Re: OMG she said Hashimotos...

[Guest guest]

Hi Pam,

She's probably saying Hashimoto's because you have both antibodies seen in GD

and ones seen in HT. However, the ones that show up in HT also show up in GD.

So you can't tell from these labs. If you also had blocking TRAb, a test you

didn't have, then you'd have a better chance of eventually developing HT than

people without these antibodies.

[Guest guest]

Hi Pam,

She's probably saying Hashimoto's because you have both antibodies seen in GD

and ones seen in HT. However, the ones that show up in HT also show up in GD.

So you can't tell from these labs. If you also had blocking TRAb, a test you

didn't have, then you'd have a better chance of eventually developing HT than

people without these antibodies.

[Guest guest]

what tests do I need for a definitive diagnosis?

Re: OMG she said Hashimotos...

Hi Pam,

She's probably saying Hashimoto's because you have both antibodies seen in

GD

and ones seen in HT. However, the ones that show up in HT also show up in

GD.

So you can't tell from these labs. If you also had blocking TRAb, a test you

didn't have, then you'd have a better chance of eventually developing HT

than

people without these antibodies.

[Guest guest]

what tests do I need for a definitive diagnosis?

Re: OMG she said Hashimotos...

Hi Pam,

She's probably saying Hashimoto's because you have both antibodies seen in

GD

and ones seen in HT. However, the ones that show up in HT also show up in

GD.

So you can't tell from these labs. If you also had blocking TRAb, a test you

didn't have, then you'd have a better chance of eventually developing HT

than

people without these antibodies.

[Guest guest]

what tests do I need for a definitive diagnosis?

Re: OMG she said Hashimotos...

Hi Pam,

She's probably saying Hashimoto's because you have both antibodies seen in

GD

and ones seen in HT. However, the ones that show up in HT also show up in

GD.

So you can't tell from these labs. If you also had blocking TRAb, a test you

didn't have, then you'd have a better chance of eventually developing HT

than

people without these antibodies.

[Guest guest]

I thought that Hashimoto's was the hypo end of the spectrum. Maybe you have

both like several others out here.

Holly

[Guest guest]

I thought that Hashimoto's was the hypo end of the spectrum. Maybe you have

both like several others out here.

Holly

[Guest guest]

That's what I'm thinking too. I went back to the symptoms list and I DO have

lots of symptoms from both sides of the list. Thats why when some of you

say you feel great when you are hyper and crappy when you are hypo... it

never made sense to me because I feel crappy all the time. I feel like an

itchy slug whose heart is going to explode.

So, the big question: how does a hyper/hypo person get treated? I just want

to get better.

Thanks,

Pam (I'm starting to feel a little bit whiny as well as an itchy slug,

sorry)

RE: OMG she said Hashimotos...

I thought that Hashimoto's was the hypo end of the spectrum. Maybe you have

both like several others out here.

Holly

[Guest guest]

That's what I'm thinking too. I went back to the symptoms list and I DO have

lots of symptoms from both sides of the list. Thats why when some of you

say you feel great when you are hyper and crappy when you are hypo... it

never made sense to me because I feel crappy all the time. I feel like an

itchy slug whose heart is going to explode.

So, the big question: how does a hyper/hypo person get treated? I just want

to get better.

Thanks,

Pam (I'm starting to feel a little bit whiny as well as an itchy slug,

sorry)

RE: OMG she said Hashimotos...

I thought that Hashimoto's was the hypo end of the spectrum. Maybe you have

both like several others out here.

Holly

[Guest guest]

That's what I'm thinking too. I went back to the symptoms list and I DO have

lots of symptoms from both sides of the list. Thats why when some of you

say you feel great when you are hyper and crappy when you are hypo... it

never made sense to me because I feel crappy all the time. I feel like an

itchy slug whose heart is going to explode.

So, the big question: how does a hyper/hypo person get treated? I just want

to get better.

Thanks,

Pam (I'm starting to feel a little bit whiny as well as an itchy slug,

sorry)

RE: OMG she said Hashimotos...

I thought that Hashimoto's was the hypo end of the spectrum. Maybe you have

both like several others out here.

Holly

[Guest guest]

> That's what I'm thinking too. I went back to the symptoms list and I DO have

> lots of symptoms from both sides of the list. Thats why when some of you

> say you feel great when you are hyper and crappy when you are hypo... it

> never made sense to me because I feel crappy all the time. I feel like an

> itchy slug whose heart is going to explode.

>

> So, the big question: how does a hyper/hypo person get treated? I just want

> to get better.

