Is it possible I have Graves' disease now????

[wildanimaluvr]

Hi. I'm wondering if you can tell me if I may actually have Graves' disease . I was diagnosed with lupus and anti phospholipid disease 13 years ago when I became extremely sick  after having a thymoma removed . I've actually had health problems since I was a child which got worse as I got older ( I got asthma and bad allergies at age 6). I have been on prednisone for 5 years now after getting off of methotrexate and plaquenil. I have not been able to taper off the prednisone. I get very sick even lowering it 1 mg. A couple years ago I felt like I was going crazy ( literally) so my dr. Tested my thyroid functions. I had TPO's in my blood and one of my thyroid tests came back abnormal also (can't remember which is was) The dr. I saw thought I had just had some sort of thyroid infection and just wanted to keep an eye on me. I am now 14 weeks pregnant and had all my first trimester blood work done . My TSH was extremely low (11)  as well as my C3 & C4 low. Had bad nausea and vomiting , no weight gain and I have had major depression along with anxiety for several years (am on 3 antidepressant which aren't even working) . Unfortunately , I just found out that my baby has Down's syndrome . Confirmed by a cvs. I'm having a D & E as being very sick myself, cannot bring a child into the world that will also have health problems (its miserable). My question is...Is it possible that I actually do have Graves' disease now and need to see an endocrinologist or is this a normal thing to happen during the first trimester of preg? Could my long term use of prednisone have caused a thyroid problem? I'm so sick of being sick with one bad thing happening after another and I'm really tired of going to drs constantly. The words I hear from every dr is " boy, you are very complicated!" And I have also had several bad experiences with drs . I don't want to jump the gun if I don't have to. What do you think? Any advice or info would be so greatly appreciated.

[Barb135]

First let's clarify a few things... You said your TSH is extremely low at 11 --- that's not low; it's actually considerably higher than normal, indicating hypothyroidism (under active thyroid), since TSH is counter intuitive.  TSH is a pituitary hormone that stimulates the thyroid to produce more thyroid hormones, so it increases when thyroid hormones are too low and decreases when thyroid hormones are too high.  Graves Disease is ALWAYS associated with hyperthyroidism (over active thyroid), not hypo.  While TPOab can be present with Graves Disease, it's most often associated with Hashimoto's.

Additionally, you mentioned "C3 and C4"... do you mean T3 and T4?  T3 and T4 are the actual thyroid hormones.  I have no idea what C3 and C4 would be.   Once again, low thyroid hormones, coupled with high TSH, would indicate hypothyroidism.  

It's possible that you've had a thyroid condition for a long time, since many doctors fail to diagnose thyroid conditions in a timely manner, due to the common use of TSH testing only.  Thyroid hormones are essential to the growth and development of a fetus and the fetus is dependent on the mother's thyroid hormones until its own thyroid is developed enough to produce hormones.

I've not heard of prednisone "causing" a thyroid issue, but all endocrine hormones must be in balance with each other.  My daughter has lupus and has been on prednisone for years; (she says) she doesn't have a thyroid issue.

[Red_Star]

American Thyroid Association - Thyroid Disease and Pregnancy...

"Overall, the most common cause (80-85%) of maternal hyperthyroidism during pregnancy is Graves’ disease (see Graves’ Disease brochure) and occurs in 1 in 1500 pregnant patients."

"Graves’ disease may present initially during the first trimester or may be exacerbated during this time in a woman known to have the disorder."

[wildanimaluvr]

Thanks so much for the response to my post. Just To clarify, my TSH was very low. The normal for this lab is 0.35-4.50 . Mine is 0.11 and has Low next to it. I also have lupus (and anti phospholipid disease) and read that long term use of prednisone ( I'm on 5 yrs) can  damadge or affect the adrenal glands which has a lot to do with thyroid functions. I haven't been able to go down on the prednisone 1mg because of how sick I get. One dr. Said that I may not be able to taper down on prednisone because my adrenal glands aren't working right which is why I have gotten so sick trying to taper off them.
C3 and C4 are called "complement" tests used for lupus and the other auto immune diseases. I'm sure your daughters had her levels tested many times because these numbers show if the immune system is in attack/inflammation mode. Mine are showing my body's in attack mode so I was wondering if the thyroid could cause this to happen. Does a LOW TSH indicate graves ? the numbers always confuse me. I am no longer pregnant and I had my blood drawn today to check the levels again before I run to another specialist . And I really really don't want to have yet another disease to have to deal with. I do have several graves symptoms of constant heart racing & anxiety and I'm very very thin loosing 3 lbs since last month . Thank u again

[Barb135]

Thank you for clarifying... there's a huge difference between a TSH of 0.11 and a TSH of 11, as you typed it above in the parenthesis.  You're correct TSH of 0.11 would be low, while a TSH of 11 would be quite high.

The C3 and C4 complement tests are not used with autoimmune thyroid disease; they are used with lupus, RA, etc to determine effectiveness of treatment.  My daughter probably has had those tests done; however, she's an adult and I don't see her blood work.

When the thyroid begins to fail, the adrenal glands kick in to take up the slack; it doesn't appear that your thyroid has begun to fail, but then we don't know what your actual thyroid hormones, Free T3 and Free T4 are, so we don't know if they are adequate or not.  Both the thyroid and adrenals are endocrine glands, so they must work in sync with each other. When one has one autoimmune disease the chances of getting another (or more) are much greater.

Low TSH, typically, indicates hyperthyroidism (that the thyroid is over producing hormones), but it does not necessarily indicate Graves Disease, since not all hyperthyroidism is Graves Disease.  There's another autoimmune thyroid disease called Hashimoto's Thyroidits.  Hashimoto's is, typically, associated with hypothyroidism, but is very often characterized by periods of hyperthyroidism in the early stages.  

You need to have thyroid specific antibodies tested to determine which thyroid disease you might have.  To test for Hashimoto's, you need to have Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).  These antibodies can also be present in small amounts with Graves Disease, but the definitive test for Graves is Thyroid Stimulating Immunoglobulin (TSI).  You can't be positively diagnosed with Graves without the TSI test and then it's not just the raw number, it's a percentage.  You should also ask for a thyroid ultrasound in order to determine whether or not you have nodules.  Usually, nodules are nothing to worry about, but sometimes they can produce hormones on their own, independently, of the thyroid.

You should also insist that your doctor order the Free T3 and Free T4 tests to determine exactly what your thyroid is doing, since TSH is a pituitary hormone, which is only a messenger and is not infallible, though some doctors think it is.  Some symptoms of hyperthyroidism can also apply to hypothyroidism, so without all the right tests, you really can't know what's going on.