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Done Thyroid Test. Diagnosed As Hashimoto's Disease And Graves Disease. Which Diagnosis Is Correct?

Posted on Fri, 7 Sep 2012

Question: I recently recently received from very confusing lad results. Minutes before my appointment I found out the clinic I was going was not covered by my insurance as they had at previous appointments claimed. So I could only afford a 10 minute appointment with the CNP to receive my test results. They showed as followed:
T4 Total 17.3 H refrence range 4.5-12.0, T3 Free 5.9 H ref range 2.3-4.2, TSH 0.01 ref range 0.40-4.50, Thyroid Peroxidase AB 547 ref range <35. The CNP told me I have Hashimotos and said I needed Armor thyroid right away then sent me to a hormones clinic for a free consult with an RPH since my hormones test were showing otherimbalances. The RPH read my results and said I did not have Hashimotos but that my results showed Graves Disease. Here is the confusing part I am extremely overweight and have huge difficulties losing even though I eat a good diet. I have also been having absense and simple complex seizures over the last year. I have been dealing with a unilateral ptosis in my left eye along with numbness on my upper cheek for about 3 to 4 yrs now. Some of the research that I have done shows that these all may be signs of Atypical Graves Disease. Please what is your opinion.

Answered by Dr. Shehzad Topiwala (4 hours later)

The lab results are suggestive of an overactive thyroid called hyperthyroidism. Graves disease is a common cause of hyperthyroidism. it is quite likely you have this condition. Doing another test called 'Radioactive Iodine 123 uptake and scan' can provide definitive diagnosis. This involves going to the Nuclear medicine department of a hospital or radiology center, and swallowing an iodine pill following whchi you are called 4-6 hours later and then again 24 hours later to scan the neck. Sometimes, a blood test called TSI (Thyroid Stimulating Immunoglobulins) is performed to aid in the diagnosis. However it is absolutely vital that you see an endocrinologist with special interest and expertise in thyroid disease in order to make an accurate diagnosis and treatment plan. There are potentially accompanying signs and symptoms relating to eye disease that are associated with Graves disease. It is important that an endocrinologist examines you to ascertain this, because it has bearing on the treatment options. Also the positive thyroid peroxidase test will mislead the non-expert into believing you have hashimoto's. it canbe complex so the approach is best left to an endocrinologist. It is possible you may only have temporary bruising of your thyroid gland called 'thyroiditis' and sometimes peroxidase antibodies can be positive in such circumstances. treatment for all these different situations is quite different and will require follow up to determine which direction your thyroid is heading in. For now, I can advise you to not take armor thyroid at all.
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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (13 hours later)

Thank you very much for your response. I am not taking the Armor. I knew her diagnosis could not be right. I will seek out a endocrinologist who specializes in thyroid in my area. Again thank you.

Answered by Dr. Shehzad Topiwala (32 hours later)

Hi,
Thanks for writing back.
If you have any more questions, please do let me know. Else, please close this discussion.
Regards

Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar