I had a baby four months ago and I just got diagnosed with hyperthyroidism but I don't know the cause yet.
Here are the test results:
anti tpo ab < 10.0, range 0 - 35.0 normal
free T3 10.1, range 2.3 - 4.2 abnormal
thyroxine free 2.61, range 0.80 - 1.76 abnormal
tsh < 0.030, range 0.55 - 4.78 abnormal
Why is the anti tpo ab in the normal range? What am I more likely to have? postpartum thyroiditis? Graves disease? Something else?
MONO in my tests results is high too.
tpo ab is a measurement of inflammation. Though it can be slightly abnormal with Graves, it usually is very high with Hashimoto's thyroiditis. You need to get tested for Graves antibodies TSI and TRAb or TBII. If they are negative, then nodules can also cause hyperthyroidism. I have just recently read literature that says all autoimmune disease stems from the Epstein Barr virus which lies dormant in the liver and spleen and gets activated at times of stress causing the immune system to try to fight it. Though traditional medicine does not yet know this, autoimmune diseases like thyroid, Rheumatoid arthritis, Mono, Lyme disease, originate from the EBV. Apparently 95% of the population have it.
Hello Ines:
My name is Shelly and I am a nurse in the USA. I have Hashimoto's thyroid disease since 1987. I know both sides of theyroid pretty well.
Congrat's on having a baby. Now when you are pregnant the body goes through stress and changes. Sometimes the thyroid gland can go either Hypo or Hyper.
Sometimes a family trait comes out after pregnancy which can trigger it. You should see if anyone else in your family, like your Mum or Aunt. Graves runs in families. It also makes TPO ab test high in antibodies.
So your blood work means this:
Antibodies - not presnet under 10 means you are not autoimmune.
Free T3 is the amount of Liothyronine T3 hormone name in your blood and it is high.
Free T4 (Thyroxine) a bit over normal.
TSH - Thyroid Stimulating Hormone- 0.03 too low means Hyper on the scale.
Now funny you mention MONO now called Epstein-Barr disease. It is a known thyroid attacker but normally makes you Hypo not Hyper. It also can make the TPOA antibodies high and yours are okay! Lucky you!
You most likely have what is called Post-Partum Thyroididtis. now it can settle down over time. The body can take a while to do this. There is a medication called Carbimazole to slow down the gland. You may want to look into that.
So it may settle on it's own, or it may require meds to slow it. How do you feel?
Hyper symptoms are: feeling anxious, feeling HOT, sweatting badly, feeling wired or nervous, eyes may buldge, insomnia, fast heart rate, losing weight fast. Do you have any of these?
Keep me posted any questions just ask,
Shelly
Hello Ines:
I do not know how the smiley face got in my post.
Shelly
Thank you so much for your answer. My aunt has Graves' disease but I read that 80% of patients with Graves' disease have high anti-tpo ab but mine are normal, and similarly for postpartum thyroiditis, 90% of patients have high anti tpo ab. This is why I wonder if I might have something else. Moreover I have light pain in my neck and a hoarse voice.
Do you know what it means when T3 are high but T4 only slightly high?
I am not feeling good. I have the symptoms of hyperthyroidism: feeling tense, insomnia, neck pain, hoarse voice, anxiety, feeling hot, sweating, loosing hair, mild headache.
Hello Ines:
Yes, usually The TPOA and TGab tests are high if it was Graves. Since you do have a family history of it, I would ask for an ESR test. See below. Have you had any ultrasound to see if any growth is on the thyroid gland?
When your T3 is high it can bother the heart and make the beat go out of sync. It may come down if the thyroid settles down. It is not good to have too much flowing in you. If the FT3 is high the thyroid is converting way too much T4 into T3. Sometimes as antibodies are attacking the thyroid gland this can happen or as in Thyroiditis infammation can do it.
You need the proper levels of course of T4 and T3.
Ask for an ESR - Erythrocyte Sedimentation Rate to see if markers appear for Graves. This test picks up autoimmune markers and is different than antibodies test. Some people may be autoimmune but not show antibodies until later in time.
When your FT4, is off, too much throxine, is not stopping as it should when the TSH which acts like a sensor should stop it. Signals from the Pituitary Gland in the brain should hit the TSH sensor and say enough is made. Again autoimmune and inflammation can bother this also.
Also blood & urine cortisol levels can work hand in hand with abnormal thyroid results, so if the adrenal glands are stressed so can the thyroid. they can test your blood for extra cortisol and or do a 24 hour urine collection. These tests will show any problem with the adrenals.
Were you okay during pregnancy? Did you have any high blood pressure?
