Graves and Hashimoto's Disease

[Sassygirl5150]

I have posted a previous question before but since I have all the test results back (except for the nuclear scan which I just had done yesterday), I thought I would post all the results in one post for simpler reading.   I am questioning the possibility of having both Graves and Hashimoto's?  Symptoms started a long time ago, but I attributed them to symptoms of menapause which I am going through earlier in life than the average.  Started sweating profusely, I thought I was having about 20-30 "hot flashes" per day, heart started racing much more than ever, including beating weird.  Tachycardia also.  Last Dr. visit   Alot of leg muscle fatigue, I cannot even squat down without needing assistance back up.  Mood swings, generally just cranky.  Insomnia, although I feel very tired.  All symptoms mimic menaupause.  Then I started losing weight without any effort whatsoever.  15 lbs in a month, time to see the doctor.  Doctor was concerned about me being in atrial fibrillation when he checked my pulse.  EKG proved that NO Atrial Fibrillation, thank goodness!  He put me on meds (beta blockers, I believe they are called?) to slow my heart rate down and ordered blood work.    The blood work came back:  parenthesis is the lab's reference range for "normal".

T3          (58-159 ng/dL)  Mine:  >400
TSH       (0.35-4.00) mcIU/ml  Mine:  <0.01
Free T4  (0.8-1.5 ng/dL)  Mine:  2.0
Thyroperoxidase Antibody (TPo AB)  (2000.00
TSI  (<140) Mine:  223

***Not sure if it is related but my liver tests ALT and AST have both gone from 19 to the very top of the "normal range".  I have a giant hemangioma on the left lobe of my liver.

So much conflicting information on the internet.  Is this Grave's Dises or Hashimoto's?  Please note that previous blood tests show my thyroid working just fine.  I go back to the doctor next Thursday.  Please help ease my mind while I wait for the scan results and next Thursday's appointment.  I had some amazing answers on my previous post, I just thought it would be easier to have it all in one place.  Thank you in advance for your time.  

[Sassygirl5150]

Thank you for your response.  The previous tests were done in 2013 I believe and well within the normal range.  I have had these symptoms for so long and they are progressively getting worse.  I thought originally they were happening because of early menapause, until I started losing weight, then I knew something wasn't right.

[Barb135]

It's entirely possible for one to have, both, Hashimoto's and Graves Disease at the same time and looking at your antibody tests, that may be what you have going on. The problem with the TSI is that it's read in a percentage not a solid number, such as yours is listed, so I'd have to wonder about any diagnosis of Graves Disease.   Your thyroid function tests indicate that you're hyper, which could very well be from a hyper phase of Hashimoto's, especially since you say that previous tests showed your thyroid to be working fine, though you don't mention how long ago that was.

It's very unfortunate that your doctor did Total T3 instead of Free T3, which is the active thyroid hormone that correlates best with symptoms.  Hopefully, the endo you're seeing next week will test better...

[Sassygirl5150]

The TPO AB was supposed to say > 2000

[Sassygirl5150]

Doctor's office called today, apparantly they got the results from the scan from yesterday and are referring me to a specialist.  I go to that appointment next Thursday a.m.  I will say that the tech who did the scan yesterday did tell me that my thyroid was really really working.  So, I'm not sure what she saw since she said she could not say anything.  

Thank you for your explanation about the possibilities.

[Red_Star]

I should of added the leakage symptoms showed up on and off at random not just a once off. :)

[Red_Star]

Excerpt from Touch Endocrinology - Hashitoxicosis – Three Cases and a Review of the Literature...

"It should be pointed out that, especially in the US literature, the term ‘hashitoxicosis’ is sometimes used to describe an autoimmune thyroid disease overlap syndrome of Graves’ and Hashimoto’s disease.2 In this article the term is strictly limited to the ‘leakage’ symptoms of active Hashimoto’s disease."

***

I've had both Hashi's and Graves antibodies simultaneously but I had been diagnosed with Hashimoto's thyroiditis previously. The leakage hyperthyroid symptoms of active Hashimoto's thyroiditis was very mild and didn't last that long..maybe a few days.  

The Graves antibodies caused me to be very hyperthyroid for two months and I also developed pretibal myxedema (caused by Graves antibodies). In my case my labs showed I was hypothyroid while being very hyperthyroid.  My liver enzymes were both above the range due to untreated Hashimoto's thyroiditis. I don't think I had liver enzyme results done when I was hyperthyroid.

An FNA biopsy will show if you have Hashimoto's thyroiditis based on certain findings such as lymphocytes and hurthle cells. A radioactive uptake scan may find something amiss as well. This is the conclusion to a study entitled: A case of simultaneous occurrence of Graves’ disease and Hashimoto's thyroiditis...

"CONCLUSION:
HT rarely occurs following GD. Our case of an elderly lady with no eye signs, lobular, firm tender goiter with patchy uptake in both lower poles on Tc99m scan were odd points in diagnosing isolated GD. FNAC confirmed simultaneous HD with GD."