# Do I have this?



## dibdab (Jul 3, 2013)

Hi all

I was diagnosed with Graves (or so I thought) in January - I have been sticking my head in the sand a little bit since then and just doing what my doctor tells me, however I have done some reading over the past week or so and came across this forum yesterday, full of useful info.

I had never heard of hashitoxicosis but when I saw the forum thought I would check my blood results against the 'criteria'. I didn't think I had been tested for TSI but having googled it seems that TSH receptor antibodies is the same thing - is that correct?

My results from January prior to any medication are below:

Free T4 56.53 (9.01 - 19.05)
Free T3 62.80 (2.63 - 5.70)
TSH <0.03 (0.35 - 4.94)

Anti TG 115.2 (0.0 - 4.1)
Anti TPO 10.2 (0.0 - 5.6)
Anti TSHR 29.50 (<1.75)

Does this mean I have hashitoxicosis and not Graves? The more reading I do the more confused I am!

I am planned for RAI which will happen as soon as my doc can get my levels within the correct ranges.


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## Octavia (Aug 1, 2011)

Hi dibdab, and welcome. I can't answer your question, but I'm wondering about those lab results. Do you have any other Free T4 and Free T3 results you could post? The ones you've shared above are SOOOOOOO far out of range...I've never seen results that high. It truly makes me wonder if they're correct.


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## Andros (Aug 26, 2009)

dibdab said:


> Hi all
> 
> I was diagnosed with Graves (or so I thought) in January - I have been sticking my head in the sand a little bit since then and just doing what my doctor tells me, however I have done some reading over the past week or so and came across this forum yesterday, full of useful info.
> 
> ...


You are hyper; wow!! Are you on a beta-blocker or anti-thyroid med? Have you had RAIU (radioactive uptake scan?) You need to make sure you don't have any suspicious nodules which would dictate surgery rather than RAI.

Anti-TPO and anti-TG antibodies are found in all types of autoimmune thyroid disease and do not distinguish Graves' disease from Hashimoto's disease. Anti-TG antibody detection does not add much to the more sensitive anti-TPO antibody test but is often performed in conjunction.
http://www.medicalobserver.com.au/news/thyroid-antibodies

And the criteria for Graves' (which I hope you don't have) is as follows..........

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.


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## dibdab (Jul 3, 2013)

Thanks to both of you for the replies.

Octavia - Further results are as follows:

6 weeks after the first results and after taking 30mg of carbimazole plus 40mg of beta blocker each day:

Free T4 9.81 (9.01 - 19.05)
Free T3 9.27 (2.63 - 5.70)
TSH <0.03 (0.35 - 4.94)

I then had a radioactive uptake scan which showed 31% uptake so my doc upped my meds to 40mg of carbimazole although blood results were almost normal - results after another 6 weeks were:

Free T4 <2.07 (9.01 - 19.05)
Free T3 <1.12 (2.63 - 5.70)
TSH 67.27 (0.35 - 4.94)

By this point I was feeling pretty dreadful and my doc then told me to stop taking anti thyroid meds completely - after a month of no meds it had swung back the other way to:

Free T4 28.35 (9.01 - 19.05)
Free T3 30.10 (2.63 - 5.70)
TSH 0.04 (0.35 - 4.94)

Andros - when you talk about suspicious nodules do you mean cancer? I had an ultrasound back in January which didn't seem to concern anyone so I must be OK on that front.

In terms of clinical signs of Graves I have had the thyrotoxicosis, I have a goiter and had very very swollen legs and feet at the beginning. I don't have bulging eyes but have had problems with my eyes recently which my ophthalmogist says is due to the thyroid so I guess this is 4 out of 4 of the symptoms you mentioned.

I haven't had a fine needle aspiration at any point.


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## Andros (Aug 26, 2009)

dibdab said:


> Thanks to both of you for the replies.
> 
> Octavia - Further results are as follows:
> 
> ...


When you had the RAIU, and irregularities would have been noted so you are probably good to go for RAI.

Yes; the pretibial myxedema. Oh, Lord.......................I forgot what my ankles looked like.

But all that will return to normal once you get that thyroid zapped and get on replacement thyroid.

Yes; you have Graves'. I am sorry but the good news is you will heal.


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