Diagnosed with Hashimoto's AND Graves disease!

[JDzWife]

I found this support group while googling about thyroid disorders.  I hope to find answers and peace of mind.  I am 47 and have always been fairly healthy.  Within the past few months, I noticed extreme fatigue, especially late afternoon.  I need a 2 to 3 hour nap daily, which is so out of character for me.  Also, since December 2008, I have gained 25 pounds and my hair is falling out at an alarming rate.  I have never had a problem with my weight, in fact, I have been slightly underweight.. until recently.  I went to my family doctor this past February, who sent me for labwork.  My TSH level came back 0.004, vitamin B12 high at 919, cholesterol 224, triglycerides 303, HDL 39, LDL 124; everything else was normal.  She then sent me for a thyroid ultrasound which came back positive for Hashimoto's thyroiditis.  Two weeks ago I had a nuclear medicine thyroid uptake scan which came back positive for Grave's disease.  Last week was my first appointment with an endocrinologist who informs me that I have both Hashimoto's AND Graves disease, which according to her, is very difficult to treat and is not that common.  Her first suggestion was the RAI (radioactive iodine), second choice was tapazole/PTU for a year to 18 months, and thirdly was surgical correction.  She tells me that the tapazole treatment will only put the hyperthyroidism in "remission" so that we can treat the hypothyroid.  

My first inclination was to proceed with the thyroidectomy.  Then I started thinking about RAI therapy.  I am really confused on what truly is the best course of treatment is for me.  I know it's a personal choice, but how do you come to a decision?  I would like to know what course of treatment(s) anyone has had that has been diagnosed with both hyper and hypothyroidism.  

I apologize for the long post.  I am just at a loss here.  Thanks in advance!

[Scaredkatherine]

I'm 21 and was diagnosed with hypothyroidism just last year and have been on levothyroxin since then, I had no idea anything was every wrong with me, makes me think i've had this all for years and never noticed. I dont exactly understand what people are saying on here as far as they couldn't handle it any more, or a roller coaster of symptoms. my blood results came back and my doctors says she has never seen someone have both graves and Hashimoto so I see an endocrinologist next week, I am terrified, the only real symptom I have is i am usually tired. I would have never known I had anything wrong or that anything had changed, any advice on questions I should ask? or what I should know going into that appt? I appreciate everything!

[DG1785]

I am on a GF diet also and feel much better.  They are trying to figure out which one I have...Hashi or Graves.  I also have a 3X3cm nodule on my right side of my thyroid. AB are elevated.

[star2217]

what are the symptoms of graves in the eyes?

[gimel]

I am not quite sure what you are looking for, so let me just give you the info on tests that would be important in trying to diagnose thyroid status.

For Graves the test is TSI.  To determine if Hashi's is present, the tests are for the thyroid antibodies, TPO ab and TG ab.  Sometimes an ultrasound of the thyroid gland also helps to determine if there are nodules present.  

To evaluate the status of thyroid hormones, the best tests are Free T3 and Free T4 (not the same as Total T3 and Total T4).  Free T3 is the most important, because it largely regulates metabolism and many other body functions.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.

There are also reports that the very best measure of tissue thyroid levels is the ratio of Free T3 to Reverse T3, so RT3  might be worthwhile to test also.  

Since patients with hypothyroid issues frequently are too low in the range for Vitamin D, b12 and ferritin, I also suggest you consider those tests.

Also it would be good to keep firmly planted in your mind that a good thyroid doctor will treat a thyroid patient clinically, for symptoms, rather than just by test results.  

[MaryPJP]

Thanks for your response, very much appreciated.

I have never been on one of these blogs before so i just asked her as it was the same.

If any one can help me I would be very appreciative, no one seems to be able to tell you anything.

Thank you

[gimel]

I doubt that you will get a reply from Hi Ay 2 Silly, since we haven't heard anything from her since way back in Feb.