Can someone has Hashimoto's and Grave's at the ... - Thyroid UK

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Can someone has Hashimoto's and Grave's at the same time?

Elenicy profile image
31 Replies

Hello,

Please I need your help. I'm very confused with my results. I'm now taking 10 mg of Carbimazole.

This was the Medichecks doctor's advice:

Your thyroid stimulating hormone is now high and your free thyroxine and T3 are both low. This suggests that your thyroid is currently under-active and that your dose of carbimazole may need to be reduced. An underactive thyroid can lead to symptoms which includes fatigue and weight gain. Your thyroglobulin antibodies are positive. This can be associated with autoimmune thyroid disease and in particular Hashimoto’s disease. Your thyroid peroxidase antibodies are also elevated. This antibody is commonly associated with autoimmune thyroid disease. It is frequently seen in conditions such as Hashimoto’s disease (where the thyroid becomes underactive) but confusingly can also be seen in Grave’s disease (where the thyroid becomes overactive). I advise discussing this result with your doctor.

I have problems with one of my eye that shows that I have the Grave's disease anyway. Now I have to deal with Hashimoto's also?????

And how T4 changed so quickly to underactive symptoms? With your experience what must be done?

Below are my latest blood test results

Thyroid Hormones

TSH X 4.26 mIU/L (Range: 0.27 - 4.2)

Free T3 X 2.99 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine X 8.440 pmol/L (Range: 12 - 22)

Autoimmunity

Thyroglobulin Antibodies X 1521.000 kIU/L (Range: < 115)

Thyroid Peroxidase Antibodies X 355 kIU/L (Range: < 34)

Thank you all in advance x

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Elenicy
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31 Replies
SlowDragon profile image
SlowDragonAdministrator

Yes you can have Graves and Hashimoto's together

Your results certainly suggest Hashimoto's

But if you have never had TSI or TRab antibodies tested you can't know if you ever had Graves' disease

Hashimoto's frequently starts with hyperthyroid test results

In your very first post SeasideSusie suggested you needed TSI or TRab antibodies tested to definitely confirm you have Graves' disease

Private testing for suspected Graves - TSI or TRab antibodies

medichecks.com/thyroid-func...

You need to see GP and ask for referral to Thyroid specialist endocrinologist and carbimazole will need reducing

Both TPO and TG thyroid antibodies are very high. This is more likely due to Hashimoto's. You can have raised TPO or TG antibodies due to Graves, but not usually such high levels

If you only have Hashimoto's and not Graves as well, then carbimazole is not correct treatment

If you do have both Graves and Hashimoto's then you would take carbimazole to "block" and Levothyroxine to "replace"

This needs management by experienced endocrinologist

Clearly your results now show you are hypothyroid

Absolutely essential to get vitamin D, folate, ferritin and B12 tested. These are frequently too low and supplementing to improve can help improve symptoms

Hashimoto's and Graves both affect the gut and can lead to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormones

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

Assuming test is negative you can immediately go on strictly gluten free diet

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

Elenicy profile image
Elenicy in reply to SlowDragon

Hi Slowdragon, thank you for your reply. The results I’ve put are from medichecks. My GP has a letter from the eye clinic doctor that suggested a sooner appointment to endocrinologist (I’m booked for 10th October). My GP said that he will try his best to change it.

A GP can’t do the block/replace?

SlowDragon profile image
SlowDragonAdministrator in reply to Elenicy

Unlikely

Doubt GP can order NHS test for TSI or TRab antibodies. But you can/should ask/insist Graves antibodies are tested

GP can test vitamins and a coeliac blood test and presumably can reduce Carbimazole

Your TSH is ABOVE RANGE and FT4 and FT3 are BELOW RANGE. GP must take action

Elenicy profile image
Elenicy in reply to SlowDragon

Hi SlowDragon. That I have Grave's is confirmed from the Maidstone Eye Clinic. (Even they lost my PTO blood test). I booked an appointment for tomorrow morning with my GP.

