# Graves vs Hashimoto's



## Mommyof2 (Oct 2, 2012)

I'm hoping someone can clarify for me because I'm a bit confused. I was diagnosed with Hashimoto's but part of me is wondering if its not Graves. My TSI was not tested but is that the only way to diagnose it? My symptoms are on both sides. My biggest complaints: hair loss, low sex drive, anxiety (original complaint was fainting episodes which I believed were brought on by anxiety), feel colder than most people, hand shakiness at times, fatigue.

My thyroid is enlarged and 2 nodules were biopsied. They were benign. Here are my lab results.

June 2012
TSH 1.08 (0.4-4.5)
T4 10.4 (4.5-12.0)
T3 total 114 (76-181)
Thyroglobulin ABS 60 (<20)
TPO 826 (<35)
also... ANA IFA screen was positive if that means anything

October 2012
TSH 1.39 (0.4-4.5)
Free T3 3.3 (2.3-4.2)
Free T4 1.3 (0.8-1.8)
TPO 901 (<35)

Can you tell by this and my symptoms if it appears more Graves or hashi's? I realized that Hashimoto's has periods or hashtoxicosis and I have no idea where to begin differentiating the two.


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## greatdanes (Sep 25, 2010)

The only way to know is to get your TSI tested. Any % of TSI is a graves indicator. My TSI was 99 back in 2007, but b/c it was in 'range' (and the docs don't know any better) I was not dx with graves. I also have low-but-in-range T3 AND T4, and have hasimotos. In my case they balance each other out so one doesn't dominate the other.


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## sleepylady (Mar 18, 2012)

Greatdanes-

How did you finally get diagnosed with Graves? Hashimoto's?

My TSI was 84%, normal FT3 middle of range and FT4 low in range.


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## Andros (Aug 26, 2009)

Mommyof2 said:


> I'm hoping someone can clarify for me because I'm a bit confused. I was diagnosed with Hashimoto's but part of me is wondering if its not Graves. My TSI was not tested but is that the only way to diagnose it? My symptoms are on both sides. My biggest complaints: hair loss, low sex drive, anxiety (original complaint was fainting episodes which I believed were brought on by anxiety), feel colder than most people, hand shakiness at times, fatigue.
> 
> My thyroid is enlarged and 2 nodules were biopsied. They were benign. Here are my lab results.
> 
> ...


Here is info.

TPO
Mild to moderately elevated levels of thyroid antibodies may be found in a variety of thyroid and autoimmune disorders, such as thyroid cancer, Type 1 diabetes, rheumatoid arthritis, pernicious anemia, and autoimmune collagen vascular diseases. Significantly increased concentrations most frequently indicate thyroid autoimmune diseases such as Hashimoto thyroiditis and Graves disease.
http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test

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

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

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.
(3 chapters) http://www.thyroidmanager.org/chapter/graves-disease-and-the-manifestations-of-thyrotoxicosis/

http://www.thyroidmanager.org/chapter/diagnosis-and-treatment-of-graves-disease/

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/


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## webster2 (May 19, 2011)

I thought TRab was an indicator too. Thyroid storm brought on my diagnosis. I kept getting told I was in menopause.


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