# Help Translating Labs - Both Hashi's & Graves?



## hashigirl (Apr 30, 2007)

I am wondering if I have both Hashi's & Graves. I am very thin and go hyper frequently when i am on no medication, I have been diagnosed with Hashi's.

Here is my last labs:

January (on no thyroid meds)
TPO 2,070
TSI 114 (2x now)
TSH 7.811
Free T3 3.9
Free T4 1.07

October
TSH .31
Free T4 1.3
Free T4 360

August 
TSH .006
Free T4 1.1
Free T3 400

Is this graves and hashi's?????


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## NastyHashi (Mar 11, 2007)

I'de call that Graves' with a touch of Hashi's - same as me. Wildly fluctuating TSH and high TSI.

You have similar labs as mine all the way around.

I would so TOTALLY love to blow my doctors mind and have you come in with me on back to back appointments to see what they say since my Endo already thinks I have a very "weird case".

If you find an answer PLEASE tell me cause I am in the same boat.

The doctors like, "well, your TSH is high so we'll give you some Synthroid but then again if it is Graves' disease then you will be overdosing on thyroid hormone and go really hyper so maybe we'll just do nothing...."

Story of my life for the last 5 years. The honest truth is that our thyroids should probably be removed since there is really no fix for this eradic behavior.


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## hashigirl (Apr 30, 2007)

I thought so about your opinion, so this is unusual??? No wonder, no endo can get this right!!! I really appreciate your input as I feel more like this is more Graves than Hashi's or as you said it does FEEL like primarily Graves with a touch of Hashi's. I agree, going to your doc with our appts. back to back would be pretty interesting. Searching for answers. Have you had RAI????? I am on no meds cause I can't tolerate the synthroid anymore, it makes me worse and more hyper than i ever was. I'd rather just roll with it and take my chances after all the ER trips i have been through. So glad you responded. Keep me posted as well. Glad to find someone else in the same boat!!!


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## NastyHashi (Mar 11, 2007)

I guess its a bit unusual. Its probably even a little more unusual for me cause I am a guy for one and second, I am way overweight. You would think I am simply hypo looking at me. I asked my endo if she has ever witnessed a fat man with graves and she said absolutely. It was more common than I would have imagined. I don't understand it though.

I too had a really bad time taking Synthroid....it made me really shakey and really wired, like I was on speed. I literally felt like I just did a hit of meth or something...it was actually sort of cool in a scary way but there is no way I could have gone on like that...I was bouncing off the walls.

I've basically gotten used to the fast heart rate and shakey hands all the time. The thing that bothers me most still are those little tremors I get in my legs and belly. They come and go but when they are around it makes my legs really weak like someone spent the night punching my thighs and hamstrings.

Now, whatever the problem actually is, its affecting my testosterone too. I am only 38 years old and just got tested with a 188 testoserone. The test does not even start until the 300's through 800. At my age, I should be around 500 - 600 but I was 188. Thankfully my wife and I already have 2 kids...I probably couldn't even have another if we wanted to with my hormones so low.

I just got another set of labs I need to get done. This one included ANOTHER pituitary MRI, ANOTHER thyroid sonogram, a 24 hour cortisol test, 24 hour creatine test and blood tests for testosterone, LH, FSH and a few others.

And yes, my endo literally said my case was not straightforward and was odd. She was mainly perplexed with my very high TSH yes all my other labs for thyroid were normal. My TSI was 179 and my TPO was also in the thousands. Sounds like me and you have the same thing going on.

Wanna write a book? Let's call Dr. House. We need someone who really knows what he's doing but ultimately, for me at least, me and my thyroid must part ways. I think thats my only solution and at this point, I can tell my endo to just write the script to muke my gland and I don't think she would argue with me with all the craziness going on inside me.


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## hashigirl (Apr 30, 2007)

Well, I can tell you my uncle has Graves and is overweight and his results are still hyper. He has had RAI twice and it didn't work, the second time he had RAI - it triggered thryoid storm. And that's a horrible thing as I am assuming you know all about. And ya, the synthroid revved my heart out, i thought i was gonna die of a heart attack, and ya i felt like i was on speed or meth, i hit 91 lbs pounds on Synthroid and i was shaking to death. It was horrible. That thyroxine stuff is like gasoline for us probably, baaadddddddd. I ran around on that stuff for two years wondering why i felt like i was on deaths door. And the synthroid made me feel crazy. I never wanna go back to that experience again, but never say never cause...bad luck. I am learning to deal with this, but soon as i get comfortable, it creeps back up on me. I have had most of your tests mentioned, my testerone is on the high end. Having my adrenals done, sure they are bouncing are around from this stuff.


