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Thyroid Diseases

Can I Have Hyperthyroidism and Hypothyroidism at the Same Time?

06/19/2006

Question:

I have a small goiter with one 1.2 cm nodule that was biopsied as having lymphocytes, so was told I had Hashinoto's. I have felt "wired but tired" for 5 years with normal labs. Last year my TSH went down to 0.03. Then 2 months later it went to 12. Finally, a few months after that, I felt lightheaded, more tired, etc. I was started on Synthroid, but immediately felt hyper with increased heartrate and much hotter, although I`m always very hot. I kept up with the Synthroid for 8 weeks, working my way up to 50 mcgs., but I couldn`t take the increased heart rate (100-120) and spikes in blood pressure, which is usually normal. Tested TSI a few weeks ago and it was at 100. Would that level indicate some form of Grave`s mixed into this Hashimoto's picture? Would it have an influence on why I don`t tolerate any thyroid medications?

Answer:

It is certainly possible for the immune system to make antibodies that stimulate the thyroid and then antibodies that block the thyroid, but it's quite rare for them to alternate every few months.  You don't mention what your thyroid blood tests were during the times when you were having so much difficulty tolerating the thyroid hormone.  If your pulse goes high when your thyroid tests are normal or low then you probably have some other disorder accounting for the periods of high pulse and blood pressure. 

Your problem is quite complicated, but more frequent thyroid tests while you are having symptoms might help sort out which symptoms are from the thyroid and which are not.

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Response by:

Thomas A Murphy, MD, FACP, FACE Thomas A Murphy, MD, FACP, FACE
Associate Professor of Medicine
School of Medicine
Case Western Reserve University