Diagnosis - Graves &/or Hashitoxicosis/thyrotoxic Phase - Graves' Disease and Thyroid Discussion - Living with Graves Disease

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Diagnosis - Graves &/or Hashitoxicosis/thyrotoxic Phase

graves diagnosis hashimotos thyrotoxic hashitoxicosis

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#1 057

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Posted 29 June 2017 - 04:11 AM

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Short story - 

Id like to know how one can be diagnosed with Graves & Hashimotos simultaneously.
(Whilst I understand some individuals may not be able to give online medical advice for legal reasons, my question remains the same, ‘How do we diagnose both,’ & I will use my situation as an example.)
 
Longer story - 
Thyroid Peroxidase Antibodies & Thyroglobulin are elevated in Hashimotos.
Thyroid Peroxidase Antibodies, Thyroglobulin & Thyroid Receptor Antibodies are elevated in Graves, although only 70(ish)% (I find conflicting stats on this) of those with Graves will test positive for Thyroid Peroxidase Antibodies & 90% of patients with Hasimotos.
People with Graves & thyroid cancer may also have an elevation in thyroid antibodies including Thyroid Peroxidase Ab., Thyroglobulin Ab. & Thyroid Receptor Ab. 
A thyrotoxic phase or Hashitoxicosis can cause hypERthyroidism for a period. 
Thyroid nodules are present in both Graves & Hashimotos.
 
Therefor, if a patient presents with the 3 elevated antibodies, elevated FT3 & FT4, a suppressed TSH & thyroid nodules,  it would be assumed that they have Graves? Although, technically, all of these symptoms could arise in Hashitoxicosis/Hashimotos. 
 
Longest story - 
I use this as an example. My mother was on Levothyroxine but was just told she was hypO & never given a reason/proper diagnosis.
I was diagnosed Graves although I had many hyPO symptoms & was hypER for no longer than 4-6 weeks. From there, after medication, I went slightly hyPO for a period, and whilst I am now within ‘normal ranges,’ I still sit on the lower end of the scale & am quite lethargic etc. I wonder if a diagnosis of Hashis has been missed on top of my Graves?
 
28/01/2016
Presented with menorrhagia, dysmenorrhea & myalgia. Thyroid bloods were tested.28/01/2016
TSH <0.05 (0.40-4.0)
FT3 6.6 (2.8-6.8)
FT4 15 (10-20)
aThyro’gb 37 (<60)
aPeroxase 180 (<60)
TRaB - 5 (<1.0)
From here I was told I was on the edge of Graves disease, either about to ramp up or fizzle down.
These results could’ve been Hashitoxicosis?
 
26/03/2016
Returned from a holiday in Vanuatu with a virus which exacerbated thyroid issues.
TSH 0.007 (0.5-4.0)
FT3 10.6 (3.0-6.7)
FT4 26.8 (10.0-21.0)
Started on 30mg Carbimazole daily.
 
Ultrasound showed small nodules. GP referred me to get a RAI test.
Endocrinologist said the nodules are not big enough to worry about & cancelled the Radioactive Iodine uptake test.
 
27/04/2016
TSH 0.032 (0.5-4.0)
FT3 4.0 (3.0-6.7)
FT4 9.4 (10.0-21.0)
Antibodies to TPO 129 (<35)
 
06/03/2017
ThyroglobulinAb 13 (<4)
TRAB <0.9 (<1.8)
Antibodies to TPO 93 (<35)
 
There were a million other blood tests but below is the most current. I have been off Carbimazole for 7 weeks. 
20/06/2017
TSH 1.1 (0.5-4.0)
FT3 4.1 (3.0-6.7)
FT4 14.4 (10.0-21.0)
 
I have an appointment with my Endocrinologist soon & need to know what Im talking about.
I would send you my first-born if you could help me out.
How would I know I had just Graves without Hashimotos? Or that it wasn’t just a Hashitoxicosis phase that lead to my diagnosis?
How does one know when they have both Graves & Hashis when the tests encompass antibodies that occur in both diseases?



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#2 mmztcass

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Posted 29 June 2017 - 03:57 PM

Hi:

 

Please realize that thyroid antibodies can switch and we can easily go from GD to Hashi's or vice versa.  It depends on which antibodies are doing the blocking or stimulating.  

 

Elaine Moore at:  elaine-moore.com has articles that can be researched on.  She can individually answer Qs at her forum as well.

 

I don't suppose you can order a TSI antibody test in Australia to determine Graves' Disease?

 

{{{hugs}}} 



#3 Allies

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Posted 29 June 2017 - 05:24 PM

Hello 057

 

I'm in Aus too! :) As far as I know docs here only test TRAb (which does not differentiate between blocking and stimulating TSH receptor antibodies) not TSI to diagnose graves.

 

According to Elaine Moore - check out her website too, she is great - TPO antibodies are a marker of thyroid inflammation and tend to be much, much higher in Hashimoto's than Graves disease. As I understand it extreme inflammation, such as in Hashi's kills off parts of the thyroid gland and when this happens any thyroid hormone stored in that part of the gland is released into the blood stream causing transient hyper symptoms and raised hormone levels in blood tests. I haven't personally researched this last part, but given that Hashimoto's eventually destroys thyroid tissue it makes sense.

