Patient's Query
Hello doctor,
Can you make a diagnosis of autoimmune or other thyroid disease based on the information? I was treated. My theory is that I have autoimmune thyrotoxicosis or Graves' disease. I was taking Lithium for cluster migraine prevention. When I discontinued Lithium, I became very anxious in line with Graves' hyperthyroidism.
I have sore shins, eleven eye orbits, photophobia, grittiness, lid lag during attaches, and lid retraction reflex with sudden upgaze. It became worse a few months back with a flare after influenza, leading me to the hospital with a 110 beats/min heart rate at rest, fever, dehydration, and exhaustion.
My eyes have proptosis when flaring, especially the right eye. You can see the sclera above the iris. Paternal grandmother had Graves' disease, severe blood work trends for the last six years, creatinine 1.31 mg/dL always up, eGFR at 60 mL/min/1.73m².
The urologist thought that the patient had hypogonadism due to exogenous testosterone (injection 100 mg/week for eight years). Elevated HDL cholesterol, high triglycerides, high monocytes, and either high or very low neutrophils and eosinophils.
May have thalassemia minor, high RBC hematocrit always, and low iron. Magnesium is always elevated. Portable for TBII antibodies level 4 cut off 10. During Lithium treatment, my thyroid TSH was 9 mIU/mL, and the T3 and T4 were in the normal range. The trend has been lower and lower TSH in low normal to 7 mIU/mL. Now the lowest but average is 1.0 mIU/mL.
I have had recent TSH and TBII done with no result yet, but will be first off Lithium. I began self-prescribing Methimazole due to the active thyroid anxiety, now gone after Lithium stopped. It is taken over.
I have positive TPO antibodies. No thyroid scan, ultrasounds, biopsies, etc. No eye or skin diagnosis. Are these eye skin signs definitive, plus blood work of Graves?
Blood work trend is high free T3, 13 average T4, low normal TSH (always while on Lithium and testosterone with LH suppressed, diagnosed as a result of therapy).
Kindly guide.
Hi,
Welcome to icliniq.com.
The diagnosis is correct, viz, hyperthyroid Graves' disease. You certainly need Methimazole for this, as well as a thyroid surgery. You should not take Lithium for prolonged use. However, bearing in mind the side effects it has. But I understand you also need it for your grittiness and mood behavior.
You should speak to an endocrinologist regarding the surgery for the same, and hopefully, you can go off both Lithium and Methimazole. The other medications do not matter here. Considering your age and family history, thyroid toxicosis could set in. So I would recommend you get it operated on.
I hope I have answered your question.
Let me know if I can assist you further.
Regards.
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Answered byDr. Aditi Gupta
Medically reviewed byiCliniq medical review team
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