# Am I still hyperthyroid? Feeling very hypo recently, but doc doesn't think so..



## zf1225 (Mar 2, 2012)

Hello everyone! I'm new to the boards, been reading a bunch of threads and found them all super helpful  I was diagnosed with Graves disease 4 weeks ago (High Free T4 5.27, High Free T3, almost zero TSH, High TSI, Antibodies present, Radioactive iodine test shows a homogeneous diffused / 2X enlarged gland).

Since then, I've been taking 20mg of Methmizole daily and started feeling better almost immediately. No more hand tremors, heartrate down from 120 bpm to 80bpm in just a week! arty0045:

However, 2 weeks w/ the meds, I started feeling incredibly lethargic (sleeping 10+ hours a day and still tired), constipated, cold, muscle cramps even when I try to scratch my back or leg! I've also gained about 7 mysterious pounds (120 to 127) in the past 2 weeks, despite eating healthier and regular exercise (I've been walking 4 + miles a day, something I never used to do..) I feel incredibly hypo and decided to stop taking the Methmizole a few days ago. I just went into my endo this week and got some updated results.

Good news is that my Free T4 is now .6 (normal range .6 to 1.6). My endo says she has never seen it drop that fast in anyone! However, my thyroid gland is much larger than before. It's now about 4X the normal size, up from 2X just a month ago. :scared0015: Endo says it may be residual thyroid hormones still acting on my gland, while T4 has dropped already. I'm not sure I buy this information.. Free T4 has a half-life of 1 week, and if mine is already on the low side of normal, meaning it was already on it's way down a week ago. How is my thyroid gland still growing? My thyroid is now quite obvious when I look at my neck in the mirror, and a month ago, barely see the difference 

my Endo says there's a rare chance I can have both Graves and Hashimotos, but she doesn't think so. I'm getting a few more tests done and results soon (TSI, Free T3, electrolytes). She asked that I drop my methmizole dosage to 5mg a day until further notice.

Does anyone have any ideas what could be going on here? Why is my thyroid growing when T4 is on the low end of normal? Is my weight gain normal? Any help / insight will be so appreciated 

Here are some results from the last few blood rounds:
Component Latest Ref Rng 2/28/2012 3/7/2012 4/2/2012 
TSH 0.34 - 4.82 uIU/mL <0.01 (L) <0.01 (L) <0.01 (L) 
T4 FREE 0.6 - 1.6 ng/dL 5.16 (H) 5.27 (H) 0.60

T3 FREE PG PER ML 2.3 - 4.2 pg/mL 19.34 (H) -Only ran on 3/7/2012
TSI % 320 (H) -Only ran on 3/7/2012

Thanks all for reading


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## Prairie Rose (Nov 17, 2011)

I don't really understand the lab results much, but I do understand the weight gain and tiredness you are dealing with. And I hate it!

I was diagnosed with Graves last fall. Shortly after being on 10 mg of methi (and steroids for my eye involvement), kaboom. I exploded.

And can NOT get rid of it at all.  Clothes are too tight, I feel bloated and uncomfortable, and energy is seriously lacking.

I try to eat right also and run constantly from daybreak to well past dark.

Endo cut me down 2 months ago to a 10 mg tab one day, and a half tab the next. He said I am slowed down too much according to my labs, which certainly matches with how I feel. I miss my energy. 
I hope he cuts me down even farther on the methi with my next visit in 2 weeks.

I don't want to get hyper again, but I do not want hypo, either.


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## zf1225 (Mar 2, 2012)

Thank you Prairie Rose for sharing your experience  The weight gain is so depressing, I'm hoping all will be normal once the hormones are in balance.

My endo says feeling tired is normal and just our bodies adjusting to the lower thyroid hormones throughout..

The thing that worries me most is that my thyroid gland has grown in size in the time my T4 has come down.. Not sure what to think of that.


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## Andros (Aug 26, 2009)

zf1225 said:


> Hello everyone! I'm new to the boards, been reading a bunch of threads and found them all super helpful  I was diagnosed with Graves disease 4 weeks ago (High Free T4 5.27, High Free T3, almost zero TSH, High TSI, Antibodies present, Radioactive iodine test shows a homogeneous diffused / 2X enlarged gland).
> 
> Since then, I've been taking 20mg of Methmizole daily and started feeling better almost immediately. No more hand tremors, heartrate down from 120 bpm to 80bpm in just a week! arty0045:
> 
> ...


It is my humble opinion that antibodies are at work. There are binding, blocking and stimulating antibodies. This activity can make your numbers go bonkers.

You might find this interesting reading.
http://www.clinicalcorrelations.org/?p=2523

Hashimoto's and Grave's are regarded by "some" as sisters in the 'hood!

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.

Both Grave's and Hashi's typically rebound meaning things quiet down for a time and then "bam!" Each time, the rebound is more vicious and longer lasting. Sad, but true.


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## zf1225 (Mar 2, 2012)

Thanks Andros! Appreciate the article suggestion and details 

I do have elevated thyroid antibodies. These were taken in early march, right before going on Methimazole.

