How do you counsel patients that are positive for both stimulatory and inhibitory autoimmune thyroid markers (TRAb, TSI and TPO Ab) regarding their likelihood of flipping from hyperthyroidism to hypothyroidism?

I do not measure multiple thyroid antibodies simultaneously at the time of initial diagnosis, so this is typically not a conversation I would have at initial patient presentation. My usual practice is to check a TSI in patients with hyperthyroidism and a TPO in patients with new hypothyroidism. In p...

If the patient is frequently oscillating between symptomatic hypo and hyperthyroidism, I would treat with a combination of methimazole to completely suppress thyroid function (thyroid clamp) and give the patient levothyroxine to maintain patient euthyroid. I will monitor the TRAB and, once normalize...

I don't typically measure both at initial presentation. However, would consider measurement if flipping hyper to hypo or vice versa in Graves' disease. If I was aware of this, I would counsel the patient on risk of flipping to hypo or hyper. If clinically, levels are challenging to control, could co...