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Newly diagnosed hashimotos
I was diagnosed with hashimotos based off antibody blood test. Yet I'm being treated for hyperthyroidism. Is this common? When you read about hashimotos it talks about hypo not hyper. Also I was put on methimazole 5mg every other day due to being pregnant. My endocrinologist said it's not safe during pregnancy and was hesitant to put me on it. Has anyone else taken this while pregnant? A little history.. I have been unwell for years no one ever tested my thyroid. I have been tested for lupus and other autoimmune. It wasn't until I had sever hives for 11 months and getting a second opinion that the allergist found out it was my thyroid causing hives and angioedema.
Excerpt from American Thyroid Association -
Hyperthyroidism When and how to use antithyroid drugs during the first trimester of pregnancy...
"Antithyroid drugs, such as methimazole (MMI) and propylthiouracil (PTU) have been used to treat hyperthyroidism during pregnancy. The American Thyroid Association and the Endocrine Society guidelines recommend using PTU in the 1st half of pregnancy if drug treatment is needed due to a greater frequency of birth defects with MMI. This increased risk of birth defects with MMI is very small as a Food and Drug Administration review of all pregnancies between 1969-2009 found 29 reports of birth defects associated with MMI use in the first trimester of pregnancy as compared to 9 reports of PTU-associated birth defects."
***
Excerpt from the article: The Medical Journal Of European 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. In this article the term is strictly limited to the ‘leakage’ symptoms of active Hashimoto’s disease."
***
Excerpts from the book: Thyroid Disorders and Related Health Conditions by James M. Lowrance...
"Some Hashimoto's Hypothyroid Patients Experience 'Hashitoxicosis'
While Hashimoto's typically causes hypothyroidism (low thyroid hormone levels) some patients can have fluctuations in their thyroid hormones, that go from hypothyroid to hyperthyroid (from abnormally-low to abnormally-high thyroid hormone) and this can be due to them having high levels of a certain type of thyroid antibody. The condition I refer to is "Hashitoxicosis".
The antibodies that are blood tested for, when Hashimoto's is being determined/diagnosed, are the anti-TPO (anti-thyroidperoxidase) and the anti-TG (anti-thyroglobulin) antibodies (also referred to as "autoantibodies"). Either or both of these testing positive helps to confirm presence of this hypothyroid disease.
However some Hashimoto's patients can also test positive for autoimmunity cells called "TSI" antibodies (Thyroid Stimulating Immunoglobulin). This antibody is what usually contributes to Grave's Disease or "autoimmune hyperthyroidism" however, some Hashimoto's patients have these antibodies at high levels, as well as having the TPO and or TG ones, that typically cause Hashimoto's.
You could say they are suffering from Grave's and Hashimoto's, simultaneously, usually for a limited period of time. This phenomenon is most prominent during the early stage of Hashimoto's and for many patients, the hyperthyroid phases will diminish over time."
'Block and Replace' Treatment for Non-Resolving Hashitoxicosis
Even without having TSI antibodies present, Hashimoto's thyroiditis patients can potentially experience flares of thyroiditis, which can also cause mild hyperthyroid type symptoms that are not as severe as those caused by Hashitoxicosis, if phases of hyperthyroidism symptoms are severe. Some patients who have both Hashimoto's thyroiditis and Grave's antibodies that cause continually unstable thyroid hormone levels and that do not resolve over time, are sometimes placed on a treatment called "block and replace".
This is a treatment in which they will block the hyper-stimulation of the thyroid with an anti thyroid drug (the medication slows hormone production) and afterward, at the appropriate timing, they will give the patient thyroid hormone therapy (replacing the diminished thyroid hormone levels). This is an alternative treatment to thyroid removal (thyroidectomy and ablation), however, if the treatment fails, once given an ample trial, thyroid removal might be recommended as a follow up treatment."
For Most Hashimoto's Patients - Hashitoxicosis Resolves on Its Own
Some Hashimoto's patients have been known to actually transition over to Graves Disease over time, when having both types of antibodies (those that destroy thyroid cells and those that stimulate thyroid hormone production) and they become progressively hyperthyroid (not common).
Most Hashimoto's thyroiditis patients who experience Hashitoxicosis however, will have intermittent hyperthyroid phase for periods of weeks or months but they will still become progressively hypothyroid afterwards and there comes a point at which the Hashitoxicosis resolves and never returns."
Hyperthyroidism When and how to use antithyroid drugs during the first trimester of pregnancy...
