graves/hashimoto? confused

[alikat1205]

I was diagnosed hypo thyroid  with hashimoto's about 7 years ago and have done fine on synthroid 50 mg since that time.  About August of this year I noticed the sudden growth of my thyroid, huge and noticeable goiter where only the month before I had nothing, so I made an emergency appointment to my doctor.  She tested my tsh (only, no other thyroid tests) and got a reading of .02 and discontinued my synthroid.  I went in for a repeat TSH four weeks later and it was still .02.  I went four weeks later and it is .02.  My doctors says she suspects Graves AND Hashimotos.  How is this even possible?  She called today and recommended repeat testing in 6 weeks.  

I am uncomfortable with this plan.  First off, the huge goiter appeared nearly overnight, and that doesn't sound good.  Second, nothing is changing, so what exactly is she waiting to find out?  She hasn't answered these questions, just ignores me.  Can the goiter shrink?  If not, what are my options to get rid of it?  I don't like it or want to keep it.  Is there a possibility it is more serious?  Is doing the TSH only acceptable?  I mean, if it not changing, it seems like maybe more information is something to think about, but she doesn't think I need anything by TSH test.  Should I just keep on going for another 6 weeks (which is really more like 8 because of the holidays) and not treat this very low number?

[goolarra]

That's a pretty strong positive TSI, then.  

I agree with you...time to find a new doctor, one who tests properly and is willing to treat.  Don't wait 6-8 weeks just for another TSH.

Let me explain a little about TSI antibodies.  (If I'm repeating what you already know, please forgive the redundancy.)  Normally, TSH from your pituitary, which is the master endocrine gland, is sent out when the pituitary senses thyroid hormone levels are too low.  If levels are just right or too high, no TSH is sent out.  TSH cannot go below zero.

When TSI antibodies are high (i.e. you have Graves' disease), the TSI can attach to TSH receptors in the thyroid and cause it to produce or overproduce hormone.  TSI antibodies are not under the control of the pituitary, but just indiscriminately stimulate the thyroid.

Since TSI are stimulating the thyroid, the pituitary is sensing that hormone levels are too high, so TSH becomes suppressed...your pituitary is, in effect, trying to put on the breaks.  

Once TSH is suppressed, it no longer gives any useful information.  All we know from your TSH is that hormone levels are too high.  They might just be a little too high, or they could be through the roof.  So, your current doctor is basically flying blind.  

Be sure your new doctor will order FT3 and FT4 along with TSH.    

[Red_Star]

TED is not nice.  I'm so happy to get rid of that guy. Light sensitivity was my worst symptom. Painful. I believe my severe stress at the time caused my TSI (TRAb) antibodies to show up.  I'm in a right bit of stress right now and getting hyper flare ups every day. Not good. Calm lotus position ommmmm. :)

Selenium can also help.  In 2011, a study demonstrated that selenium supplementation (200 mcg per day) can slow the progression of eye disease and improve quality of life in patients with Graves' disease with mild ocular involvement (Graves' ophthalmopathy).  Dietary wise, brazil nuts have the highest selenium content. Each brazil nut contains anywhere from between 50 - 90mcg of selenium depending on the soil.

[alikat1205]

oh yes, sorry, less than 1.3 I gave TSH range.

[goolarra]

Is that a TSI or a TSH?  0.3-3.0 is a typical TSH range.  The range on a TSI should be something like "less-than 130%" or "less-than 1.3".

[alikat1205]

and I am in beginning stages of TED as per my last appointment but she says there is no way of treating that. :(

[alikat1205]

.3-3.0 is normal