory issues, forgetfulness, like I'm preoccupied and miss stuff I didn't used to miss.  I'm 36 and have always been very sharp so this part scares me a little. I'm ready to start feeling better. help

[ancientmariner]

I had RAI in 2002, and highly regret it. There are other options, surgery being the only other one that was recommended to me. I have since learned that it is possible to take ATDs (anti-thyroid drugs) for a lot longer than my doctor said, and wish I had been given that option.

I have never heard of doing RAI just because you have Hashi's, but it sounds like your doc thinks it'll make it easier to treat you. In another thryoid group I belong to, people with Hashi's are being treated by taking full thyroid replacement to suppress the thyroid, which gives the antibodies nothing to do. They say that stabilizes the condition.

I would just suggest that you read as much as you can about RAI before consenting to have it done. I wish I had!

[Mark Lupo, M.D.]

You have hypothyroidism.  The TSH is borderline elevated and the antibodies are suggestive of Hashimotos.  The elevated uptake is seen in hypothyroidism as the TSH is eleveated and this is the primary signal for the thyroid to take up iodine -- the I-123 uptake report should never say "hypo" or "hyper" becauses these are diagnoses based on lab testing not uptakes - the uptakes help us determine the cause of hyperthyroidism and is typically useless in cases of hypothyroidism.

Unless there has been documented low TSH levels or elevated T4/T3 I would not think that you have hashitoxicosis -- ie, swinging between hyper and hypo.  The symptoms are not always specific to the hypo/hyper and I have seen hypo patients with anxiety, tremor and palpitations.  If there is documented fluctuation between high and low thyroid labs (in the absence of thyroid hormone replacement or anti-thyroid drug use) then it may be necessary to knock the thyroid out with I-131 to gain control -- I have done this a few times, but it is seldom necessary.

Start taking some thyroid hormone - would use T4 alone at a 25mcg dose for 2 weeks then increase to 50mcg and check TSH 5 weeks later -- this suggestion is based on the "hyper" symptoms you are having just to be cautious.