 

Your TRAb was nice and low in March, do you mind me asking what sort of diet/lifestyle you follow? I'm really interested in the sorts of things that trigger the antibodies and since yours went down quite nicely, you must have been doing something right :)

 

Cheers
Allies



#4 057

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Posted 30 June 2017 - 03:46 AM

Hey Allies, thanks for taking the time to reply.

I was under the impression that TSI & TRAb were the same test? 

Any ideas then on how to diagnose Hashis with Graves?

I started on a low FODMAP Paleo diet which seemed to bring my antibodies down pretty quickly. I would've gone for an AIP diet but I am super sensitive to FODMAPs. Only when I really followed the diet properly (with no cheating) did I start to see results.

I got non fluoridated toothpaste & deodorant with no aluminium. 

Aside from that, I vape cannabis to sleep - its saved my life. Otherwise I do not sleep & that scrambles my brain preeeeeeetty quickly. Unfortunately not legal here in Aus yet, until then I guess I am an outlaw!

 

mmztcass

It does say something on the bottom of my blood test form about TSI - "A small percentage of patients with TSH receptor antibodies (TRAb) negative Graves disease may have identifiable Thyroid Stimulating Immunoglobulin (TSI). TSI is available as a rebateable test under Medicare."

I wonder why I would never have had one of these? If I need to get one, on what grounds do I ask for it, as in, what will it help me to learn/why do I need it?

Cheers!



#5 Allies

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Posted 30 June 2017 - 11:26 PM

Hi again 057

 

As I understand it the TSH receptor antibodies (TRAB) test is a combined test for a sort of family of antibodies that attach to receptor sites on the thyroid gland. TSI - thyroid stimulating immunoglobulin - these stimulate the gland to produce more thyroid hormone, TBII - TSH binding inhibitor immunoglobulin - which block the production of thyroid hormone and there is at least one more, the name of which I can never remember, whose action is considered neutral. I find it interesting that TSI is available under Medicare; I wonder why Aus docs seem to use the TRAB test instead? Maybe it's just a case of getting 'more bang for you buck' ... :). As in the TSI test would only detect the stimulating antibodies but not the inhibitory ones?

 

Perhaps the TRAB test considered alongside clinical signs and symptoms plus thyroid hormone levels provides enough information to reach a diagnosis and to monitor treatment. (can I say I'm just thinking out loud here when I'm actually typing and not talking? :) )

 

Your TRAB ( <0.9 (<1.8)) is interesting, it's not zero, but it looks like it is lower than the test can detect; perhaps what antibodies you DO have are of the blocking variety? Might explain why your free ts are on the low side and you feel hypo?

 

It could be that if you keep doing what you are doing diet-wise etc the blocking inhibitory antibodies (if, in fact, that's what is going on) will reduce further and your free ts will come up all by themselves. Are you doing the FODMAP diet under the supervision of a doctor? If so perhaps they will agree to testing your iodine levels and/ or other vitamins minerals that may have an impact on thyroid hormone production and then they could help you adjust your diet accordingly. I had to pay out-of-pocket to get my iodine tested - with no Medicare rebate - which I found rather bemusing given the link between thyroid disorders and iodine levels!

 

Cheers
Allies

 

PS thanks for the info re your dietary approach :). I'm currently eating a sort of primal diet, mostly paleo but with dairy. I kind of wish I had just jumped in and gone full-on AIP from the get-go, because by now I'd be adding stuff back in to see how the ol bod responds instead of (reluctantly) contemplating removing dairy completely.

 

PPS I think with Hashi's or hashtoxicosis your TPOabs would be a LOT higher and your free ts a lot more volatile (but I am a bit of a noob)



#6 mmztcass

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Posted 01 July 2017 - 12:49 PM

Hi all:

 

Yes, for sure that if Hashi's diagnosis, the TPoab and the TgAb are much higher.  This is likely Graves' Disease diagnosis.  But would like to see the TSI to see for sure.  If higher would explain why.

 

Ya know I kept my dietary stuff nice and simple.  I simply switched everything I could with going organic to be as free of chemicals and toxins.  This included with the household and personal products as well.  

 

Then I worried about the sugars in foods by keeping things as low as possible.  I find that if I had too much sugar (I am talking about using the organic ones even) I paid for it dearly in my joints and muscular as I have Rheumatoid Arthritis.  

 

Then I worked on my vitamins and supplements by trying for as organic as possible.  For the synthetic vitamins, I went with the Pure Encapsulations brand mostly because these don't contain any added fillers and such to the vitamins.  I also used organic whole foods vitamins.  

 

Then lately I went from organic wheat (which still contained gluten) to being as totally gluten free as possible.  I noticed the difference with my hips no longer being tight.  This should make my getting up and down (standing) more tolerable.  Now the catch with the going gluten free, there are many products out there that will be gluten free and organic.  I had to make do with what was available.  I also had to make sure that Xanthan Gum is not part of the gluten free flour blends because consuming products with this in it gave me such awful stomach pains.  

 

I still have raw dairy of raw milk and raw cheeses that are grass-fed and organic as possible.  Same with having the yogurts and kefirs as organic as possible.

 

So following these things as much as possible and way lot less eating out except for places that served organic and gluten free, I've managed to maintain my Free T3 near mid range and the Free T4 at the upper third range with taking only 0.625 mg of MMI per day.  So happy dance for me!   :)  

 

{{{hugs}}}       







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