THYROID PEROXIDASE AB	
Me: >1000	
Range: LESS THAN 35 IU/mL

THYROGLOBULIN AB	
Me: 557	
Range: LESS THAN 20 IU/mL

I've also had Radioactive iodine uptake test in late feb / early march performed. As well as a scan to see the thyroid. The radiologist / nuclear med doctor said it's a "thyroid gland demonstrates diffuse homogeneous increased uptake in a relatively enlarged thyroid gland most compatible with Grave's disease. Iodine uptake by the thyroid gland is 82 % at 6 hours and 70 % at 24 hours. At 6 hours, the normal range is 6-18%. At 24 hours, the normal range is 10-35%."

What I'm confused about:
1. I thought TPO AB was usually high in hypos? Mine are off the charts high, while I had high FT4 and high FT3 :confused0003:
2. I didn't know Hashi's can cause hyper too. Learn something new everyday!

I'm going to see if I can get another round of antibodies test (now that my T4 is lowered).

Many thanks!!
:hugs:


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## Andros (Aug 26, 2009)

zf1225 said:


> Thanks Andros! Appreciate the article suggestion and details
> 
> I do have elevated thyroid antibodies. These were taken in early march, right before going on Methimazole.
> 
> ...


Actually, TPO Ab is not exclusive to thyroid but rather a myriad of autoimmune diseases including cancer.

Anti-microsomal Antibodies- TPO Ab
Negative test is normal; you should not have any of these antibodies. And the healthy person does have a low titer of TPO.
http://www.nlm.nih.gov/medlineplus/ency/article/003556.htm

I don't think Hashi's causes Graves'. My take on the article is that they are closely intertwined and it is hard to diagnose w/o the proper in-depth testing and some serious clinical evaluation.

Occasionally the picture of Hashimoto's thyroiditis blends rather imperceptibly into that of thyrotoxicosis, and some patients have symptoms of mild thyrotoxicosis, but then develop typical Hashimoto's thyroiditis. In fact, it is best to think of Graves' disease and Hashimoto's thyroiditis as two very closely related syndromes produced by thyroid autoimmunity. Categorization depends on associated eye findings and the metabolic level, but the pathogenesis, histologic picture, and function may overlap.

http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/


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## zf1225 (Mar 2, 2012)

Thanks again, andros for the detailed reply 

I just received my updated TSI results back. It actually went up in the past month, while my FT4 and FT3 lowered (due to the methimazole use).

4/3/12
TSI: 359 (normal <140)
FT4: .6 (normal .6-1.6)
FT3: 4.4 (normal 2.3-4.2)

3/1/12
TSI: 320
FT4: 5.2
FT3: 19.3
20mg methimazole

According to my endo, due to the higher TSI, my goiter has enlarged quite a bit and suggested I continue with Methimazole in 5mg per day for the next month. Just hope that the lethargy / weight gain does not continue


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## Lovlkn (Dec 20, 2009)

zf1225,

20mg of Methmizole is a moderate dose I began on that dose and went hypo within a month - it does and can happen that quickly.

With your FT-4 that low I would be sure to re-test within 4 weeks. Have they offered you propranolol to help bring down your FT-3?

It is very important that you test your FT-4 and FT-3 each time and dose off of them - not the TSH test because the antibody involvement will likely skew the TSH test.

In my opinion if you are testing high on TSI and high on TPO antibodies you likely have hashitoxicosis.

I was told by my surgeon that I had hashitoxicosis - was on Tapazole for 4.5 years prior to my surgery - the entire time my TPO antibodies increased until I gave in and opted for surgical removal of my thyroid - Ahhh - it was the best decision I could have made.

You should NOT have RAI - not with both antibodies being present in my opinion.


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## zf1225 (Mar 2, 2012)

Thanks, Lovlkn!

How is Hashitoxiosis diagnosed? From what I understand, you need a high TSH, normal FT4 and FT3s, and high antibodies? I asked my doc about this awhile back, and my endo did not think I have both hashis and graves.. Are there other markers I'm missing?

I've been reading a lot about Bugleweed and it's possible lowering of TSI. I feel like taking methimazole is just treating the symptoms of Graves, not the actual cause, which is the autoimmune disease that causes my antibodies to go sky high. Seeing that TSI is now higher than before, I'm going to try bugleweed.

If it comes to removing my thyroid, I would opt for the surgery and not RAI. Something about injecting yourself with a high dosage of radiation, does not sit well with me :glow:


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## Andros (Aug 26, 2009)

zf1225 said:


> Thanks, Lovlkn!
> 
> How is Hashitoxiosis diagnosed? From what I understand, you need a high TSH, normal FT4 and FT3s, and high antibodies? I asked my doc about this awhile back, and my endo did not think I have both hashis and graves.. Are there other markers I'm missing?
> 
> ...


Bugleweed would also be a panacea.

Bugleweed should never be substituted for prescription thyroid medications except on the recommendation of a doctor. Patients who suffer from osteoporosis or who are taking oral contraceptives or fertility drugs should consult their doctor before taking bugleweed.

Bugleweed has only been tested in thyroid conditions involving overactive thyroid. There have been no clinical studies performed on humans. The information on the effects of bugleweed was derived from animal studies. The effects of medication on animals may be different than the effect on humans. Researchers have not yet evaluated the inhibiting effects of bugleweed on hormones.

http://www.herbal-supplement-resource.com/bugleweed-herb.html

If I could do it over again; I would go straight on to surgery. 2 years on anti-thyroid meds almost killed me.

Give all this some very serious thought.

Whatever you decide, we will support your efforts. Everyone is different!


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