Pam --

That's what made me choose the RAI. I got so tired of my TSH running up

and down, but staying within the normal scale. That made it nearly

impossible to treat me. I figured that at least with RAI, I'd go hypO and

then just have one problem to deal with, not two.

As posted yesterday, my TSH as of Tuesday was 68.xx . picked up my

prescription last night. It's for " Synthroid 100MCG " -- 1 tablet, 1x per

day -- although my endo told me to take two for the first three days. So,

anyone have any experience with how long it takes to get into your system

and make you start feeling a bit better? I've got an appt. with the endo

on April 11th, and he asked that I schedule labs for 6 weeks (although if

I start feeling really bad, I'm always free to request them sooner), so I

presume that it takes 6 weeks to really start working.

--patti

*~*~*~*~*

Patti Spicer patti@...

" Those who would give up freedom for security deserve neither "

--Ben lin

http://www.cyphergirl.com - My photography, cookbooks, thyroid info, and more!

[Guest guest]

> That's what I'm thinking too. I went back to the symptoms list and I DO have

> lots of symptoms from both sides of the list. Thats why when some of you

> say you feel great when you are hyper and crappy when you are hypo... it

> never made sense to me because I feel crappy all the time. I feel like an

> itchy slug whose heart is going to explode.

>

> So, the big question: how does a hyper/hypo person get treated? I just want

> to get better.

Pam --

That's what made me choose the RAI. I got so tired of my TSH running up

and down, but staying within the normal scale. That made it nearly

impossible to treat me. I figured that at least with RAI, I'd go hypO and

then just have one problem to deal with, not two.

As posted yesterday, my TSH as of Tuesday was 68.xx . picked up my

prescription last night. It's for " Synthroid 100MCG " -- 1 tablet, 1x per

day -- although my endo told me to take two for the first three days. So,

anyone have any experience with how long it takes to get into your system

and make you start feeling a bit better? I've got an appt. with the endo

on April 11th, and he asked that I schedule labs for 6 weeks (although if

I start feeling really bad, I'm always free to request them sooner), so I

presume that it takes 6 weeks to really start working.

--patti

*~*~*~*~*

Patti Spicer patti@...

" Those who would give up freedom for security deserve neither "

--Ben lin

http://www.cyphergirl.com - My photography, cookbooks, thyroid info, and more!

[Guest guest]

A definitive diagnosis of HT is made by a biopsy that shows tissue changes or

by the presence of blocking TSH receptor antibodies or very high titers of

thyroglobulin antibodies.

[Guest guest]

A definitive diagnosis of HT is made by a biopsy that shows tissue changes or

by the presence of blocking TSH receptor antibodies or very high titers of

thyroglobulin antibodies.

[Guest guest]

Hi Patti-

Levothyroxine has a 1/2 life of 6 days so it'll probably take you that long

to start feeling better. By 12 days, you'll feel a lot better. 1 month and

you'll have an idea of how you're going to do on that dose. My endo says it

takes 3 months though to see the full effects of dose changes.

That doesn't mean that your endo won't switch you if you're not doing well

by that 6 week mark (mine will switch me at 1 month). If it's apparent that

100 mcg isn't enough or if it's too much, he'll be able to catch it by then.

Take care,

....

>

>

> > That's what I'm thinking too. I went back to the symptoms list and I DO

have

> > lots of symptoms from both sides of the list. Thats why when some of

you

> > say you feel great when you are hyper and crappy when you are hypo... it

> > never made sense to me because I feel crappy all the time. I feel like

an

> > itchy slug whose heart is going to explode.

> >

> > So, the big question: how does a hyper/hypo person get treated? I just

want

> > to get better.

>

> Pam --

>

> That's what made me choose the RAI. I got so tired of my TSH running up

> and down, but staying within the normal scale. That made it nearly

> impossible to treat me. I figured that at least with RAI, I'd go hypO and

> then just have one problem to deal with, not two.

>

> As posted yesterday, my TSH as of Tuesday was 68.xx . picked up my

> prescription last night. It's for " Synthroid 100MCG " -- 1 tablet, 1x per

> day -- although my endo told me to take two for the first three days. So,

> anyone have any experience with how long it takes to get into your system

> and make you start feeling a bit better? I've got an appt. with the endo

> on April 11th, and he asked that I schedule labs for 6 weeks (although if

> I start feeling really bad, I'm always free to request them sooner), so I

> presume that it takes 6 weeks to really start working.

>

> --patti

[Guest guest]

Hi Patti-

Levothyroxine has a 1/2 life of 6 days so it'll probably take you that long

to start feeling better. By 12 days, you'll feel a lot better. 1 month and

you'll have an idea of how you're going to do on that dose. My endo says it

takes 3 months though to see the full effects of dose changes.