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## hashigirl (Apr 30, 2007)

My latest labs are:

TSI: 197
TSH: .001


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## hashigirl (Apr 30, 2007)

This story does have a good ending and answer at last. I just got diagosed with Schmidt's Syndrome which tests positive for hashi's, graves', and hyperthyroidism and it accompanied by Addison's Disease. ADRENAL INSUCCIFFIENCY THREW MY LABS OFF LIKE [email protected]@@@ I was accidentally diagnosed with Panic Disorder and it almost killed me. I only take adrenal medication every day now and I forgot about my thyroid cause my health is soooo good now. I hope this helps some here. Adrenal Problems are very very very scarey serious stuff. Don't be afraid to search for your truth and good luck to you all! Thanks!


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## hashigirl (Apr 30, 2007)

more useful info i found regarding this topic

SCHMIDT'S SYNDROME

This is often co-morbid to Hashimoto's.

Many Hashimoto patients have SCHMIDT'S SYNDROME -- coexisting autoimmune adrenalitis with addisonism. Further, if there's a problem with the pituitary or hypothalamus causing the hypothyroidism, there's likely to be concurrent secondary adrenal insufficiency. So... before you give that patient in myxedema coma a nice booster of thyroid hormone, first administer glucocorticoid so as not to cause death from acute adrenal insufficiency!

http://www.pathguy.com/lectures/thyroid.htm

Type II (Schmidt's syndrome): Multiple glandular failure generally occurs in adults, with peak incidence at age 30. It occurs twice as often in women. It always involves the adrenal cortex and frequently the thyroid gland and the pancreatic islets, producing type 1 diabetes. Autoantibodies against the target glands are frequently present, especially against P-450 cytochrome adrenocortical enzymes. Both mineralocorticoid and glucocorticoid deficiency can occur. Glandular destruction results mostly from cell-mediated autoimmunity, either from depressed suppressor T-cell function or some other type of T-cell-mediated injury. Reduced systemic T-cell-mediated immunity is common, manifested by a poor response on skin testing to standard antigens. Reactivity is also reduced in about 30% of 1st-degree relatives with normal endocrine function.

Some patients have thyroid-stimulating antibodies and initially present with symptoms and signs of hyperthyroidism.

Theoretically, specific HLA types may have increased susceptibility to certain viruses that might induce the destructive reaction. Inheritance usually follows an autosomal dominant pattern with variable expressivity.

Read on.......
http://www.merck.com/mmpe/sec12/ch154/ch154a.html


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## GD Women (Mar 5, 2007)

What is your Labs reference ranges. You have some off readings or perhaps you forgot some decimal points (?).

I don't know if you are Graves'/Hashi or not. Your thyroid levels do not relate to either.
In early Hashi TSH will be very low in which does not necessarily mean Graves'. 
FT4 is increased in hyperthyroidism and decreased in both primary and secondary hypothyroidism. Yours has been low in all three test suggesting hypothyroidism 
FT3 is increased from medications, etc. Yours has been high in all three test. 
However, they do relate to goiter - do you have one? A Colloid nodular goiter is the enlargement of an otherwise normal thyroid gland. Or, Endemic goiter form of IODINE deficiency disorders. 
Also your last two test relates to hyperthyroidism. TSI found in the blood indicates that the thyroid stimulating immunoglobulin is the cause of a person's hyperthyroidism. We can be hyperthyroid without being autoimmune (but we can't be autoimmune without being hyperthyroid). TSI is 130% (130 or 1.30) and under is normal. Higher than 130 would indicate autoimmune.
Thyroid Peroxidase (TPO) Antibody main use is to confirm a diffuse goiter and/or hypothyroidism are due to autoimmune thyroiditis. Your FTs confirms suggested goiter. range 2 or less is normal. Your test shows right on the cusp.
Positive TPO test could mean chronic thyroiditis; temporary hyperthyroidism,other autoimmune disorders as Sjogeren's syndrome, lupus, rheumatoid arthtitis, pernicious anemia. Higher levels of ATPO do not necessary associate with anomalies of the thyroid function as shown by TSH. The increased values of ATPO as seen in Hashimoto's Thyroiditis can show a higher chance for having a second autoimmune disease. 
You also should have done Thyrotropin (TSH) Receptor Antibody Test (TRAb) *blocking* and binding which confirms Hashi.
Also a 24 hour RAIU would help in diagnose, as well as thyroid scan or thyroid ultrasound. Don't know if you had these done.

Thyroid antibodies may be found in a variety of other autoimmune disorders, such as thyroid cancer, type 1 diabetes, rheumatoid arthritis, pernicious anemia, and autoimmune collagen vascular diseases. Also, a certain percentage of healthy women with no thyroid issues can be positive for one or more thyroid antibodies. The prevalence of these antibodies tends to be higher in women and tends to increase with age. However, while most may never experience thyroid dysfunction, it could mean that you might become autoimmune thyroid in the future with your thyroid levels indicating so . Hashi and Graves share some of the same antibodies and does not necessarily mean we have both diseases. The higher antibody with corresponding thyroid levels prevails to which thyroid disease.

