# Need guidance on conflicting opinions



## mcclearytiff (Mar 12, 2018)

I need guidance on conflicting opinions. Almost 3 years ago after giving birth to my 4th child, I went to the doctor with complaints of fatigue, hair loss, insomnia. My PCP ordered thyroid tests and referred me to the ENT here. I ended up switching to an endo because I was tired of the rollercoaster feelings and him telling me to wait and see, do labs every 6 months. The ENT says Hashi's, the Endo says Graves. Here are all of my labs:

4/22/15: Free T4 2.1 (0.76-1.45)
TSH. <0.01 (0.36-3.74)
TPO ab 182. (</= 60)

8/12/15 Tot T4 8.6 (4.7-13.3)
TPO ab 357 (</= 60)

5/11/16 Tot T4 10.6 (4.7-13.3)
TSH. <0.01 (0.36-3.74)

11/16/16 Free T4 1.22 (0.8-1.8)
TSH. 0.77 (0.27-4.20)
TSI. 188. (<122)

5/10/17. Free T4 1.0 (0.76-1.46)
TSH. 3.13 (0.36-3.74)

10/23/17 TPO ab 347 (15-60)
Free T4 0.9 (0.76-1.46)
TSH. 2.56 (0.36-3.74)

3/8/18. TPO ab 268 (15-60)
TSH. 1.62 (0.36-3.74)
Free T4. 0.9. (0.76-1.46)
My november 2016 labs were done by the Endo, and diagnosed Graves based on my TSI and said they were surprised by this lab value. My May 2017 lab was also ordered by emdo. Due to being in school and lack of time, I went back to the ENT locally for the October 2017 labs. He mentioned subclinical hypo and put me on tapered prednisolone. That seemed to help and he still says I have Hashis. He also said that if I felt symptomatic to let him know and he would order labs. If labs were abnormal, we could try the steroid again or thyroid meds. I just got my last lab results today so I havent heard from doc yet. However, I fully expect him,to say my labs are normal and to "wait and see" despite my symptoms. I also recently found out that I have trace mitral valve regurgitation and am now wondering,if this,could have been caused by my thyroid over the years (prior to diagnosis). In my childhood years, I suffered uticaria (hives) with no known cause despite allergy tests and changing everything we could think of(soaps, food, etc). Benedryl didnt help the hives...the only thing that worked was prednisone. Which leads me to believe that back then, my thyroid was to blame. It was inflamed and the prednisone tamed it and in turn, made the hives go,away. Can I be Hashis AND Graves? Ive googled relentlessly and havent found anything closely related to my situation.


----------



## joplin1975 (Jul 21, 2011)

Yes, you can have both. Its often called hashitoxocisis. You can google that term and find some interesting information.

There's basically two options in your case. The first is surgical removal of the thyroid. Which, yeah, I get it...it sounds like a bummer, but I would strongly advocate for it. Antibodies are nasty, but TSI in particular is really notorious for making you feel awful. Those won't go away until the thyroid does.

The option option is to try what's called "block and replace." I don't know a whole ton about it, but you essentially attempt to block your naturally occurring thyroid hormones and replace them with thyroid medication to attempt to get to some level of stability. From the few posters who have reported on their experiences, it doesn't sound like an easy long term solution -- there's always lots of tinker and ups and downs. But, it IS an option.

In either case, you should have a thyroid ultrasound.


----------



## mcclearytiff (Mar 12, 2018)

I forgot to add that I have had a thyroid Ultrasound! The findings are:
"Thyroid gland normal in size & slightly heterogenous in echotexture. No masses or cysts identified. Relatively symmetric color flow to both thyroid lobe. Isthmus appears normal"


----------



## jenny v (May 6, 2012)

Ugh, I had both TSI and TPOAb and it was not fun! Some days you feel hyper, some days you feel hypo, and it's very hard to control it. I eventually opted to have my thyroid removed (after about 10 years on the roller coaster).

I would start with two things, if your doctor is hopefully open: 1. do a complete thyroid panel (TSH, Free T4, Free T3, TSI, TPOAb, reverse T3), and 2. do a repeat ultrasound if it's been more than 6 months since your last one.


----------



## mcclearytiff (Mar 12, 2018)

Hopefully he will be open to it. It was June 2017 that I had the US done. I've never even had,my T3 done, which I find odd.


----------



## Lovlkn (Dec 20, 2009)

mcclearytiff said:


> Hopefully he will be open to it. It was June 2017 that I had the US done. I've never even had,my T3 done, which I find odd.


More common that you would think. During the initial phase of treatment for Graves my endo never tested T3 and only did so when I insisted.

Post Thyroid removal I have found a doc who tests FT-4 and FT-3 every 6 months which was very helpful in dialing in replacement hormone.

I have Hashitoxicosis - both high TPO and TSI antibodies. Was on anti thyroid meds for 4.5 years and kept in a hypo state before I decided to remove my thyroid. I waited WAY TOO LONG to remove and should have done it sooner. Your body will not heal - unfortunate but true. Life for me is much better post TT and taking thyroid hormone replacement without the antibodies making my thyroid output all over the place,


----------