That doesn't mean that your endo won't switch you if you're not doing well

by that 6 week mark (mine will switch me at 1 month). If it's apparent that

100 mcg isn't enough or if it's too much, he'll be able to catch it by then.

Take care,

....

>

>

> > That's what I'm thinking too. I went back to the symptoms list and I DO

have

> > lots of symptoms from both sides of the list. Thats why when some of

you

> > say you feel great when you are hyper and crappy when you are hypo... it

> > never made sense to me because I feel crappy all the time. I feel like

an

> > itchy slug whose heart is going to explode.

> >

> > So, the big question: how does a hyper/hypo person get treated? I just

want

> > to get better.

>

> Pam --

>

> That's what made me choose the RAI. I got so tired of my TSH running up

> and down, but staying within the normal scale. That made it nearly

> impossible to treat me. I figured that at least with RAI, I'd go hypO and

> then just have one problem to deal with, not two.

>

> As posted yesterday, my TSH as of Tuesday was 68.xx . picked up my

> prescription last night. It's for " Synthroid 100MCG " -- 1 tablet, 1x per

> day -- although my endo told me to take two for the first three days. So,

> anyone have any experience with how long it takes to get into your system

> and make you start feeling a bit better? I've got an appt. with the endo

> on April 11th, and he asked that I schedule labs for 6 weeks (although if

> I start feeling really bad, I'm always free to request them sooner), so I

> presume that it takes 6 weeks to really start working.

>

> --patti

[Guest guest]

Hi Patti-

Levothyroxine has a 1/2 life of 6 days so it'll probably take you that long

to start feeling better. By 12 days, you'll feel a lot better. 1 month and

you'll have an idea of how you're going to do on that dose. My endo says it

takes 3 months though to see the full effects of dose changes.

That doesn't mean that your endo won't switch you if you're not doing well

by that 6 week mark (mine will switch me at 1 month). If it's apparent that

100 mcg isn't enough or if it's too much, he'll be able to catch it by then.

Take care,

....

>

>

> > That's what I'm thinking too. I went back to the symptoms list and I DO

have

> > lots of symptoms from both sides of the list. Thats why when some of

you

> > say you feel great when you are hyper and crappy when you are hypo... it

> > never made sense to me because I feel crappy all the time. I feel like

an

> > itchy slug whose heart is going to explode.

> >

> > So, the big question: how does a hyper/hypo person get treated? I just

want

> > to get better.

>

> Pam --

>

> That's what made me choose the RAI. I got so tired of my TSH running up

> and down, but staying within the normal scale. That made it nearly

> impossible to treat me. I figured that at least with RAI, I'd go hypO and

> then just have one problem to deal with, not two.

>

> As posted yesterday, my TSH as of Tuesday was 68.xx . picked up my

> prescription last night. It's for " Synthroid 100MCG " -- 1 tablet, 1x per

> day -- although my endo told me to take two for the first three days. So,

> anyone have any experience with how long it takes to get into your system

> and make you start feeling a bit better? I've got an appt. with the endo

> on April 11th, and he asked that I schedule labs for 6 weeks (although if

> I start feeling really bad, I'm always free to request them sooner), so I

> presume that it takes 6 weeks to really start working.

>

> --patti

[Guest guest]

Pam B. -

Boy, what a puzzle! There are a couple things I found for Hashitoxicosis

when I was looking (very few!). Here are some links to articles from

Elaine's site on Suite101:

http://www.suite101.com/article.cfm/graves_disease/71806

This is about Hashitoxicosis in general. Summarizing, it says the TPO and

antithyroglobulin ABs cause thyroid cell inflammation and destruction. Then

as the cells die, the stored hormone is released into blood this is

responsible for hyper symptoms. Then blocking TRAb's keep the thyroid from

absorbing hormone, making hypo symptoms worse.

http://www.suite101.com/article.cfm/graves_disease/54459

This one is interesting about all the different thyroid antibodies.

And, in an article from the thyroidmanager.org site (reference for this is

http://www.thyroidmanager.org/Chapter15/15-6.htm) it says, " Measurement of

TSH receptor antibodies may be particularly useful in distinguishing the

toxic phase of CLT (TSH receptor antibody negative) from patients with both

CLT and Graves' disease ( " Hashitoxicosis " , TSH receptor antibody positive). "

(By the way, Elaine told me CLT is just another term for Hashimoto's). So, I

would have thought that since your TSI were so elevated, you'd have GD. Now

if you have both, I still would have thought that your TSI are high enough

that they must be the predominating antibodies (hate to see how high the

blocking AB's would have to be to beat those!) I'm also not sure what the

difference between your TSI and TRAb receptor antibody tests are - did you

get a description of those from the doc? If not, maybe asking what the

difference is could shed some light on it. Unless the TRAb one just checks

to see if there are _any_ TSH receptor antibodies, but not necessarily which

kind.

