The below article was created from an e-mail response I made to a thyroid patient who has symptoms of being both hypothyroid (under-active thyroid) and hyperthyroid (over-active thyroid). In my response her, I gave some detailed explanation about the "antibodies" that cause diseases of the thyroid, resulting in hypothyroidism and hyperthyroidism and how these antibodies can all be present in the same patient, causing symptoms of both types of thyroid imbalance.

MY E-MAIL RESPONSE:

With Hashimoto's thyroiditis, which typically causes hypothyroidism (low thyroid hormone) patients can have fluctuations from hypothyroid to hyperthyroid and this can be due to having high levels of thyroid antibodies. The antibodies that are tested for, when Hashimoto's is being determined, are the TPO and TG antibodies (either or both testing positive helps confirm it) however, some Hashimoto's patients also test positive for antibodies called the TSI antibodies (thyroid stimulating immunoglobulins). This antibody is what usually contributes to Grave's Disease (autoimmune hyperthyroidism) however, some Hashi's patients have these antibodies as well as the TPO and/or TG ones, that typically cause Hashimoto's and is why they have the spells of Hashitoxicosis (intermittent hyperthyroidism). You almost could say they are suffering from Grave's & Hashi's, simultaneously. Even without having the TSI antibodies present, Hashi's patients can still experience spells of thyroiditis, which can also cause mild hyper type symptoms that are not as severe as those caused by Hashitoxicosis but are still concerning ones.

Some patients who have both Hashi's & Grave's antibodies, are placed on a treatment called "block and replace". This is where they will block the stimulation of the thyroid with an anti-thyroid medication (slows hormone production) and then replace the patient with thyroid hormone therapy (replaces the diminished hormone levels). It is a fairly recently developed treatment and I don't know a great deal about it but your Doctor could inform you in more detail about this.

The most important step for you at this point, in my opinion, is that your Doctor order you the TSI, TPO and TG antibodies tests. I don't mean to sound forward but if it were me, I would not take "no" for an answer in requesting these tests. I say this because it will be difficult to move forward in finding another cause for your symptoms, before first establishing whether or not it could be related to having these antibodies causing the problem.

It sounds very much like to me, that with your having hypothyroidism and the hormone fluctuations, chances are strong that you have these antibodies warring against each other, for control of your thyroid. Some Hashi's patients have been know to actually transition over to Grave's Disease (hyperthyroidism), when having both types of antibodies and they become progressively hyperthyroid. Other Hashimoto's patients will have hyperthyroid spells but will still become progressively hypothyroid afterward. It may also be encouraging for you to know that many Hashimoto's patients have the hyperthyroid spells more-so during the early onset of the disease but after time, the hyper spells subside and give way to progressive hypothyroidism.

In regard to the supplements of vitamins and minerals you take, these should not affect your thyroid hormones. Two supplements that can affect them however, are calcium and iron, which can decrease absorption in your body, of the thyroid medication, so need to be taken six hours apart from your Synthroid (thyroid hormone medication) dose.

In regard to you switching to a different thyroid medication, such as Amour which contains both T-4 and T-3 hormone, in my opinion, a patient has as much chance of doing well on a T-4 only medication like Synthroid, as they do on Armour. I say this because blood retests are the best indicator of how well your thyroid medication is working. In my opinion, a Doctor should follow up on thyroid hormone therapy, with blood retests of not just TSH only but of it, plus the Free T-4 and Free T-3. For some reason many Doctors don't believe thyroid hormone therapy needs monitored with anything other than repeat TSH levels but I feel these other two should be added to at least the first one or two blood retests, for a better overall evaluation of the hormone replacement therapy. Rarely patients will have a T-4 to T-3 ratio that is off (T-4 converts into T-3 in the body), in other words, the T-4 will be disproportionately higher than the T-3 and this would indicate that the patient is not converting the T-4 to T-3 well and need addition of T-3 in their hormone therapy. This is when a combination T-4-T-3 medication is needed but is a rare probability. Usually deciding between Synthroid or Armour or any other brand, is more so, just a preference expressed by either Doctor or patient, or both and not necessarily because they pre-determine that one will work better than the other. This cannot be definitively determined by any other method, other than simply being placed on a trial of either and switching if necessary if one doesn't seem to work satisfactorily.

I hope this info helps and I actually created an article from my last e-mail response to you and will do so from this one as well. It is nice to have an opportunity that creates even more opportunities to inform others, so I took advantage of these replies I've sent you, to help educate others.

I feel strongly that those "thyroid antibodies" tests are very important for you at this point.

Sincerely,

JimLow