Is this really Graves disease?

[rlosab]

Hi all, In the end of December 2011 I discovered a slightly retracted left upper eyelid. In February I also had a choking feeling most times I ate, I did bloodwork & I had mild hyperthyroidism:  Here are all my tests:

Feb  23: TSH 0.01, FT4 33 (12-22)
Mar 12: abTPO 12 (<34 negative), TRAB < 1.0 (<1.8 negative), abTG 289 (<115 positive)
Jun 14: TSH < 0.01, FT4 25.9 (12-22), FT3 7.7 (2.8-7.2) slightly hyper
Aug 9: TSH < 0.01, FT4 17 (12-22) mid range

A doctor who did the ultrasound in March told me I had thyroiditis while the endocrinologist diagnosed me with Graves disease. He insisted I take the antithyroid drugs but I did not because I was convinced that my hyperthyroidism was either silent thyroiditis or induced by iodine (from August to September I had taken a supplement containing iodine without knowing it & my diet has mostly been iodine deficient). Furthermore, no one in my family has any thyroid or autoimmune diseases. In the mid august I had my second visit with the endocrinologist who continued insisting with Graves disease. When I questioned her about the absence of Graves antibodies she responded that I had the abTG antibodies to confirm the diagnosis.

Now, one month after my latest tests, I am confident I have entered hypothyroidism. I have been eating less, yet I have gained 2-3pounds in 10 days. I am sure it's water retention. I feel a bit tired. My last period came 4 days earlier than usual!

Is this is really Graves disease? Eyelid resolved on its own in 3 months (no antithyroid drugs). The hyperthyroidism resolved on its own over 5-6 months. Now I believe to be in hypo state. I know that Graves disease can go into spontaneous remission but I have not read about cases of spontaneous remission in 6 months or even going  into hypothyroidism in 7-8 months. This usually takes years. Is it so impossible for mine to be a case of thyroiditis or iodine induced thyrotoxicosis? Any experiences you may share? Thanks so much!!

[Mark Lupo, M.D.]

Tg-Ab does not confirm Graves'.  The Ab for TSH-Receptor (TSI, TBII, TRAB) is specific for Graves' but not always present.
This may be iodine induced or a thyroiditis.  Documenting I-123 uptake during biochemical hyperthyroidism (and in the absence of iodine overload) would have been the most helpful in this situation.  It may be an atypical thyroiditis confounded by iodine intake.  Monitoring thyroid levels closely is important as the trend is often what makes the diagnosis.

[rlosab]

Hello
Once you log in to MedHelp and go to My MedHelp tab you should see a button "Post a Question". Hope this helps.

[serenityseeker56]

could you tell me how you post a question to this forum,  would be greatly appreciated

[rlosab]

Hello, I redid the bloodwork yesterday morning and just got my results today afternoon.

TSH 0.04 (range 0.27-4.20),
FT4 12.1 (range 12.0-22.0),
FT3 3.2 (2.8-7.1).

I believe to be borderline hypothyroid. Before I got sick, my normal thyroid hormones have always been in the mid-upper range. Am I hypo because my TSH is only now starting to rise? Is there a way to predict whether the hypothyroidism is permanent or temporary? I am so tired of my endocrinologist that refuses to see that the course of my disease is not typical of Graves. Plus the only antibodies that were positive in my case were the TGab (289 with the normal range being < 115). I have decided to change the endo. Unfortunately I am located in Italy and I don't know if anyone has a good endocrinologist to recommend. Regardless what do you recommend I do: shall I just watch it and redo the bloodwork after 2 months?

[rlosab]

Thanks a lot for your feedback. Really appreciate it.