Graves disease and nodules
Common Questions and Answers about Graves disease and nodules
graves-disease
Have you been tested for thyroid antibodies to make sure you do, in fact, have Graves disease and are not simply in a hyper phase of Hashimoto's? Both Graves and Hashimoto's are autoimmune.
While Graves is always connected with hyperthyroidism, Hashimoto's is most often connected with hypothyroidism, however it's not uncommon for one to have periods of hyperthyroidism in the beginning stages.
You should ask for thyroid antibody tests.
Many of us have nodules on our thyroid and most of them need no treatment, unless they cause some sort of issue or are cancerous, which is quite rare.
Nodules are quite common with autoimmune thyroid disease, such as Hashimoto's and/or Graves Disease. Do you know if you have either of these?
Hashimoto's is most often associate with hypothyroidism (low thyroid levels), but can be characterized by periods of hyperthyroidism, as well.
Is TSH the only test your endo is ordering for you? If so, you might want to start looking for another. You should also have Free T3 and Free T4 tested every time TSH is tested.
Have you had antibody tests to confirm/rule out Graves Disease and/or Hashimoto's? While Graves Disease is always associated with hyperthyroidism, not all hyperthyroidism is Graves Disease.
Has your doctor told you, you have Graves Disease? Yes, your TSH is extremely low and your FT4 is extremely high, indicating that you are hyper, but your antibody tests indicate Hashimoto's. TSI is the definitive test for Graves Disease and I don't see that listed.
Have you been put on antithyroid med?
Assuming that you are not taking any thyroid medication, the high levels of FT4 and FT3 make me wonder about the possibility of also having Graves Disease. Having both is unusual, but if you search the Forum archives, you will see patients who have posted that have had both. Here is one example.
http://www.medhelp.org/posts/Thyroid-Disorders/Hasimotos-or-Graves/show/1265756
To confirm Graves disease you should have the Thyroid-Stimulating Immunoglobulins (TSI) test.
Yes, TT stands for total thyroidectomy...surgical removal of the entire thyroid gland.
Do you know whay you have nodules? Do you have Hashimoto's thyroiditis or Graves' disease. Depending on the cause of the nodules, iodine supplements can make the condition worse. Were you advised by your doctor to take this?
Are you taking any thyroid meds?
Similarly, sarcoidosis of the thyroid gland may develop in response to an established thyroid disorder including Graves’ disease, nodular goiter, and thyroid cancer. Patients with Graves’ disease may also have concomitant conditions of sarcoidosis affecting the lungs. Patients with systemic sarcoidosis may also develop sarcoid lesions in various organs including the thyroid gland.
Based on your current lab work, Graves Disease is likely.
You need a second opinion.
Based on what you describe, you have autoimmune thyroid disease with markers for Graves' (TSI) and the other common antibodies (TPO and Tg) that are usually associated with hashimoto's. Graves' and Hashi should be considered as entities on two ends of a spectrum, not two completely different diseases.
This may cause fluctuating thyroid function to hypo and hyper and back but this is not common.
You have hyperthyroidism. Most commonly this would be Graves' disease. The ultrasound did not show a nodule that would be "hot". The vascularity on the ultrasound was unremarkable, typically in thyroiditis this is a low. Classically in Graves' disease it is high but this does not exclude Graves' disease. The antibody you've had have been negative but these are nonspecific for Graves' disease.
An autoimmune thyroid disease is one, in which, for some reason, the body sees the thyroid gland as "foreign", so produces antibodies to destroy it. Graves Disease and Hashimoto's Thyroiditis are the 2 autoimmunes that attack the thyroid.
Graves Disease is most often linked to hyperthyroidism, while Hashimoto's is usually linked to hypothyroidism; however --- some with Hashimoto's can be hyperthyroid before becoming hypothyroid.
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