Tranny problems HELP

Hey guys I have an 86 E350 box truck and about a month ago, from a start it would make a nasty grind and clanking noise so i would have to baby it and as soon as i got out of first the truck was ok. Also it is worse if you have to go slightly up hill from a start. At first i thought mabey it was the drive shaft but then someone said it was the tranny so i need some help, what do you guys think it is?

Sounds like the beginning of a tranny problem. Get it checked out before it gets worse. You could be damaging it more by driving it resulting in higher repair cost.