You are experiencing the bad symptoms of Hyperthyroidism. How were you prior to pregnancy?
Regards,
Shelly
It can happen that the pregnancy caused a trigger in you and the thyroid is swollen and putting out too much hormone. It does happen.
I was fine during the pregnancy, no problem at all and my blood pressure was fine as well. My thyroid was tested at the beginning of the pregnancy and it was fine as well. It is after giving birth that I felt very bad very quickly: soft stools, pain going to the bathroom, feeling hot at night... I suspect the hyperthyroidism started very soon wich goes against the diagnosis of Graves disease.
Before the pregnancy I was fine except for a little bit of insomnia that I thought resulted of years of high stress previously, also I had gastritis the year before with no apparent cause but it went away with PPI for three months and a strict diet.
The endocrinologist thinks I have an underlying autoimmune condition because I am intolerant to gluten but the blood test seem to say otherwise.
I am still waiting for two blood tests: TSH receptors ab and thyroid stim immglob. I should get them tomorrow.
I have some cortisol tested planned for in a month. I don't know why they don't do this now.
I suspect I had hyperthyroidism pretty soon after delivery also because I had problems breastfeeding and low milk supply which resulted in trying to feed the baby every hour day and night from which I was truly exhausted like I had never been before. This probably did not help. After two weeks I had to start formula as the baby kept loosing weight and was not getting enough from me.
I haven't had an thyroid ultrasound but if the tests results tomorrow don't show anything, I will suggest it to the endocrinologist.
Do you now why I have now pain in the region of the thyroid, pain in my throat and my voice that is starting to get hoarse? Would that help make a diagnosis?
Hello Ines
In some people with autoimmune it is common in early stages of autoimmune problems to show okay in the blood and not be okay inside. The other blood tests should be able to determine any markers or pick up any abnormal antibodies level.
Can you k for the cortsiol levels now? Your Endo may be right, about the undelying autoimmune disease.
You sound like after the baby things got worse. This is a puzzling item, because you should have shown problems during pregnancy if you were autoimmune.
It could be a bit of post partum thyroiditis along with early stages autoimmune underneath. Many people who are autoimmune, can't take Gluten so that fits in also.
Let me know what those tests say.
Regards,
Shelly
Hello Ines:
If the thyroid is swollen or with inflammation it can make your voice hoarse as it sits on top of the trachea and can press and make it feel like something is poking you.
Also it can or could have a growth on it which can make extra hormone and cause pain. I would ask for the Ultrasound to be sure. Some grow cysts or nodules on the gland.
Any trouble breathing? If that happens make sure you go to your Emergency Room, if you feel any tightness in your airway.
Did the doctor press hard to feel for lumps or the size of the gland? An ultrasound can show the size and if it is swollen. Hoarse voice can come from the irritation in the gland.
Keep me posted,
Shelly
I don't have troubles breathing.
The Dr touched my neck but did not pressed hard and did not say anything.
What do you think I am more likely to have?
Hello Ines:
Sorry for my delay in answering, it was my bedtime in the USA. I think you fit more with Thyroiditis but the unknown is the extra blood marker tests for autoimmune.
Some people can have both but since you had no bad symptoms prior to pregnancy, I would lean on the Thyroiditis.
Hormone levels have to change a lot after pregnancy and the thyroid gland is under major stress and can swell or act up from just that.
Keep me updated on the rest of the blood work. We can figure it out better once that comes back in.
Regards,
Shelly
Shelly, it is my understanding that if TPOA and TGAb are high it is Hashimoto's. High TSI and TBII or TRAb is indicative of Graves. However it is possible that some people have both Graves and Hashimoto's at the same time. In any case, I agree with you that her probable diagnosis is thyroiditis.
From what I read, 90% of people with postpartum thyroiditis have high anti tpo an and 50-80% of people with Graves have highl anti tpo ab.
But postpartum thyroidis is much more frequent
Hello Linda:
Graves and Hashi's are related by Autoimmune markers and can share TPOA to some extent. When I was first diagnosed in 1987 they thought Graves was it and then came up with Hashi's. Both are possible in a person.
I agree Graves is more diagnosed via other tests, you mention above as well as a family history also. She still has blood owrk to come back in which should tell us for sure.
I also feel this is pregnancy related, post partum thyroiditis.
Regards,
Shelly
30 % of Graves are triggered by pregnancy though.
Acording to the thyroid foundation of Canada, 80% of cases of hyperthyroidism after pregnancy are due to postpartum thyroiditis, 10-15% due to Graves and the rest is due to other causes (hot nodule, etc).
How do you not go crazy waiting for test results?