"Antithyroid drugs, such as methimazole (MMI) and propylthiouracil (PTU) have been used to treat hyperthyroidism during pregnancy. The American Thyroid Association and the Endocrine Society guidelines recommend using PTU in the 1st half of pregnancy if drug treatment is needed due to a greater frequency of birth defects with MMI. This increased risk of birth defects with MMI is very small as a Food and Drug Administration review of all pregnancies between 1969-2009 found 29 reports of birth defects associated with MMI use in the first trimester of pregnancy as compared to 9 reports of PTU-associated birth defects."
***
Excerpt from the article: The Medical Journal Of European 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. In this article the term is strictly limited to the ‘leakage’ symptoms of active Hashimoto’s disease."
***
Excerpts from the book: Thyroid Disorders and Related Health Conditions by James M. Lowrance...
"Some Hashimoto's Hypothyroid Patients Experience 'Hashitoxicosis'
While Hashimoto's typically causes hypothyroidism (low thyroid hormone levels) some patients can have fluctuations in their thyroid hormones, that go from hypothyroid to hyperthyroid (from abnormally-low to abnormally-high thyroid hormone) and this can be due to them having high levels of a certain type of thyroid antibody. The condition I refer to is "Hashitoxicosis".
The antibodies that are blood tested for, when Hashimoto's is being determined/diagnosed, are the anti-TPO (anti-thyroidperoxidase) and the anti-TG (anti-thyroglobulin) antibodies (also referred to as "autoantibodies"). Either or both of these testing positive helps to confirm presence of this hypothyroid disease.
However some Hashimoto's patients can also test positive for autoimmunity cells called "TSI" antibodies (Thyroid Stimulating Immunoglobulin). This antibody is what usually contributes to Grave's Disease or "autoimmune hyperthyroidism" however, some Hashimoto's patients have these antibodies at high levels, as well as having the TPO and or TG ones, that typically cause Hashimoto's.
You could say they are suffering from Grave's and Hashimoto's, simultaneously, usually for a limited period of time. This phenomenon is most prominent during the early stage of Hashimoto's and for many patients, the hyperthyroid phases will diminish over time."
'Block and Replace' Treatment for Non-Resolving Hashitoxicosis
Even without having TSI antibodies present, Hashimoto's thyroiditis patients can potentially experience flares of thyroiditis, which can also cause mild hyperthyroid type symptoms that are not as severe as those caused by Hashitoxicosis, if phases of hyperthyroidism symptoms are severe. Some patients who have both Hashimoto's thyroiditis and Grave's antibodies that cause continually unstable thyroid hormone levels and that do not resolve over time, are sometimes placed on a treatment called "block and replace".
This is a treatment in which they will block the hyper-stimulation of the thyroid with an anti thyroid drug (the medication slows hormone production) and afterward, at the appropriate timing, they will give the patient thyroid hormone therapy (replacing the diminished thyroid hormone levels). This is an alternative treatment to thyroid removal (thyroidectomy and ablation), however, if the treatment fails, once given an ample trial, thyroid removal might be recommended as a follow up treatment."
For Most Hashimoto's Patients - Hashitoxicosis Resolves on Its Own
Some Hashimoto's patients have been known to actually transition over to Graves Disease over time, when having both types of antibodies (those that destroy thyroid cells and those that stimulate thyroid hormone production) and they become progressively hyperthyroid (not common).
Most Hashimoto's thyroiditis patients who experience Hashitoxicosis however, will have intermittent hyperthyroid phase for periods of weeks or months but they will still become progressively hypothyroid afterwards and there comes a point at which the Hashitoxicosis resolves and never returns."
Even more important, we need to know about any symptoms you have. Have you had an ultrasound of the thyroid gland?
Test results and calculated ranges vary from lab to lab, so we need to know the ranges shown on the lab report for those results.
My lab results are
TSH 0.01
T3 uptake < 15.0
T7 index undetectable
T4 free 1.1
T3 free 3.6
TPO antibody 91
TSH 0.01
T3 uptake < 15.0
T7 index undetectable
T4 free 1.1
T3 free 3.6
TPO antibody 91
Please post your thyroid related test results and reference ranges shown on the lab report. Also please tell us about any symptoms you have. Have you had an ultrasound test of the thyroid gland?
Perhaps other members will respond to your question about taking Methimazole during pregnancy.
Perhaps other members will respond to your question about taking Methimazole during pregnancy.
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