Still another mention of Hashitoxicosis is

http://www.auntminnie.com/MD2/nucmed/Endocrine/Thyroid/Th.../Th

yroiditis.htm

which says, " Hashimoto's thyroiditis can also manifest as an acute mild to

moderate hyperthyroidism in 3-5% of cases. Hashitoxicosis refers to the

presence of chronic lymphocytic thyroiditis [that CLT mention before, which

is another name for Hashi's - my note] PLUS hyperthyroidism. These patients

have high antibody titers as seen in Grave's disease (in fact, this disorder

probably represents superimposed Grave's on Hashimoto's). The

antigen-antibody reaction leads to relatively rapid follicular cell damage

and excess hormone release into the circulation. RAIU is normal or elevated.

The hyperthyroidism is typically self-limited and resolves spontaneously

over a period of weeks to several months. "

The best info I found so far was in Werner and Ingbar's book, The Thyroid.

It says on pg 152, 153 of the edition I used, " There is in addition a small

group of patients who present with the clinical manifestation of Graves'

hyperthyroidism but have the serologic and histologic features of typical of

Hashimoto's thyroiditis. Some patients with Graves' disease have elevated

levels of antithyroid antibodies in the range found in classical Hashimoto's

thyroiditis and in others the thyroid gland histologically shows the classic

appearance of Hashimoto's thyroiditis. These patients have been termed

" Hashitoxicosis " by some thyroidologists. The clinical manifestations and

radioactive iodine studies are usually typical for those with Graves'

disease. Hashitoxicosis follows the normal course found in the usual patient

with Graves' hyperthyroidism but there is an increased tendency for

remission of the thyroitoxicosis to occur and for spontaneous hypothyroidism

to develop. In Hashimoto's thyroiditis, as well as Graves' disease, thyroid

stimulating immunoglobulins (TSI) may be present. As previously discussed,

TSI are antibodies against the TSH receptor in the thyroid gland and thought

to be the likely factor that stimulates the thyroid gland to cause thyroid

hyperfunction. However, in Hashimoto's thyroiditis, because of the thyroid

gland destruction, the glandular tissue us normally unable to produce excess

levels of thyroid hormone except in a few circumstances (Hashitoxicosis).

Continued destruction of the thyroid gland will prevent the thyroid from

being able to fully respond to TSI stimulation...Opthalmopathy is

infrequently present in Hashimoto's disease....Furthermore, Kriss has

suggested that the thyroglobulin-antithyroglobulin complexes could reach the

orbit by way of cervico facial lymphatics draining the thyroid and bind

specifically to retro-orbital muscle. " (That last bit was interesting.)

I don't blame you for being confused about the diagnosis. I'm extra curious

because I might be in the same situation you are, but I don't get my new

labs till next month. So my hope is that if we can figure out your

diagnosis, it might help me figure out what mine is doing, too!

I wouldn't think they'd want to give you replacement hormone since your T4

and T3 were high and your TSH was low...what did the doc recommend as the

next step for treatment, if anything? Or is it just wait and see? (that's

where I am...kind of frustrating, I know)

Forgot something else - the TSH receptor blocking antibodies tests that

Elaine mentioned - I've seen them referred to as either TRBAb or TSI-block.

Hope that helps!

Since the board will be down this weekend, if you want to email me, I'm at

mlbuck@... or I'm also on Mediboard.

(took me all day to write this one!)

OMG she said Hashimotos...

>...but that I couldn't rule out the possibility that it was Graves' and

that

>I should go see a naturopath and an ophthalmologist... and if my eyes get

>worse then to come back to her for more traditional/aggressive treatment.

>If it wasn't for my eye involvement then she would take the wait and see

>approach.

>

>Oh, am I confused. Why is she saying it looks like Hashimotos? This is the

>second doc who said that. The first said she " suspected " Hashimotos.

>

>There is no question that I'm hyperT. There is no question that I have

>autoimmune thyroid disease. The labs say Graves' all over them. There is no

>mention of Hashimotos in the labs. Why would she say I have HT? I am so

>bummed out right now. I thought we would have a diagnosis tonight and

>tomorrow I could start figuring out treatment options.