Thank you for all! x

SlowDragon profile image
SlowDragonAdministrator in reply to Elenicy

If you haven't had a TSI or TRab antibodies tested you need them done. This confirms Graves' disease

You can have eye problems with Hashimoto's too

Elenicy profile image
Elenicy in reply to SlowDragon

I didn't know that can have eye problems with Hashimoto's. Thank you SlowDragon.

ling profile image
ling in reply to Elenicy

If you mean TPO results were lost, TPO can mean either Graves or Hashimoto's or both.

Looks like the eye clinic didn't test TRAb or TSI either : (

ling profile image
ling in reply to Elenicy

Here's the thing Elenicy.

If it's Hashimoto's that u have right now, then carbimazole is the wrong medicine to be on.

Your eye problem sounds pretty severe. To get it better, the main thing is to correct the underlying condition. If it's Hashimoto's, (and u might have that since your TG and TPO antibodies are still very high), correcting the Hashis will bring relief for your eyes.

Not to be dramatic, but the longer you remain untreated for the Hashis, if it is Hashis, the more damage will be to your eyes. Thyroid eye disease when in the active phase, can progress quite rapidly and do quite a fair bit of damage.

We're not here to pressure you, as I'm sure you are trusting the doctors to order the correct tests for you. They are after all, the professionals.

All the best.

Elenicy profile image
Elenicy in reply to ling

Hi ling. Thank you for your response.

To be honest, with this you write here, I start now to understand :) Actually I didn't know that Hashimoto's related with eye problems. Unfortunately the only antibodies test results I have are those I put on this post.

About the comment you did about professionals, antibodies checked private by medichecks because my GP was unable to write them for me with the excuse that he can't do it.

Thanks God and bless you all here for your support.

SlowDragon profile image
SlowDragonAdministrator in reply to Elenicy

Medichecks standard blood test checks BOTH TPO and TG antibodies. These can be very high due to Hashimoto's or slightly less high due to Graves

Your results are extremely high - suggests Hashimoto's

You need TSI or TRab antibodies tested to confirm Graves.GP may not be able to test, usually has to be done by endocrinologist

medichecks.com/thyroid-func...

Many Hashimoto's patients have swollen/dry/gritty eyes

Hypromellose eye drops can help. No longer available on prescription. Can buy cheaply on EBay

Elenicy profile image
Elenicy in reply to SlowDragon

This I did at medichecks (Thyroglobulin Antibodies and Thyroid Peroxidase Antibodies are different from TSI or TRab? Sorry if it is stupid question. Actually I'm confused

SlowDragon profile image
SlowDragonAdministrator in reply to Elenicy

Yes

Link about different antibodies

thyroiduk.org.uk/tuk/about_...

You can have raised TPO and/or raised TG antibodies due to Hashimoto's or Graves

More likely Hashimoto's if they are very high

But if TSI or TRab are high these are ONLY due to Graves

SlowDragon profile image
SlowDragonAdministrator

Sorry can't open that link

humanbean profile image
humanbean

Your link doesn't work because it is a link to the C Drive on your computer. And random people on the internet are not allowed to access that, you'll be glad to hear. :)

Elenicy profile image
Elenicy in reply to humanbean

Oh sorry. It was because I saved it.

humanbean profile image
humanbean in reply to Elenicy

If you can find where you copied it from you can give the link to that, and it should be possible for us to read it.

SlowDragon profile image
SlowDragonAdministrator

It's linked to your own account

This is quite helpful

gps.camdenccg.nhs.uk/cdn/se...

And this

pathology.leedsth.nhs.uk/pa...

More general guidelines

nhs.uk/conditions/underacti...

Elenicy profile image
Elenicy in reply to SlowDragon

baspath.co.uk/clinical_chem...

this is the link

SlowDragon profile image
SlowDragonAdministrator in reply to Elenicy

Your results from very first post ....

healthunlocked.com/thyroidu...

