MANAGEMENT OF GRAVES’ DISEASE

QUESTION--I am Endotext reader and really like your site which has helped me and thousands for best management of thyroid disorders. I have attached a blood test of a young lady with Type1 DM and Coeliac disease with recent thyrotoxic symptoms and persistently suppressed TSH despite normal FT4 and FT3.She has positive TSH stimulating Ab's and taking 10 mg Carbimazole since Nov till she was referred to me. She feels better but still clinically not euthyroid.
Do you think she might have antibodies direcetd against T3/T4 as well ?I have not asked for uptake scan yet but it might be helpful as ultrasound showed heterogenous echogenecity and lidly increased flow and was not very helpful.I am grateful of your input. Dr Ali Sharafi

RESPONSE- Dear Dr Sharafi--This lady has Graves disease (+ve TRAb) and almost certainly Hashimoto's disease as well as judged by her TPO antibody status.It is not unusual for Patients on carbimazole to retain a supressed TSH for up to 2 years or so while the T4 and T3 are normal.
She needs to stay on the Carbimazole for up to 18 months. I do not think she will have T4 or T3 antibodies.An uptake scan will not be very helpful at this stage. Kind regards, John Lazarus, MD