>

>Here are my labs again, now that I have them in print:

>

>TSI: 501 H % (range <130%)

>TRAB (TSH Receptor Antibody): 24 H % (<10 %)

>TBII: 29.0 H % (range <10%)

>AntiThyroglobin: 14.8 (range <2.1)

>T.PEROX.AUTOAB: <2.09(a) (range <2.1)

>

>T3: 48.1 (25-40)

>T4: 22.0 (5-12)

>TSH: <0.01 (0.40-5.00)

>

>Thanks for reading.

>Pam B.

>

>

>

>-------------------------------------

>The Graves' list is intended for informational purposes only and is not

intended to replace expert medical care.

>Please consult your doctor before changing or trying new treatments.

>----------------------------------------

> DISCLAIMER

>

>Advertisments placed on this yahoo groups list does not have the

endorsement of

>the listowner. I have no input as to what ads are attached to emails.

>---------------------------------------------------------------------------

-----------

>

>

[Guest guest]

Pam B. -

Boy, what a puzzle! There are a couple things I found for Hashitoxicosis

when I was looking (very few!). Here are some links to articles from

Elaine's site on Suite101:

http://www.suite101.com/article.cfm/graves_disease/71806

This is about Hashitoxicosis in general. Summarizing, it says the TPO and

antithyroglobulin ABs cause thyroid cell inflammation and destruction. Then

as the cells die, the stored hormone is released into blood this is

responsible for hyper symptoms. Then blocking TRAb's keep the thyroid from

absorbing hormone, making hypo symptoms worse.

http://www.suite101.com/article.cfm/graves_disease/54459

This one is interesting about all the different thyroid antibodies.

And, in an article from the thyroidmanager.org site (reference for this is

http://www.thyroidmanager.org/Chapter15/15-6.htm) it says, " Measurement of

TSH receptor antibodies may be particularly useful in distinguishing the

toxic phase of CLT (TSH receptor antibody negative) from patients with both

CLT and Graves' disease ( " Hashitoxicosis " , TSH receptor antibody positive). "

(By the way, Elaine told me CLT is just another term for Hashimoto's). So, I

would have thought that since your TSI were so elevated, you'd have GD. Now

if you have both, I still would have thought that your TSI are high enough

that they must be the predominating antibodies (hate to see how high the

blocking AB's would have to be to beat those!) I'm also not sure what the

difference between your TSI and TRAb receptor antibody tests are - did you

get a description of those from the doc? If not, maybe asking what the

difference is could shed some light on it. Unless the TRAb one just checks

to see if there are _any_ TSH receptor antibodies, but not necessarily which

kind.

Still another mention of Hashitoxicosis is

http://www.auntminnie.com/MD2/nucmed/Endocrine/Thyroid/Th.../Th

yroiditis.htm

which says, " Hashimoto's thyroiditis can also manifest as an acute mild to

moderate hyperthyroidism in 3-5% of cases. Hashitoxicosis refers to the

presence of chronic lymphocytic thyroiditis [that CLT mention before, which

is another name for Hashi's - my note] PLUS hyperthyroidism. These patients

have high antibody titers as seen in Grave's disease (in fact, this disorder

probably represents superimposed Grave's on Hashimoto's). The

antigen-antibody reaction leads to relatively rapid follicular cell damage

and excess hormone release into the circulation. RAIU is normal or elevated.

The hyperthyroidism is typically self-limited and resolves spontaneously

over a period of weeks to several months. "

The best info I found so far was in Werner and Ingbar's book, The Thyroid.

It says on pg 152, 153 of the edition I used, " There is in addition a small

group of patients who present with the clinical manifestation of Graves'

hyperthyroidism but have the serologic and histologic features of typical of

Hashimoto's thyroiditis. Some patients with Graves' disease have elevated

levels of antithyroid antibodies in the range found in classical Hashimoto's

thyroiditis and in others the thyroid gland histologically shows the classic

appearance of Hashimoto's thyroiditis. These patients have been termed

" Hashitoxicosis " by some thyroidologists. The clinical manifestations and

radioactive iodine studies are usually typical for those with Graves'

disease. Hashitoxicosis follows the normal course found in the usual patient

with Graves' hyperthyroidism but there is an increased tendency for

remission of the thyroitoxicosis to occur and for spontaneous hypothyroidism

to develop. In Hashimoto's thyroiditis, as well as Graves' disease, thyroid

stimulating immunoglobulins (TSI) may be present. As previously discussed,

TSI are antibodies against the TSH receptor in the thyroid gland and thought

to be the likely factor that stimulates the thyroid gland to cause thyroid

hyperfunction. However, in Hashimoto's thyroiditis, because of the thyroid

gland destruction, the glandular tissue us normally unable to produce excess

levels of thyroid hormone except in a few circumstances (Hashitoxicosis).

