Guest Author - Jim Lowrance

I was talking to a woman who visited her Doctor due to symptoms she was having of unusual weight gain and fatigue. Her Doctor immediately pronounced her as having depression but she felt within her body that further investigation of her symptoms was merited. Upon her Doctor ordering her tests for "thyroid antibodies" and of her "TSH" level (pituitary hormone that reflects thyroid function in the blood), which she had to request, both came back abnormal. Her TSH being flagged below normal indicated an overactive thyroid gland. Her thyroid antibodies tested positive and were flagged hundreds of points above normal, indicating autoimmune thyroid disease. Her symptoms however were those of hypothyroidism or an under-active thyroid. I pointed out to her the fact that the two diseases (Hashimoto's & Graves') can cause positive thyroid antibodies but I also pointed out how these two diseases can have crossover symptoms early into the onset of them. Her case, like many thyroid disease patients, was in need of further investigation by a qualified physician.


Here is generally what I told her:
Your story is typical unfortunately and I hear it so often, it is alarming. Some Doctors over time become burnt out and they resort to antidepressant prescribing as a cure all that saves them time and effort. This sounds blunt but is true although there are patients who do need these drugs and do benefit from them. This also does not take away from the fact that there are excellent Doctors out there! Your choice to see an Endocrinologist is a wise one and I'm willing to bet you'll get proper testing and treatment from him/her.

There are two stronger possibilities with your thyroid antibodies being highly elevated and that would be that you either have "Hashimoto's thyroiditis" (autoimmune hypothyroidism) or "Graves' Disease" (autoimmune hyperthyroidism). I lean toward Hashimoto's because that was likely the TPO (anti-thyroidperoxidase) test you had a high-positive result on and it is highly elevated more often in Hashimoto's than in Graves'. The "TSI" antibody is one more typical of Graves' "Thyroid Stimulating Imunnoglobulin" but can be present in Hashimoto's as well and will cause hyperthyroid phases (Hashitoxicosis) before it causes progressive hypothyroidism.

My suspicion is that your Endocrinologist will want to test you for the TSI antibodies, if your TSH is still low. He will also likely want to test your T-3 and T-4 thyroid hormone levels. He will likely also feel of your thyroid to see if you have palpable (detectable by feel) goiter (general thyroid swelling) or nodules (growth-tumors). If any are found, he may want to send you for a thyroid ultrasound, which will give detailed imaging of your thyroid. Some patients with autoimmune thyroid disease have "hot nodules" that actually cause the thyroid gland to produce too much hormone.

It sounds like, with highly elevated antibodies and a flagged-low TSH on two consecutive tests, your case needs further investigation. I commend you for demanding those tests that led them on the right track, rather than accepting the emotional diagnosis. Your story in that regard is very similar to mine and many other thyroid patients I know.