Thyroid

[Otto44$]

Dear Dr. Lupo,

I previously sent you a question in April 2012 and was new to this site. Now, I'm unable to find your response. I also tried to send you a thank you note, but apparently I put posted to the community forum and was informed that the experts don't read there. I do have more questions that I'm trying to find answer to. I feel like I'm falling apart. Anyhow, here are my thyroid level's:

3/24/2012-TSH 0.236,
                 Free T4 1.00

4/16/2012-  Anti-Microsomal 599 IU/ml
                   Thyroglobulin Ab <20 IU/ml

5/16/2012-TSH 0.693
                  Free T4 0.98
                  Free T3 3.74

7/5/2012-TSH 1.307 uIU/mL
                Free T4 1.04 ng/dl
                Microalbumin 30 mg/L mg/L

I was excited thinking I don't have hypo/hashi's with the now normal tsh levels. However, my PCP, informed me because of the Anti-Microsomal 599 IU/ml being so high, that's how it's determined. Anyhow, he told me that he's happy to see that my tsh levels are back to normal, but in time they'll go off the chart that he was using in explaining to me. He said it's at that time, he'd put me on medicine's. I;ve read because the Anti-Microsomal are high, even though the tsh levels are normal now, I should be on medicine. Please advise as to your opinion. I'm real concerned, because I now have high liver enzymes and from what I've read the reason could be from the hypo/hashi's? therefore, in the meantime I'm unable to take my metformin and lipitor.
In the meantime he had me go for a thyroid ultrasound and the results of that are normal. It reads: The right lobe measures 4.1 x 1.5x1.5 cm. The left lobe measures 3.8 x 1.6 x 1.3 cm. Heterogeneous thyroid parenchymal echotexture without evidence of a discrete nodule. My understanding is that if my ultrasound was normal, there would be no concern of thyroid cancer and no reason for a thyroid scan. Am I correct? or am I missing something?  Thank you for your assistance in this matter.

[Mark Lupo, M.D.]

The antibodies are consistent with autoimmune thyroid disease, most commonly this is Hashimoto's with eventual hypothyroidism.  In some cases the positive antibodies may indicate a risk for Graves' disease.  The ultrasound findings are very typical for Hashimoto's and at this point you do not have a goiter or nodules.  There would be no reason to do a nuclear scan.  Typically for patients with normal TSH and positive antibodies we do not give thyroid medication, the only possible exception to this is a woman who is trying to conceive or who are pregnant.  Even this is debated.  The high liver enzymes would not be due to Hashimoto's.  This may need separate evaluation.

[Otto44$]

I've been doing alot of research about antibodies & thyroid. I must say it's a very complicated Issue. Anyhow, in my findings if I'm understanding it correctly. Me having microsomal (TPO) antibodies of 599 and should not be higher than 34, means that I have an autoimmune disorder, pretty scary thought. Anyhow, what other test results that I provided above would actually give me a diagnosis that I've Hashimoto's or Graves disease? seeing that autoimmune can be from what I read 101 different things. I was not aware that everyone that has a thyroid issue, doesn't always have a autoimmune disorder. Now that I've done some research & reading that with high level's of TPO alone, may be something other than Hashi's or Graves disease (understanding that I could end up with one of the other) that I or my PCP will need to further investigate why my antibodies are so high at this time, before just assuming it's Hashi's or Graves?

Thank You for reviewing my post and helping me understand. Once again, I thank you for all you do in helping people with their illnesses.

[Otto44$]

Thank you for your response and all you do! I greatly appreciate it.

[Otto44$]

I feel like I'm falling apart. Anyhow, here are my thyroid level's:

3/24/2012-TSH 0.236,
                 Free T4 1.00

4/16/2012-  Anti-Microsomal 599 IU/ml
                   Thyroglobulin Ab <20 IU/ml

5/16/2012-TSH 0.693
                  Free T4 0.98
                  Free T3 3.74

7/5/2012-TSH 1.307 uIU/mL
                Free T4 1.04 ng/dl
                Microalbumin 30 mg/L mg/L

I was excited thinking I don't have hypo/hashi's with the now normal tsh levels. However, my PCP, informed me because of the Anti-Microsomal 599 IU/ml being so high, that's how it's determined. Anyhow, he told me that he's happy to see that my tsh levels are back to normal, but in time they'll go off the chart that he was using in explaining to me. He said it's at that time, he'd put me on medicine's. I;ve read because the Anti-Microsomal are high, even though the tsh levels are normal now, I should be on medicine. Please advise as to your opinion. I'm real concerned, because I now have high liver enzymes and from what I've read the reason could be from the hypo/hashi's? therefore, in the meantime I'm unable to take my metformin and lipitor.
In the meantime he had me go for a thyroid ultrasound and the results of that are normal. It reads: The right lobe measures 4.1 x 1.5x1.5 cm. The left lobe measures 3.8 x 1.6 x 1.3 cm. Heterogeneous thyroid parenchymal echotexture without evidence of a discrete nodule. My understanding is that if my ultrasound was normal, there would be no concern of thyroid cancer and no reason for a thyroid scan. Am I correct? or am I missing something?  Thank you for your assistance in this matter.
Tags: Thyroid