Doesn't suggest Graves. Looks like early stage Hashimoto's

Slightly low TSH, mildly raised FT4. Typical results from small Hashimoto's flare

As advised at the time. These results did NOT suggest Graves

Your GP might have assumed they did, but GP's often know little about thyroid disease

We see many Hashimoto's patients misdiagnosed as Graves......especially if tested in early stages and test happens to catch low TSH

I nearly was misdiagnosed myself. Fortunately my GP ran antibodies testing and TPO were extraordinarily high (over 4,000) .....plus I was lucky my TSH was higher. But he had assumed I was hyper not hypo. I had lost weight too. Common in early stages of Hashimoto's. But with Hashimoto's we are hypothyroid. Even if have temporary hyper mini swings.

Elenicy profile image
Elenicy in reply to SlowDragon

So, if this is my case then I don't need Carbimazole at all.

SlowDragon profile image
SlowDragonAdministrator in reply to Elenicy

Exactly,......which is perhaps why your results are now so terrible

Carbimazole is completely wrong Treatment for Hashimoto's

But GP will probably try to cover up their mistake

an ultrasound scan of thyroid can also confirm Hashimoto's

Elenicy profile image
Elenicy in reply to SlowDragon

I'm having an appointment tomorrow with a GP (not my usual because he is sick off as they told me). I will let you know.

Elenicy profile image
Elenicy in reply to Elenicy

Hi SlowDragon.

Please, I have 2 questions if you can help me with the answers:

- If I do the TSH Receptor Stimulating Antibodies blood test now, can be shown if I have Grave's or Hashimoto's?

- Is someone with Hashimoto's can have a bulging eye (exophthalmos)?

Thank you in advance for your precious help. xx

ling profile image
ling in reply to Elenicy

SlowDragon

SlowDragon profile image
SlowDragonAdministrator in reply to Elenicy

It is possible to have both Graves and Hashimoto's

It's more unusual

An ultrasound scan of thyroid can help diagnose Hashimoto's.

But your hypothyroid blood tests and high TPO and high TG antibodies would suggest Hashimoto's

Eye problems are possible with Hashimoto's. I have had some noticeable swelling in both eyes, very dry and gritty.

But not heard of only one eye being affected

You will likely need see Thyroid specialist endocrinologist

Dionne at Thyroid Uk has list of recommended thyroid specialists

Elenicy profile image
Elenicy in reply to SlowDragon

Thank you SlowDragon

humanbean profile image
humanbean

Someone having hypothyroid and hyperthyroid symptoms and fluctuating blood test results may have a condition called hashitoxicosis.

1) My understanding of this condition (which is very limited) suggests that the name is sometimes used to describe the hyperthyroid condition that may occur in the early stages of Hashimoto's Thyroiditis.

2) I've also seen it described as a condition in which the patient has antibodies normally found in Hashimoto's Thyroiditis and also in Graves' Disease. I don't know which set of antibodies would be considered to be definitive for hashitoxicosis.

I don't know which of these is the "true" definition. But it would be worth doing some research to see if any of the info out there on the subject is of help to you.

Elenicy profile image
Elenicy in reply to humanbean

Thank you humanbean!

jgelliss profile image
jgelliss in reply to humanbean

Yes I experienced It . I first was hyperthyroid where I experienced palpitations lost lots of weight . It was followed by hypothyroidism where I gained weight no matter how much I watched my weight exercised. Became lethargic , was cold all the time when others where comfortable tired all the time no energy etc.

Elenicy profile image
Elenicy in reply to jgelliss

I gained weight but I don't feel cold. Yes, I am weak and also high blood pressures and pulses.

Lora7again profile image
Lora7again

I think I might have both ... I haven't had my private blood test yet because I am waiting for a Consultant Endo appointment. At the moment I feel very well .. I have lost 7lbs and my skin and hair look good. I no longer have night sweats and I can smell & taste food again. However, I still have tinnitus so I think this mustn't be connected with my thyroid disease. I think I am in remission again but I have no idea how long it will last this time.

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