Graves and Hashimoto?

[kiksbutt]

My wife tested her TSH levels in May 2017 and it was 2.35. Her OBGYN tested it again in November and reported her TSH as 0.01. She went and saw and endo early in December and her lab results came in:

TSH 0.04 (0.34-4.20)
Free T3 3.92 (2.3-4.4)
Free T4 - 1.18 (.61-1.40)
Thyroglobulin Antibody - 52.7 (<4)
TPO Antibody - 28.9 (<9)
Thyrotropin Receptor Ab - 4.43 (0-1.75)
Thyroid Stim Immunoglobulin - 285% (0-139)

Normal sedimentation rate and all other blood test. Ultrasound was good, no issues besides minor enlargement. Her endo said it's mild hyperthyrodism. He recommended to wait 6 weeks and re-test before starting treatment since it could be viral thyroditis.

Any input on the hormone tests? Both graves and hashimito? She doesn't have any symptoms besides irregular periods which may or may not be related.

Thanks

[Barb135]

It looks like your wife definitely has Graves Disease, as evidenced by the TSI (Thyroid Stimulating Immunoglobulin), which is the definitive test for Graves Disease.   It's not unusual to have slightly elevated TPOab with Graves, as well, but the elevated TgAb could indicate that she also has Hashimoto's.  It's pretty rare to have both, but certainly not impossible.

Although her Free T4 is higher than is normally recommended (72% of range), her levels aren't what would, normally, be considered terribly hyper.  That said, higher than necessary thyroid hormones can cause fewer or lighter periods.

Both Graves Disease and Hashimoto's are autoimmune diseases.  Once we have them, we have them for life, so neither of them will go away in 6 weeks.  That said, treatment will depend on your wife's actual thyroid hormone status, which will be the Free T4 and Free T3 levels, not the TSH... If the doctor starts anti-thyroid medication, based only on the TSH level, to bring it back up, the Free T4 and Free T3 levels will driven down to hypothyroid status, which is just as bad as hyper.  

Recommended level for Free T4 is approximately mid range and recommended level for Free T3 is upper half to upper third of its range.  Free T3 should be higher in its range than Free T4 in its range.

Free T3 is the hormone used by individual cells, while Free T4 is a "storage hormone" and must be converted to the active Free T3.  

TSH neither causes, nor alleviates any symptoms; it's merely a messenger from the pituitary that stimulates the thyroid.  Right now, your wife's thyroid does not need stimulation, so TSH production has ceased... I agree that levels should be retested in 6 weeks (or sooner if new symptoms appear).

It's important to note that when one has, both, Hashimoto's and Graves Disease, either can be dominant at any given time.  Also important is that with Hashimoto's, one can swing from back and forth, from hyper to hypo before finally settling into permanent hypo, so one must be monitored carefully, by a doctor who is diligent in watching Free T4 and Free T3 levels, not just TSH.  

Since it was an Ob/Gyn that tested your wife's levels last, at the risk of being nosy, I'd wonder if your wife might be trying to conceive.  

[kiksbutt]

Thanks, Barb. It seems to us that this was caught way early, since in a span of 5-6 months, it went down to these levels. She's still asymptomatic so I'm not sure if medicine is required right away. Since they're both autoimmune, I'm sure diet and lifestyle (stress) play an important role. I've heard of stories of people lowering their antibodies naturally without medicine.

We'd rather try the natural route first so that's what she'll be doing over the next six weeks and see if it has any impact on the thyroid. For these current levels, it does seem "mild". I've seen antibody levels through the roof. Is there a risk in waiting a bit longer to start meds especially if she's not exhibiting symptoms?

[Barb135]

Sorry, I missed your post yesterday... Yes, diet and lifestyle can play an important role in autoimmune diseases.  I, too, have heard/read of many stories in which antibodies have been lowered without medication, however, the jury is still out on whether or not this can actually happen.  Of course, it never hurts to improve ones diet and lifestyle for better all around health; just don't be disappointed, if, at some point your wife has to have some type of thyroid medication.  For some of us, it can't be avoided.

I agree that your wife's condition does seem mild, at this point, and as long as she doesn't have symptoms, there's probably not a harm in waiting to start meds, however, be very careful about getting pregnant, especially, if anti-thyroid meds are prescribed.  Adequate thyroid hormones are absolutely essential for the proper growth and development of a fetus, so if thyroid levels are dropped too low by means of anti-thyroid drugs, there may not be enough for a growing fetus.  

I highly recommend that you see a good thyroid doctor prior to your wife getting pregnant vs having an ob/gyn prescribe the medication, unless the ob/gyn is also a trained thyroid doctor.

Whoever treats your wife, please do not allow them to treat, based only on TSH level... make sure that Free T4 and Free T3 levels are, either too high or too low and actually warrant medication...