Continued destruction of the thyroid gland will prevent the thyroid from

being able to fully respond to TSI stimulation...Opthalmopathy is

infrequently present in Hashimoto's disease....Furthermore, Kriss has

suggested that the thyroglobulin-antithyroglobulin complexes could reach the

orbit by way of cervico facial lymphatics draining the thyroid and bind

specifically to retro-orbital muscle. " (That last bit was interesting.)

I don't blame you for being confused about the diagnosis. I'm extra curious

because I might be in the same situation you are, but I don't get my new

labs till next month. So my hope is that if we can figure out your

diagnosis, it might help me figure out what mine is doing, too!

I wouldn't think they'd want to give you replacement hormone since your T4

and T3 were high and your TSH was low...what did the doc recommend as the

next step for treatment, if anything? Or is it just wait and see? (that's

where I am...kind of frustrating, I know)

Forgot something else - the TSH receptor blocking antibodies tests that

Elaine mentioned - I've seen them referred to as either TRBAb or TSI-block.

Hope that helps!

Since the board will be down this weekend, if you want to email me, I'm at

mlbuck@... or I'm also on Mediboard.

(took me all day to write this one!)

OMG she said Hashimotos...

>...but that I couldn't rule out the possibility that it was Graves' and

that

>I should go see a naturopath and an ophthalmologist... and if my eyes get

>worse then to come back to her for more traditional/aggressive treatment.

>If it wasn't for my eye involvement then she would take the wait and see

>approach.

>

>Oh, am I confused. Why is she saying it looks like Hashimotos? This is the

>second doc who said that. The first said she " suspected " Hashimotos.

>

>There is no question that I'm hyperT. There is no question that I have

>autoimmune thyroid disease. The labs say Graves' all over them. There is no

>mention of Hashimotos in the labs. Why would she say I have HT? I am so

>bummed out right now. I thought we would have a diagnosis tonight and

>tomorrow I could start figuring out treatment options.

>

>Here are my labs again, now that I have them in print:

>

>TSI: 501 H % (range <130%)

>TRAB (TSH Receptor Antibody): 24 H % (<10 %)

>TBII: 29.0 H % (range <10%)

>AntiThyroglobin: 14.8 (range <2.1)

>T.PEROX.AUTOAB: <2.09(a) (range <2.1)

>

>T3: 48.1 (25-40)

>T4: 22.0 (5-12)

>TSH: <0.01 (0.40-5.00)

>

>Thanks for reading.

>Pam B.

>

>

>

>-------------------------------------

>The Graves' list is intended for informational purposes only and is not

intended to replace expert medical care.

>Please consult your doctor before changing or trying new treatments.

>----------------------------------------

> DISCLAIMER

>

>Advertisments placed on this yahoo groups list does not have the

endorsement of

>the listowner. I have no input as to what ads are attached to emails.

>---------------------------------------------------------------------------

-----------

>

>

[Guest guest]

Pam B. -

Boy, what a puzzle! There are a couple things I found for Hashitoxicosis

when I was looking (very few!). Here are some links to articles from

Elaine's site on Suite101:

http://www.suite101.com/article.cfm/graves_disease/71806

This is about Hashitoxicosis in general. Summarizing, it says the TPO and

antithyroglobulin ABs cause thyroid cell inflammation and destruction. Then

as the cells die, the stored hormone is released into blood this is

responsible for hyper symptoms. Then blocking TRAb's keep the thyroid from

absorbing hormone, making hypo symptoms worse.

http://www.suite101.com/article.cfm/graves_disease/54459

This one is interesting about all the different thyroid antibodies.

And, in an article from the thyroidmanager.org site (reference for this is

http://www.thyroidmanager.org/Chapter15/15-6.htm) it says, " Measurement of

TSH receptor antibodies may be particularly useful in distinguishing the

toxic phase of CLT (TSH receptor antibody negative) from patients with both

CLT and Graves' disease ( " Hashitoxicosis " , TSH receptor antibody positive). "

(By the way, Elaine told me CLT is just another term for Hashimoto's). So, I

would have thought that since your TSI were so elevated, you'd have GD. Now

if you have both, I still would have thought that your TSI are high enough

that they must be the predominating antibodies (hate to see how high the

blocking AB's would have to be to beat those!) I'm also not sure what the

difference between your TSI and TRAb receptor antibody tests are - did you

get a description of those from the doc? If not, maybe asking what the

difference is could shed some light on it. Unless the TRAb one just checks

to see if there are _any_ TSH receptor antibodies, but not necessarily which

kind.

