# Hashimoto and exophtalmos



## dg9528 (Feb 9, 2012)

HELLO, i have hashimoto since 2011 and on levothyroxine 25 . i want to knw wether exophtalmos is possible in hashimoto??
i have tested the trak anitobodies which is <1 that means its negative.so we can have exophtalmos without presence of trak???
one day i was on computer for over 8 hours!...i felt that my eye musces became tightened ...i thought its due to over working on pc....but next day i awakened with my left eye enlarged..but till evening it came back to normal...but my cornea moved up little bit...no one can notice except me who spend 15 mints to notice that...no irretation no pain ...
i went to 2 ophtalmogist ...one said its ptosis other said its exophtalmos ..;
even if its exophtalmos then is itt possible that my eye get enlarged or reduce to normal with time????
thnx


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## Andros (Aug 26, 2009)

dg9528 said:


> HELLO, i have hashimoto since 2011 and on levothyroxine 25 . i want to knw wether exophtalmos is possible in hashimoto??
> i have tested the trak anitobodies which is <1 that means its negative.so we can have exophtalmos without presence of trak???
> one day i was on computer for over 8 hours!...i felt that my eye musces became tightened ...i thought its due to over working on pc....but next day i awakened with my left eye enlarged..but till evening it came back to normal...but my cornea moved up little bit...no one can notice except me who spend 15 mints to notice that...no irretation no pain ...
> i went to 2 ophtalmogist ...one said its ptosis other said its exophtalmos ..;
> ...


Okay; you should have no Trab. At all. Nor should you have TBII, TPO.

It is possible to have exophthalmos with Hashimoto's but more importantly many w/Hashi's do go on to develop Grave's.

If you have any TSI, even if it is below the range, that is "definitive" for hyperthyoid. As to the reason, that's another story. It could be because of cancer, Hashimoto's or Graves'.

Hashimoto's is diagnosed by FNA. If certain Hurthle Cells indigenous to Hashi's are present, then you have Hashi's.

Histologic diagnosis of Hashimoto's
http://emedicine.medscape.com/article/120937-diagnosis

The criteria for Graves' is clinical. You must exhibit..........goiter, exophthalmos, pretibial myxedema and thyrotoxicosis as per Dr. Robert Graves' of the 1800 era. 3 out of the 4 qualify.

Otherwise you are classified as hyperthyroid either because of Hashi's, the criteria for that being high TPO Ab and a grapelike appearance of the thyroid, both of which are "suggestive" because this is commonly seen in Hashi's with FNA (fine needle aspiration) confirming those suspicions "if" there are Hurthle Cells indigenous to Hashimoto's. Or because of cancer. We don't know which comes first, the hyperthyroid or the cancer. We just know that they are often found together.

Substances not found in normal serum
http://www.thyroidmanager.org/Chapter6/Ch-6-6.htm

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

If you do indeed have exophthalmos, it has to be treated. There is much to be done. What did the Ophthalmologist suggest to you?

Welcome to the board!


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## dg9528 (Feb 9, 2012)

I havé Both TPo and tbi
5 Times more than lab range ...to confirm i don hâve hyper i asked the trak result which is négative so its sûre that i m not hyper only hashimoto bécoz of antibodies TPo tbi ....main question is ...my éye was enlarged and then came back to normal...so itmeans by the Time it ll change


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## Octavia (Aug 1, 2011)

Can you please restate your question? I do not understand what you are asking.


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## dg9528 (Feb 9, 2012)

my question is wether in exophtalmos eyes can get back to normal position???becoz my eye was enlarged one day then came back to normal ..its only cornea which has moved upwards ..thnx


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## Octavia (Aug 1, 2011)

Have you seen an Opthalmologist about it? That would be my recommendation...sorry I don't have an answer to your question...perhaps someone else does.


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## dg9528 (Feb 9, 2012)

hello,i had ct scan last friday and they found exophtalmos in left eye...my ophtalmo said u need to reconsider ur thyroid dosage ....and my doctor said ur tsh is within range...in france range is between 1 to 4 ..mine was 3.19 ....i don knw what to do ..ophtalmo sends me to doctor and doctor said u need to visit ophtalmo ....i m on 25 levothyroxine and if i take 50 then it could be more dangerous for exophtalmos becoz its hyperthyroidism which causes exophtalmos ...
in ct scan they just found that my optic nerve was bit enlarged as compare to right side eye...beside there was no tumor nothing which was forcing eye ..any idea???should i leave taking thyroxine or need to adjust ??


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## lainey (Aug 26, 2010)

The eye disease is caused by the presence of the thyroid stimulating antibodies (TSI), not being overmedicated (which you are not).

Many times for these antibodies the doctor will tell you "negative" because they are not out of range. For TSI, it is whether or not you have them, not how high they are. They can cause the eye disease even after your thyroid has stopped working.

Reducing your medication is not going to help--the medication does not control the antibodies that cause it.

You need to find a different eye doctor to treat the eye disease--drops, a program of steroids, is usually where it begins. A university, or endocrinologist that treats patients who have hyperthyroidism (Grave's Disease) is a place to start for a referral.


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## Andros (Aug 26, 2009)

dg9528 said:


> hello,i had ct scan last friday and they found exophtalmos in left eye...my ophtalmo said u need to reconsider ur thyroid dosage ....and my doctor said ur tsh is within range...in france range is between 1 to 4 ..mine was 3.19 ....i don knw what to do ..ophtalmo sends me to doctor and doctor said u need to visit ophtalmo ....i m on 25 levothyroxine and if i take 50 then it could be more dangerous for exophtalmos becoz its hyperthyroidism which causes exophtalmos ...
> in ct scan they just found that my optic nerve was bit enlarged as compare to right side eye...beside there was no tumor nothing which was forcing eye ..any idea???should i leave taking thyroxine or need to adjust ??


I sure hate to hear this. And by the way, it is typical for one eye to be worse than the other and it usually is the left but there are exceptions. For some it is the right eye.

Have you had an ultra-sound of your thyroid?

Do you know if you have antibodies?

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/

I am wondering if you really should be on thryoxine replacement at this time because you could have blocking, binding and stimulating antibodies which could be skewing your lab numbers.

Is TSH the only test you have had? Did doctor not do the FREE T3 and FREE T4?

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.

http://www.drlam.com/articles/hypothyroidism.asp?page=2#diagnosis: standard laboratory test


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