Another thought is, you might have what is called Ha****oxicosis which is a primarily a condition of hypothyroidism characterized by the presence of stimulating TSH receptor antibodies, the antibodies that cause hyperthyroidism in Graves' disease. These antibodies cause transient symptoms of hyperthyroidism. These antibodies cause transient hyperthyroidism whenever these antibody levels rise in sufficient amounts to cause a temporary burst of excess thyroid hormone. Test include all 4 showing positive; Thyroglobulin antibodies Blocking, TSH receptor antibodies, TPO antibodies, Stimulating TSH receptor antibodies (thyroid stimulating immunoglobulins or TSI).
Individuals with Hashi-toxicosis are at high risk for Graves' ophthalmopathy (thyroid eye disease or TED). TSH receptor antibodies are known to contribute to trigger Graves' ophthalmopathy and worsen symptoms. Patients in the early phases of Ha****oxicosis may have normal thyroid function tests because of their blocking TSH receptor antibodies blocking TSI from reacting with thyroid cells. In this case, patients may be diagnosed with Graves' disease.

After all has been said, you should go by what your doctor diagnosed you with having.
Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

Good Luck!


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## hashigirl (Apr 30, 2007)

Well,
All I can say is I do extremely well now on no thyroid medication, and I am only taking medication for Addison's Disease, I take Fludrocortisone, i feel better than ever my whole lifetime, yes , i have an enlargment, a mild goiter. My last 2 TSH's on only adrenal medation only came back at a TSH 2.0 and 2.76, and I felt great! I also test postive for the DNA Antibody for Lupus and positive for the Lupus Anticoaglant. Any thoughts?


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## hashigirl (Apr 30, 2007)

Also, my last TPO was at 2,040 per/ml. My Endo won't do a scan imaging of my thyroid because he says he can't since I am allergic to Iodine. Is that true, can it not be done if I am allergic to iodine. My left lobe has been enlarged for about 2 years. Also, I have several family members diagnosed with Graves on my dad's side of my family. And my mother and grandmother on my mom's side both had hashi's.


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## GD Women (Mar 5, 2007)

I don't believe thyroid scan or thyroid ultrasound is done with iodine.
Also a FNB can be done too. RAIU uses every little iodine.

Are you sure the comma in your TPO level is not suppose to be or represent, a period.
High TPO would suggest Hashi, IF, your thyroid levels reflected it, in which case yours do not, not the ones you listed anyway. As I mentioned below, TPO can reflect other autoimmune disorders such as lupus, as you said you tested positive for "Antibody for Lupus and positive for the Lupus Anticoagulant".

Higher levels of TPO do not necessary associate with anomalies of the thyroid function. 
As seen in Hashimoto's Thyroiditis, TPO can show a higher chance for having a second autoimmune disease which you know doubt do, lupus and others.

When you were on medication, the dose might have been too high for you. I am 12 years into treated Graves and have not found my right dose. Either I go hypo or hyper. Just changed dosage again. At least we have found that I am some where in between 88 and 100, I hope, or else in time, another RAI treatment. Sometimes I think I am Graves'/Hashi the way my levels swings and with the symptoms of both. However, my levels always relate Graves'.

However, if your TSH stays around 2.0 and 2.76 as you mentioned, you are fine without meds. If it were me, I'd wait until TSH reaches 7 plus without symptoms and feeling fine. You know your body and your doctor knows your health.

In my family there is no Graves' or Hashi, however there is hypothyroidism. I am the only Hyper/Graves'. Where it came from, I don't know.


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## Andros (Aug 26, 2009)

hashigirl said:


> I am wondering if I have both Hashi's & Graves. I am very thin and go hyper frequently when i am on no medication, I have been diagnosed with Hashi's.
> 
> Here is my last labs:
> 
> ...


I just joined recently and was going through posts.

What I understand is this..........

TSI (thyroid stimualating immunoglobulin) is "definitive" for hyperthyroid. Hashimoto's patients can be in the hyperthyoid state and so can Graves' Disease patients. Only FNA (fine needle aspiration) can be "definitive" for Hashimoto's and that would be "if" certain Hurthle cells indigenous to Hashimoto's are found by the pathologist.

Clinically, the criteria for Graves' Disease are Thyrotoxicosis, Goiter, Exophthalmos and Pretibial Myxedema. You do not have to have all 4 to meet the criteria for Graves'.

http://www.thyroidmanager.org/Chapter11/11-frame.htm

I do hope this is helpful to you. It gets very very confusing because many with Hashimoto's present w/ TED (Thyroid Eye Disease) and sometimes even a goiter.

That is why lab tests, uptake scans and FNAs are so important. And that is why a good doc is also important.

I hope as of this posting you are doing much better.

Andros


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