I have hashimoto's and graves disease. my endo is 2 hours away in a major city, and she is even perplexed? how rare/difficult to treat is this combo?

Difficult: Just remember that doctors are human and we, too, need help and 2nd opinions. Maybe you should look into a larger regional hospital that has a specialist who deals specifically with your condition. It never hurts to call ahead.

Not that rare: Actually, mixed hashi/graves is not all that rare, although it can create a mixed picture and be perplexing at times. If you are hyperthyroid, you need to be treated. You need to follow up with your endocrinologist.