Still another mention of Hashitoxicosis is

http://www.auntminnie.com/MD2/nucmed/Endocrine/Thyroid/Th.../Th

yroiditis.htm

which says, " Hashimoto's thyroiditis can also manifest as an acute mild to

moderate hyperthyroidism in 3-5% of cases. Hashitoxicosis refers to the

presence of chronic lymphocytic thyroiditis [that CLT mention before, which

is another name for Hashi's - my note] PLUS hyperthyroidism. These patients

have high antibody titers as seen in Grave's disease (in fact, this disorder

probably represents superimposed Grave's on Hashimoto's). The

antigen-antibody reaction leads to relatively rapid follicular cell damage

and excess hormone release into the circulation. RAIU is normal or elevated.

The hyperthyroidism is typically self-limited and resolves spontaneously

over a period of weeks to several months. "

The best info I found so far was in Werner and Ingbar's book, The Thyroid.

It says on pg 152, 153 of the edition I used, " There is in addition a small

group of patients who present with the clinical manifestation of Graves'

hyperthyroidism but have the serologic and histologic features of typical of

Hashimoto's thyroiditis. Some patients with Graves' disease have elevated

levels of antithyroid antibodies in the range found in classical Hashimoto's

thyroiditis and in others the thyroid gland histologically shows the classic

appearance of Hashimoto's thyroiditis. These patients have been termed

" Hashitoxicosis " by some thyroidologists. The clinical manifestations and

radioactive iodine studies are usually typical for those with Graves'

disease. Hashitoxicosis follows the normal course found in the usual patient

with Graves' hyperthyroidism but there is an increased tendency for

remission of the thyroitoxicosis to occur and for spontaneous hypothyroidism

to develop. In Hashimoto's thyroiditis, as well as Graves' disease, thyroid

stimulating immunoglobulins (TSI) may be present. As previously discussed,

TSI are antibodies against the TSH receptor in the thyroid gland and thought

to be the likely factor that stimulates the thyroid gland to cause thyroid

hyperfunction. However, in Hashimoto's thyroiditis, because of the thyroid

gland destruction, the glandular tissue us normally unable to produce excess

levels of thyroid hormone except in a few circumstances (Hashitoxicosis).

Continued destruction of the thyroid gland will prevent the thyroid from

being able to fully respond to TSI stimulation...Opthalmopathy is

infrequently present in Hashimoto's disease....Furthermore, Kriss has

suggested that the thyroglobulin-antithyroglobulin complexes could reach the

orbit by way of cervico facial lymphatics draining the thyroid and bind

specifically to retro-orbital muscle. " (That last bit was interesting.)

I don't blame you for being confused about the diagnosis. I'm extra curious

because I might be in the same situation you are, but I don't get my new

labs till next month. So my hope is that if we can figure out your

diagnosis, it might help me figure out what mine is doing, too!

I wouldn't think they'd want to give you replacement hormone since your T4

and T3 were high and your TSH was low...what did the doc recommend as the

next step for treatment, if anything? Or is it just wait and see? (that's

where I am...kind of frustrating, I know)

Forgot something else - the TSH receptor blocking antibodies tests that

Elaine mentioned - I've seen them referred to as either TRBAb or TSI-block.

Hope that helps!

Since the board will be down this weekend, if you want to email me, I'm at

mlbuck@... or I'm also on Mediboard.

(took me all day to write this one!)

OMG she said Hashimotos...

>...but that I couldn't rule out the possibility that it was Graves' and

that

>I should go see a naturopath and an ophthalmologist... and if my eyes get

>worse then to come back to her for more traditional/aggressive treatment.

>If it wasn't for my eye involvement then she would take the wait and see

>approach.

>

>Oh, am I confused. Why is she saying it looks like Hashimotos? This is the

>second doc who said that. The first said she " suspected " Hashimotos.

>

>There is no question that I'm hyperT. There is no question that I have

>autoimmune thyroid disease. The labs say Graves' all over them. There is no

>mention of Hashimotos in the labs. Why would she say I have HT? I am so

>bummed out right now. I thought we would have a diagnosis tonight and

>tomorrow I could start figuring out treatment options.

