Graves or Hashi? What do labs mean? Should I be on meds or not?

Hello, I'm new here and new to thyroid autoimmune diagnosis - 4ish mos ago. I'm getting mixed advice from doctors. Is this Hashimoto's or is it Graves? I had one doctor tell me it's going towards Graves. Can you have both? I've had a doctor tell me I should be on meds, then others said no. Hoping someone here can tell me if I should be on meds or not, and if so, which kind?

TSH has never been over 1.6 until spring, when jumped to 1.8. I've always had low body temp and really don't sweat. Have goiter, and 2 nodules tested @benign. Then thyroid antibodies tested at over 1000. An nd put me on a natural T3-T4 thyroid med. Got more fatigued, started gaining weight, so got 2nd and 3rd opinions. Both said no meds. So I stopped after 3-4 weeks. Energy was better, but still gaining weight, and very up/down in body and joint pain, head aches. Sometimes feeling cold and achey. When I am feeling awful, my day time, sitting still temp is 97.6-98.2 and I am narcoleptic. When it gets to be 98.7, I'm feeling better. One day it was 99.1, and I felt like a real human for a few minutes.

Last year, before I knew I had a thyroid problem, I was 6lbs thinner (I am very petite, so this is a lot for me), very energetic, felt so much better and enjoyed life! I have felt awful all year, and am sick/unable to be productive almost all of the time. Can't seem to go more than few days or a week without being sick for weeks. I just got over being non-stop sick for last 3 weeks. Two days ago started feeling better. I'm starting to think that this is my thyroid levels going up and down as my body is trying to kill it off?

New nd did new lab tests. He says no meds. Anyone else think he's wrong besides me?

TSH..... 0.23....(0.27-4.20) noted as low on lab report
FT4......1.26....(0.93-1.70) ng/dL
FT3......2.8....(2.0-4.4) pg/mL
RT3.....19....(8-24) ng/dL
Anti Thyroglobulin AB.........37....(<115)
Ant Thyroid Peroxidase......392....(<34)

Not tested for thyroid stimulating immunoglobulin (TSI), but I'd be curious to see what this is at.

I'm thinking that the T3/T4 natural thyroid med 1 grain, is what made my TSH nose dive? Or just my body trying to kill off my thyroid? How can I bring this level up? I just want to feel good again.

New nd who ordered these tests originally said that my T3 is low. I asked about this in email yesterday, and he is now saying it is normal. Not by my simple math, it is not. I am less than half of range in FT3 and FT4, right? And this is not optimal? My understanding is that it should be in upper 3/4 of range to feel the best? So, how do you raise those levels?

I tried to figure out the FT3/RT3 ratio, but because FT3 is in pg/mL and RT3 is in ng/dL, I can't figure it out. No math wiz here. ;-)

I'm thinking I need meds to stablize my thyroid, but I'm a thyroid disease newboobe. I've read about T3 therapy and short term supplementation to try to get the body temp back up. From what I've read, this sounds like it could help me? Otherwise, what meds should I be on? Anyone know?

Thank you for reading my long post!

Post Edited (There's Always Hope) : 9/22/2015 12:33:13 PM (GMT-6)

Thank you for replying. I was off thyroid medication for 6-7 weeks before drawing the blood for the above results.

Will methimazole help me get back to my normal weight? I am peri menopausal and am so afraid this weight gain is the start of the downward weight gain spiral of menopause and I'll never fit into my clothes again. Plus, gaining weight will influence all hormones changing and assist estrogen in taking over, right?

Somebody said...
I am less than half of range in FT3 and FT4, right? And this is not optimal? My understanding is that it should be in upper 3/4 of range to feel the best? So, how do you raise those levels?

That is simply Hocus Pocus , your TSH is below range,__________which why you feel hyper________, in case you were off NDT medication for at least six weeks before the labs then they are showing hyperthyroidism due to Hashimoto's disease , and yes hashi can cause both hypo and hyper .

As I mentioned above , if you have hyper due to hashi and not the natural desiccated thyroid hormones you were on then the treatment is anti thyroid medication like methimazole to bring your TSH up to around 2.5***

Somebody said...

Thanks! I think I might need to clarify:_________I am not feeling hyper._______I am feeling HYPO._______Low TSH does not just mean hyper._______My T3 and T4 are also low._______If I was low TSH and my body was producing excess amounts of T3 and T4, then I would probably have Graves Disease, and then my body would experience hyper symptoms.______I have not been tested for TIS, the marker for Graves.______I have the marker for Hashimoto's though. It s off the charts high.

Instead, I have low TSH, low T3 and T4, and low TPO antibodies: the antibodies for Hashimoto's.

I do not have any of the following Hyper symptoms:

-Thinning of hair
-Increased sweating = (****I do not sweat****)
-Dizziness
-Heat intolerance = (****I run on the cold side****)
-Hand tremors
-Shortness of breath
-Mood swings
-Nervousness or anxiety
-Rapid heartbeat
-Heart palpitations or irregular heartbeat
-Skin dryness, Trouble sleeping
-Weight loss = (****I have weight gain****)
-Increased frequency of bowel movements,
-periods or skipping periods

But what I do have are the following HYPO symptoms:

-Weight gain (actual body fat), water retention and bloating
-Low basal body temp
-Fatigue
-Weakness
-Puffy face
-Cold intolerance
-Muscle frequent muscle aches, tenderness, occasional cramps (esp. when temp goes too low)
-Lots of body pain and stiffness (esp. when temp goes too low)
-When my temp goes too low, I feel cold and my body pain increases
-Constipation
-Abnormal menstrual cycles
-Slowed heart rate
-Decreased libido

***My TSH has never been over 1.8 in my entire life of medical records, so bringing it up to 2.5 might not ever happen. Restoring it to normal levels would be a better goal.

Post Edited (There's Always Hope) : 9/23/2015 10:29:35 AM (GMT-6)

Hi hH, Thanks! Funny you mention that....pituitary issue. I asked about this to one of the dead end doctors this months ago. They said no way. I'm going to get my annual today, so I'm asking her if she'll run prolactin, atch, Igf-1 and gh. Haven't been tested for thos. Also for referral to yet another endocrinologist.

My weight gain today is now up to 7-8 lbs. :-(