# Hyperthyroidism, Graves' Disease and Hashimoto's



## simplenester (May 4, 2012)

Hello I'm a 27y.o female recently diagnosed with all the above diseases/conditions. I started with severe watery diarrhea, causing profound dehydration. I was also very Tachycardic, my pulse was in the mid 130s. I was also very diaphoretic to the point where the sweat would soak up my clothes. I was getting very light headed as well. I was admitted in the hospital for 9days. The last time I had similar symptoms was in October of 2011 but they never officially diagnosed me with anything. In October of 2011 when they did an ultrasound of my thyroid it showed one nodule to the left. I underwent a needle-guided biopsy.

My pregnancy test always comes back positive and each time I know I am NOT. I was referred to an OBGYN in 2011 for follow-up who after running weekly serum pregnancy tests for two months dismissed without definitive diagnosis. When I was admitted in the hospital three weeks ago my serum pregnancy test was positive again even if a follow ultrasound showed no IUP (which of course I already knew) There are only two reasons for false pregnancy positives. One being a probability of ovarian tumors or cancer and the other being a cross reactivity between the thyroid hormone (TSH) and the pregnancy hormone (HCG). I'm not sure if it could be both. I had a pelvic/uterus and trans vaginal ultrasound to check for tumors and ithey all came back negative. However, am wondering if there is a more definitive test to check for ovarian tumors.

Now Hashimoto's indicates HYPOthyroidism. In my case in six months I've gone from having one left sided nodule on my thyroid from my last hospitalization in October of 2011 to four nodules on each side (both right and left) as shown by the thyroid ultrasound done during my last hospitalization three weeks ago. My hormones remain critical high even after taking Tapazole 40mg p.o daily for 3 weeks and Atenolol 50mg p.o daily. I do not have all my results infront of me as I post here but will post them later. However my anti-body tpo which the normal range is 0-9 mine is 2, 500. Anti-body tpo is the definitive test for Hashimoto's. However all my other thyroid sensitive tests are also critical high thus having Graves' disease. I was NOT aware I could have Hashimoto's and be Hyprethyroid at the same time. Is this possible? My endocrinologist who has 16yrs experience in this specialty told me she's never seen a case like mine. She keeps telling me everything about my case is "rare" I'm seeking a second opinion next Friday.

My symptoms remain the same. My diarrhea has stopped however I have anywhere from 10-15 episodes of loose stools everyday. If I do light chores like washing dishes I become very diaphoretic. When I sleep at night even with the windows open and fan on because of heat intolerance my heart still races. I'm worried am not getting better despite the medication high doses. I'm well aware medication can take a while to work. However, I also want to ensure am getting the care I should, all the tests run and all options explored to leave no stone unturned so to speak.

I apologize for the long post. I appreciate your time and assistance/advice in advance.

Thank you,
Simplenester


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## polly (Oct 29, 2010)

Good Morning Simplenester - I'm so sorry for all you are going thru. I only have Graves and mine has been mild compared to so many others here. Some one here will come a long soon that can relate more to what you are going thru. Just hang in there and know that we here care! hugs1


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## joplin1975 (Jul 21, 2011)

I'm thinking you might want to check out the hashitoxocisis boards. I can't offer much help, but you might find some of those posts insightful.

Has anyone discussed total removal of the thyroid?


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## Andros (Aug 26, 2009)

simplenester said:


> Hello I'm a 27y.o female recently diagnosed with all the above diseases/conditions. I started with severe watery diarrhea, causing profound dehydration. I was also very Tachycardic, my pulse was in the mid 130s. I was also very diaphoretic to the point where the sweat would soak up my clothes. I was getting very light headed as well. I was admitted in the hospital for 9days. The last time I had similar symptoms was in October of 2011 but they never officially diagnosed me with anything. In October of 2011 when they did an ultrasound of my thyroid it showed one nodule to the left. I underwent a needle-guided biopsy.
> 
> My pregnancy test always comes back positive and each time I know I am NOT. I was referred to an OBGYN in 2011 for follow-up who after running weekly serum pregnancy tests for two months dismissed without definitive diagnosis. When I was admitted in the hospital three weeks ago my serum pregnancy test was positive again even if a follow ultrasound showed no IUP (which of course I already knew) There are only two reasons for false pregnancy positives. One being a probability of ovarian tumors or cancer and the other being a cross reactivity between the thyroid hormone (TSH) and the pregnancy hormone (HCG). I'm not sure if it could be both. I had a pelvic/uterus and trans vaginal ultrasound to check for tumors and ithey all came back negative. However, am wondering if there is a more definitive test to check for ovarian tumors.
> 
> ...


Wow!!! First and foremost have you had any FNA (fine needle aspiration) of the nodules in your thyroid?

Secondly, TPO is not definitive of Hashimotos. TPO is merely "suggestive" and it is also "suggestive" of a myriad of other things 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

If you had FNA and Hurthle Cells were found that are indigenous to Hashimoto's, that would be definitive. There are also Hurthle Cells indigenous to thyroid cancer so you can see the need for a good pathologist.

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

Hashimoto's Hurthle cells
http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)71549-2

Cancer Hurthle Cells
http://www.thyroidmanager.org/Chapter21/ch01s12.html

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.

Hashi's and Graves' closely related
http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/

Graves' is defined by the following criteria.

It is my humble opinion that the following would sort things out.

FNA of nodules

TSI lab test

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

And RAIU ( radioactive uptake scan.)

Furthermore, I do think on at least one ocassion you were hospitalized because of a Thyroid Storm.

Thyroid Storm Symptoms
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001437

I am sorry for what brought you here but am very glad you are here.










I forgot to say that yes, you can flit back and forth from hypo to hyper w/Hashimoto's but on the long haul, that usually ends up to be Graves'. This stuff is very very complicated.

Hashi's and Graves' closely related
http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/


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## simplenester (May 4, 2012)

@Polly thank you so much for your kind and warm welcome


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## simplenester (May 4, 2012)

@Joplin1975 thank you for the great suggestion I just posted there as well


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## simplenester (May 4, 2012)

@Andros so so much great and insightful information. I have definitely not had a FNA. I will bring it up on my second opinion appointment next week. About the TSI I need to review my labs and see if that was checked and if it was what the results were. The thyroid CA is scary but I'd rather find out early and get it figured out than hold off on it. My anti-body TPO was obviously super high at 2, 500 so am super worried but am hoping for the best. Thanks again!!!


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## Andros (Aug 26, 2009)

simplenester said:


> @Andros so so much great and insightful information. I have definitely not had a FNA. I will bring it up on my second opinion appointment next week. About the TSI I need to review my labs and see if that was checked and if it was what the results were. The thyroid CA is scary but I'd rather find out early and get it figured out than hold off on it. My anti-body TPO was obviously super high at 2, 500 so am super worried but am hoping for the best. Thanks again!!!


Of course "we" would rather find out. Then a move can be made on it pronto if needed.

Please do let us know what happens at your second opinion.

You are very very welcome for any help given. That is what we are here for!


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## simplenester (May 4, 2012)

@Andros thanks again will definitely post an update after my second opinion at the end of this week.


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