Can Grave's Disease be Diagnosed by Ultrasound?

[blogntog]

I hear different things on this. My postpartum labs showed hyperthyroid behavior, so we did the antibodies test and it came back negative. They then did an ultrasound and they said that they could see that I had Graves' from that.

Now, after having another pregnancy and postpartum labs, I'm showing as hypo instead of hyper - again antibodies test came back negative for that too.

I hear that some people say you can see Grave's on an ultrasound - others say that is not a definitive method of diagnosing a patient, can anyone help me with this?

[Barb135]

What antibody tests did they do and what were the actual results with reference ranges?  

Hashimoto's is often characterized by periods of hyperthyroidism in early stages, alternating with periods of normal or hypo, before ultimately settling into permanent hypo.  

The antibody tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin (TgAb) for Hashimoto's.  If they didn't do both of those tests, you could be misdiagnosed.  

Thyroid Stimulating Immunoglobulin is the definitive test for Graves Disease.  

[blogntog]

I did both of the tests that you mentioned, twice - and both came back with 0 antibodies present. So they did the ultrasound and said that I had graves at the time. Now, a new doctor is saying that I don't have graves because the antibodies aren't present and to just wait it out because it's postpartum thyroiditis instead?

[Barb135]

I just did a little research and it seems that they can tell whether one is normal or has either Graves or Hashimoto's, but they can't differentiate between those 2 conditions... here's one excerpt:  "In conclusion, our findings indicate that because of low sensitivity of sonography, differentiation between Graves’ disease and Hashimoto’s thyroiditis is not possible but due to high specificity it can differentiate normal thyroid from Graves’ disease or Hashimoto’s thyroiditis. It is suggested that if thyroiditis or Graves’ disease is defined by sonography, it should be further confirmed by clinical and laboratory with laboratory data. "
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5401130/

There are 2 tests for Hashimoto's and one for Graves.  If they didn't do the TSI, they can't know if you have Graves or not, but if you've gone hypo, per your labs, it's likely you don't because people with Graves Disease don't, typically, go hypo without thyroidectomy or RAI, unless they have Hashimoto's, too.  

Did the ultrasound indicate whether or not you have any nodules on your thyroid?  Sometimes, nodules can produce hormones independently of the thyroid.  

Postpartum often becomes permanent or Hashimoto's.  

What are your actual thyroid lab values with reference ranges and what symptoms do you have?  The bottom line is that if you're hypo, you need treatment no matter what's causing you to be hypo because the thyroid controls so many body functions.  We simply don't function well without adequate thyroid hormones.

Perhaps it's time for second opinion.

[Red_Star]

"Thyroid inferno refers to the colour Doppler appearance of the thyroid gland in active Graves disease (inclusive of variants such as Marine Lenhart syndrome), and consists of multiple small areas of colour flow seen diffusely throughout the gland representing increased vascularity and arteriovenous shunting.

It should be kept in mind that usually in cases of Hashimoto thyroiditis colour Doppler study shows normal or decreased flow but occasionally there might be hypervascularity similar to a thyroid inferno 1."*

*Thyroid Inferno - Radiopaedia

[blogntog]

So if Graves' was diagnosed by way of ultrasound by the visual appearance of Thyroid Inferno, how does it happen that now my levels are showing as hypo? instead of hyper?

[Red_Star]

I found a study on Pregnancy and thyroid disease - What are the best approaches for diagnosing the etiology of thyrotoxicosis following delivery?...

"These results demonstrate that early onset of thyrotoxicosis within 3 months after delivery of a baby is usually the result of thyroiditis, whereas later onset after 6.5 months is almost certainly from Graves’ disease.  Between 3 and 6.5 months the etiology of postpartum thyrotoxicosis could be either Graves’ or thyroiditis. In this situation measuring thyroid stimulating antibody levels and thyroid blood flow on neck ultrasound can help differentiate the two."