Looking for diagnosis - possible Graves' disease

[Cosmos1977]

Hello, I am posting on behalf of my wife. She is 35 years old.

She was told by her GP that she had thyrotoxicosis due to below bloods. She has had confusing symptoms for the past 9 years, so since she was 26 years old:

The symptoms that she remembers having back in 2011 were:

Dry skin, eyes and lips

Constipation

Oily hair

Heavy and painful periods

Sweating

Anxiety

Low mood

Fatigue

And the symptoms she is now experiencing are:

Blocked nose

Pins and needles in hands and feet

Sweating

Anxiety

Depression

Fatigue

Headaches

Bruising

Constipation

Eyelash and hair loss

Dry skin and eyes

Loss of appetite

Heavy and painful periods

Inability to gain weight

Are there any other tests the GP should do? Also the front of her neck swelled up a year after she started getting the symptoms, in 2012, and it seemed to have resolved on its own since it never returned. We are at a complete loss as to what to do next. Her mum has hypothyroidism and there is a history of autoimmune illness in the family.

Thank you very much.

NOV-2011

TSH 5.2 mIU/L (0.2 - 4.2 pmol/L)

Free T4 15 pmol/L (12.0 - 22.0 pmol/L)

AUG-2017

TSH <0.02 mIU/L (0.2 - 4.2 mIU/L)

Free T4 38.9 pmol/L (12.0 - 22.0 pmol/L)

Free T3 10.6 pmol/L (3.1 - 6.8 pmol/L)

AUG-2020

TSH 5.37 mIU/L (0.2 -4.2 mIU/L)

Free T4 10.7 pmol/L (12.0 - 22.0 pmol/L)

Thyroid Peroxidase antibodies 1300.1 IU/mL (0 - 34 IU/mL)

Thyroglobulin antibodies 276 (0 - 115 IU/mL)

[PurpleNails]

Are these recent results? do you have records of previous tests to compare ?

Has she been referred to a hospital specialist endocrinologist? GP might leave to them to determine cause and treatment as she is currently hyper (going by result above if recent)

Testing thyroid Antibodies very important:

Thyroid Peroxidase (TPO) and Thyroglobulin (Tg or TGab) are often positive in BOTH Hashimoto's AND Graves. Hashimotos known as autoimmune thyroiditis can have phases of transient hyper, ultimately hypo). Graves causes continuous hyper. TPO has higher elevations in hahis.

Graves can only be confirmed by Thyroid Stimulating Immunoglobulin (TSI) or TSH receptor antibodies (TRAb), which are high when Graves is diagnosed.

Being hyper depletes nutrients compounding health matter. So ensure her folate, ferritin, B12 and vitamin D are tested & optimal.

[Cosmos1977 in reply to PurpleNails]

These are results going back to 2017, it is these ones we're really thrown by. She had thyroid function checked before that in 2011 around about the same time she had symptoms and the results of those were:

TSH 5.2 mIU/L (0.2 - 4.2 mIU/L)

Free T4 15 pmol/L (12.0 - 22.0 pmol/L)

She did ask for antibodies to be tested at the time and the GP said they only test for them in special cases. She is not under an endocrinologist.

Ones in August 2020:

TSH 5.37 mIU/L (0.2 - 4.2)

Free T4 10.7 pmol/L (12.0 - 22.0)

She had thyroid antibodies tested privately instead - through Blue Horizon:

Thyroid Peroxidase antibodies 1300.1 IU/mL (0 - 34 IU/mL)

Thyroglobulin antibodies 276 (0 - 115 IU/mL)

Thank you

[PurpleNails in reply to Cosmos1977]

In August she was hypothyroid. Above range tsh, under range FT4. very high TPO. Wasn't she prescribed thyroxine ?

[Cosmos1977 in reply to PurpleNails]

No, she wasn't prescribed anything.

[PurpleNails in reply to Cosmos1977]

Can you date the results above please? Just want to be clear on what is her most recent results are.... How is it left with your doctor now are they planning any follow up or offering any treatment?

[Cosmos1977 in reply to PurpleNails]

I have added dates to the results now. The GP is going to check her thyroid function again in 3 weeks time and they will follow up with her then.

[PurpleNails in reply to Cosmos1977]

The hyper results in 2017 was likely a transient attack sometimes referred to as a temporary hashi hyper flare or swing. The immune system attacks the thyroid causing a surge but leaves it damaged ultimately under active.

She had high TSH, low FT4 and high TPO antibodies.

Post this history on the thread you started the main thyroid forum. SlowDragon often links a flow chart which shows when levothyroxine should be prescribed. You need to take this to your GP.