graves/hashimoto? confused

[alikat1205]

I was diagnosed hypo thyroid  with hashimoto's about 7 years ago and have done fine on synthroid 50 mg since that time.  About August of this year I noticed the sudden growth of my thyroid, huge and noticeable goiter where only the month before I had nothing, so I made an emergency appointment to my doctor.  She tested my tsh (only, no other thyroid tests) and got a reading of .02 and discontinued my synthroid.  I went in for a repeat TSH four weeks later and it was still .02.  I went four weeks later and it is .02.  My doctors says she suspects Graves AND Hashimotos.  How is this even possible?  She called today and recommended repeat testing in 6 weeks.  

I am uncomfortable with this plan.  First off, the huge goiter appeared nearly overnight, and that doesn't sound good.  Second, nothing is changing, so what exactly is she waiting to find out?  She hasn't answered these questions, just ignores me.  Can the goiter shrink?  If not, what are my options to get rid of it?  I don't like it or want to keep it.  Is there a possibility it is more serious?  Is doing the TSH only acceptable?  I mean, if it not changing, it seems like maybe more information is something to think about, but she doesn't think I need anything by TSH test.  Should I just keep on going for another 6 weeks (which is really more like 8 because of the holidays) and not treat this very low number?

[goolarra]

I'd just like to add that TSH is NEVER sufficient by itself to manage thyroid disease.  A bare minimum of testing is FT3, FT4 and TSH EVERY time labbs are drawn.

Has your doctor tested for the antibodies that are markers for Graves' and Hashi's?  Graves' is characterized by elevated TSI (thyroid stimulating immunoglobulin) and Hashi's by elevated TPOab (thyroid peroxidase antibody) and/or TGab (thyroglobulin antibody).  Your doctor shouldn't have to "suspect"; these simple antibody tests (blood tests) will confirm or eliminate those diagnoses.

It does sound like a contradiction in terms that you can have both Graves' and Hashi's, but although rare, it is possible.  You can have the antibodies for both Graves' and Hashi's.  You are treated depending on which condition dominates at the time.

[alikat1205]

how long did you wait from goiter to thyroid storm?  I am going on nearly three months at this point.  my doctor seems very laid back.

[Totie]

My goiter appeared over night as well. I had graves/hyper/toxic goiter.

However, I was in full blown thyroid storm by the time I went to Endo.

I ended up getting RAI, then another thyroid storm and by then I was 88 lbs..and HR at 140 sitting down. They quickly did the thyroidectomy.

[Red_Star]

Yes, you can have both Hashimotos and Graves. This is sometimes referred to as Hashitoxicosis. I've has this condition myself but thankfully only lasted 2 months. My pretibal myxedema (due to the Graves antibodies) took another year to disappear though. Another sign I had of Graves was the Joffroy's sign - "absence of forehead wrinkling when the gaze is suddenly directed upward." That was one of my party tricks. :)

http://www.medhelp.org/posts/Thyroid-Disorders/Diagnosed-with-Hashimotos-AND-Graves-disease/show/944756