Hyperthyroidism 4 months postpartum with normal anti tpo ab, what does it mean?

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?

If I do the math, I have more or less equal chances to have anything...

Hello Ines:

That is true it can be triggered by pregnancy.  It is hard on the body. It causes your pancreas to make more insulin, and all sorts of hormonal chnages during and after.

The body is not that happy with changes and in some of us it can aggravate the thyroid badly.

If you have a ultrasound that can pick up any nodules or cysts and the size of the gland and that is helpful to know also.

Let's see what the other blood work says, but Thyroiditis happens and seems to fit with your situation.

I know hang in there, we are here for you, and I am praying that it is not Graves. How is the baby? Boy or Girl?  I was unable to have children due to Polycystic Ovarian Syndrome, so you are blessed.

XO, Shelly

I agree Shelly.

I am sorry you could not have children. I have a friend who just got a child with polycystic ovarian syndrome though, maybe it is not too late?

Our daughter is doing very well. She is a happy baby. I am sorry I am not totally there for her since my mind is busy a lot worrying. She smiles and laugh a lot, I hope I can answer those smiles back soon enough.

One thing that makes me think it is more likely to be thyroiditis is that I have problems soon after delivery and Graves usually happens later. Also I have discomfort in my throat and even though Graves can cause a goiter, I think it happens later? Do you know? From what I read it seems that thyroiditis is more likely to cause discomfort. Last thing but I found very mixed results about this. I found on one webpage that Graves usually happens to people in their 20 and 30 and I am 40. But I read somewhere else that it can happens at any age with a bell curve whose median is around 30-40. My aunt had it at 16 unrelated to pregnancy but then I talked to a woman who got it after a pregnancy at 37. Maybe I am just looking for reasons to convince myself that I will be fine but I guess anything is possible. Thank you for your support!

Hello Ines:

No problem as I am 54 now and passed that point in my life. My sister had fraternal twins  2 boys and made up for me!

Oh how wonderful to have a daughter!  Enjoy all the milestones in her life.

I agree Graves can happen later and also earlier in life like your teen years.  So it seems to me that it is thyroiditis.

Pregnancy is hard on the body and I know women who had it soon after. You will be fine, as it should calm down. 

I know how scary it is.  So think positive and let me know when the extra blood work is back. We live in good MODERN medicine times and it can be dealt with.

XO, Shelly

 

I have one more question. Instead of taking the beta-blockers I am drinking cabbage/kale juice 4 times/day. It works really well removing my symptoms  but I worry about the baby as I read that the Isothiocyanates (goitrogenic compounds) of cabbage/kale pass into breastmilk and i don't want her to get hypothyroidism. Juliette used to get 1/4 breastmilk 3/4 formula but I am afraid to nurse now. She seemed to be fine the few times I nursed her recently though. What do you think?

Hello Ines:

Breast Milk gives certain good things to the baby, like better immune system support, and good brain development, doing milestones early.  Formulas are good also but your own breast milk is always better.

So unless she is having colic or gas pains, you should give her 1/4 breast milk.  I am sure she will be okay and not a high chance of anything bad happening.

Of course certain medications can go through like Beta Blockers and pain meds etc... so then a person would have to use formula all the time.

Regards,

Shelly

Thank you Shelly. I am feeling depressed right now and anxious about these results that are not coming.

Some days I feel hot, tense and shaky, others like today I just feel exhausted and depressed. I am not sure what to do about all this.

Hello Ines:

When the thyroid is making too much hormone you will feel HOT and shaky and anxious.  It is all related to having too much thyroxine in you.

Take it day by day, don't try to do too much and give yourself as much rest as you can.  I know that is hard to do with a young baby.  Blood work can take a while to come back on certain tests.

Regards,

Shelly

 

Hi Shelly,

The endocrinologist just called me and my TSH receptors ab, and thyroid stim immglob came back normal. She said it is very unlikely I have Graves disease. She confirmed that I probably have postpartume thyroiditis. I am so relieved. Do you think I should ask for an ultrasound?

Hello Ines:

Oh that is what I thought also.  Thyroiditis will settle down.  The ultrasound can show the size of the thyroid gland and if anything like a cyst or nodule is there.  It would be a good idea to have it done to make sure and then you have a baseline for the future to go by.

Thanks for the update and keep us posted on how you do,

Shelly

Hi Shelly,

I have one last question.

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Hello Ines:

TSH is okay at .90 and between 0.45 to 4.50 is good.  Even better if it is 1.0 to 2.5 as an ideal range. 

The Thyroid Stim Immoglob (TSI)  test should be lower and some say close to  Zero. However I have seen it at all sorts of numbers and the people did not have autoimmune disease.  I would  watch it. Since you have thyroiditis, I would ask to have it repeated in another 3 months.  It should come down more.   Since your other blood work is good, I think this is a temporary thing and will be less in the near future.

Remember anything that can bother the immune system like Gluten or a Virus could bother the thyroid gland.  They have done studies that Gluten can be a trigger to autoimmune so watch labels on foods and buy items in non gluten isle of the market.

Just have the doctor repeat this blood work in about 3 months time.

Please keep in touch, any questions just ask,

Shelly

 

Thank you so much Shelly, I am so grateful for your answers!

Thank you for your suggestion about gluten. I already have been eating gluten free for years. I don't have celiac (I got tested) but I get an inflammation in my bowels with gluten (IBS maybe?) that completely goes away when I eat gluten free. I wonder if I should eat dairy free as well.

Hello Ines:

Dairy free is also a good idea.  They say stay away from anything white! However, I know it may be hard to do.  I also stay away from dairy as I found I could bloat and have loose bowels quick from it.

IBS is a back and forth with bloating, stomach problems and loose bowels and cramps and then constiaption.  Dairy is a known culprit!

Many of people are doing Gluten free and they find it helps their joints also.

Have a great weekend,

Shelly