Confused

[Angel1313]

I was diagnosed with graves disease 13 years ago but last year I was diagnosed with underactive thyroid.. How can I have both?

[Clutter]

Angel1313,

Were you hyperthyroid too?

[Angel1313 in reply to Clutter]

Yes

[Clutter in reply to Angel1313]

Angel1313,

A period of hyperthyroidism can be followed by remission but that will sometimes be followed by hypothyroidism years later. It's as if the original hyperthyroidism burns out the the thyroid gland.

The Graves Disease autoimmunity may become dormant but Graves will sometimes go on to attack other organs, usually the eyes.

[cjrsquared]

Graves’ disease causes overstimulation of thyroid and it eventually ‘ burns out’ destroying the thyroid and causing hypothyroidism. This is why endo’s Are happy to zap thyroid with radioactive iodine or suggest thyroidectomy as they assume that eventually the thyroid will be destroyed by the disease process.

[Clutter in reply to cjrsquared]

cjrsquared,

Unfortunately, Graves antibodies do NOT burn out, even after the thyroid has been destroyed, and can go on to attack other organs, usually the eyes.

[cjrsquared in reply to Clutter]

I agree the antibodies don’t go away, burn out was probably not a good phrase to use. The thyroid becomes repeatedly overstimulated and the thyroid cells stop working and the thyroid doesn’t produce anymore thyroid hormones, but the autoimmune disease doesn’t go away. Thank you for makIng that clearer.

[Valarian in reply to cjrsquared]

Interesting, do you have an article on this cjrsquared? I thought the swing from hyper to hypo was generally caused by a change in the balance of those pesky antibodies. Apparently 65% of those of us with Graves’ have both elevated TSI and TPO. If my thyroid doesn’t settle down with Carbimazole, I will probably refuse RAI (in the first instance, anyway) and would actually be even more likely to do so if I thought my thyroid would eventually burn out of its own accord.

The only guidance offered by my endo so far has related to the potential side-effects of Carbimazole, and the difficulty of maintaining stable thyroid levels in Graves’ patients who fail to achieve remission after the usual treatment period. Hypos clearly have problems with this too, but there is the balance of issues caused by a racing metabolism as opposed to a sluggish one.

[Angel_of_the_North in reply to Valarian]

I think RAI is contraindicated if you have TED or there is a chance of getting it.

[greygoose]

Did you actually have antibodies tested to confirm your diagnosis of Grave's? I think we're going to need a lot more detail to understand this!

[Angel_of_the_North]

It is possible to have both Graves and Hashis together but I think the Graves usually wins. It could be that you were never tested for TSI/TRAb antibodies -- the Graves ones - and just had Hashis and were diagnosed during a Hashi flare when your bloods would have show up as overactive. TPO and TG antibodies are Hashis and TRab or TSI are Graves. Without those tests, the doctor is just guessing as what is causing the overactive blood results. Or your Graves could have now destroyed your thyroid.