>

>Here are my labs again, now that I have them in print:

>

>TSI: 501 H % (range <130%)

>TRAB (TSH Receptor Antibody): 24 H % (<10 %)

>TBII: 29.0 H % (range <10%)

>AntiThyroglobin: 14.8 (range <2.1)

>T.PEROX.AUTOAB: <2.09(a) (range <2.1)

>

>T3: 48.1 (25-40)

>T4: 22.0 (5-12)

>TSH: <0.01 (0.40-5.00)

>

>Thanks for reading.

>Pam B.

>

>

>

>-------------------------------------

>The Graves' list is intended for informational purposes only and is not

intended to replace expert medical care.

>Please consult your doctor before changing or trying new treatments.

>----------------------------------------

> DISCLAIMER

>

>Advertisments placed on this yahoo groups list does not have the

endorsement of

>the listowner. I have no input as to what ads are attached to emails.

>---------------------------------------------------------------------------

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>

>

[Guest guest]

> Hi Patti-

>

> Levothyroxine has a 1/2 life of 6 days so it'll probably take you that long

> to start feeling better. By 12 days, you'll feel a lot better. 1 month and

> you'll have an idea of how you're going to do on that dose. My endo says it

> takes 3 months though to see the full effects of dose changes.

Yesterday was day 4 on the Synthroid -- and I swear, I actually felt a

difference -- I feel it today too. I can't really put my finger on it

though... I was at the sinus dr. yesterday, and it turns out that I have

the " cough of the week " (ie: whatever's going around). This cough or

whatever is making me feel REALLY bad, but despite that, I'm feeling

like a human being again. It's something that I can't really describe....

I'm coughing and hacking, and my nose is stuffed up, but mentally I'm back

in the game.... the fog seems to be lifting a bit.

--patti

*~*~*~*~*

Patti Spicer patti@...

" Those who would give up freedom for security deserve neither "

--Ben lin

http://www.cyphergirl.com - My photography, cookbooks, thyroid info, and more!

[Guest guest]

> Hi Patti-

>

> Levothyroxine has a 1/2 life of 6 days so it'll probably take you that long

> to start feeling better. By 12 days, you'll feel a lot better. 1 month and

> you'll have an idea of how you're going to do on that dose. My endo says it

> takes 3 months though to see the full effects of dose changes.

Yesterday was day 4 on the Synthroid -- and I swear, I actually felt a

difference -- I feel it today too. I can't really put my finger on it

though... I was at the sinus dr. yesterday, and it turns out that I have

the " cough of the week " (ie: whatever's going around). This cough or

whatever is making me feel REALLY bad, but despite that, I'm feeling

like a human being again. It's something that I can't really describe....

I'm coughing and hacking, and my nose is stuffed up, but mentally I'm back

in the game.... the fog seems to be lifting a bit.

--patti

*~*~*~*~*

Patti Spicer patti@...

" Those who would give up freedom for security deserve neither "

--Ben lin

http://www.cyphergirl.com - My photography, cookbooks, thyroid info, and more!

[Guest guest]

> Hi Patti-

>

> Levothyroxine has a 1/2 life of 6 days so it'll probably take you that long

> to start feeling better. By 12 days, you'll feel a lot better. 1 month and

> you'll have an idea of how you're going to do on that dose. My endo says it

> takes 3 months though to see the full effects of dose changes.

Yesterday was day 4 on the Synthroid -- and I swear, I actually felt a

difference -- I feel it today too. I can't really put my finger on it

though... I was at the sinus dr. yesterday, and it turns out that I have

the " cough of the week " (ie: whatever's going around). This cough or

whatever is making me feel REALLY bad, but despite that, I'm feeling

like a human being again. It's something that I can't really describe....

I'm coughing and hacking, and my nose is stuffed up, but mentally I'm back

in the game.... the fog seems to be lifting a bit.

--patti

*~*~*~*~*

Patti Spicer patti@...

" Those who would give up freedom for security deserve neither "

--Ben lin

http://www.cyphergirl.com - My photography, cookbooks, thyroid info, and more!

[Guest guest]

Hi Patti,

Am sorry to hear about your cold A good friend of ours has one that has

laid him out since last Thursday...hope yours doesn't last so long.

It is good to here you are already feeling the effects of the synthroid!

Hope you just keep on improving here!

Jody

_________________________________________________________________

Send and receive Hotmail on your mobile device: http://mobile.msn.com

[Guest guest]

Hi Patti,

Am sorry to hear about your cold A good friend of ours has one that has

laid him out since last Thursday...hope yours doesn't last so long.

It is good to here you are already feeling the effects of the synthroid!

Hope you just keep on improving here!

Jody

_________________________________________________________________

Send and receive Hotmail on your mobile device: http://mobile.msn.com