Hypothyroidism with mixed symptoms

[vivekks12]

I am Vivek, 32 male from India. last year April I was diagnosed with hypothyroidism with levels as follows:
April 2010---
Free T3: 1.30 pg/mL
Free T4: 0.23 mg/dL
TSH (Ultrasensitive):326.548 uIU/dl
Glucose, Fasting: 97 mg/dL

I started with Thyrox 50 gradually making it to 150 in a month. My levels
July 2010---
Free T3: 2.96 pg/mL
Free T4: 1.30 mg/dL
TSH (Ultrasensitive):0.6798 uIU/dl
Glucose, Fasting: 98 mg/dL    

I continued with Thyrox 150

My levels in April 2011
April 2011---
Free T3: 2.460 pg/mL
Free T4: 1.22 mg/dL
TSH (Ultrasensitive):0.044 uIU/dl
Glucose, Fasting: 99 mg/dL

Just before (15 days or so) this test I have started having problems like: palpitations, constant  pain in back of the neck, cramps in stomach, elevated Heart rate. I contacted the doctor, he asked me to take propanalol 10 for a week and reduced the dosage to Thyrox 50.

I got the levels checked again
May 2011--
Free T3: 2.30 pg/mL
Free T4: 1.21 mg/dL
TSH (Ultrasensitive):4.759 uIU/dl

I increased the dose to Thyrox 75.
However, my neck pain has not gone at all, rather its getting more severe. I am having pain in left shoulder blade, chest -mild but constant (particularly in left part), pain in legs and hands. There is very slight swelling on left side of my neck-front and slight pain in between right ear and salivary glands. I am confused what is it and why my problems are not going away. I have given my blood sample for fresh levels and also for Anti TPO and Tg levels. Results will be available tommorrow. My cholestrol level during 2010-11 varied between 273 - 222. (normal 200)

Please suggest me what could be the cause of the problem? Shall I go for imaging or ultrasound of my thyroid glands? I am having mixed symptoms of hypo and hyper, why?
Thank you in advance.

[Mark Lupo, M.D.]

The dose decrease may have been too much from 150 to 50mcg and now it may take some time to get levels back to normal (TSH 0.5-2.5) to help prevent and stress on the thyroid due to higher TSH levels.  100mcg may be the best next choice, but discuss with your doctor after updating TSH and T4 levels.  Would also agree with thyroid ultrasound in this situation.

[Mark Lupo, M.D.]

You could wait until pain decreases to have ultrasound, but would do eventually as there appears to be an increased risk of thyroid cancer in patients with Hashimoto's (like you).

The thyroid usually slowly is destroyed in this chronic autoimmune inflammatory process but usually the body aches/pains should get better within several months (hopefully sooner).

[vivekks12]

Thank you very much Dr Lupo.
My test results are as follows:
Anti TPO: 4988 u/mL   (normal range <=60)
Anti Tg:    41.50 U/mL (normal range <=60)
free T3: 2.40 pg/mL     (normal range 2.30--4.20)
free T4: 1.20 ng/dL      (normal range 0.70--1.51)
TSH:     2.579             (normal range 0.550--4.780)

My doctor says its Auto Immune Primary Thyroidism. He suggested to go with Thyrox 100 mcg along with Propanalol 10 mg and Nise MR for 10--20 days.

Will my glands be finally destroyed? What is the usual time frame for that? Will my problem of neck pain and bodyache be there till then?
Is there any benefit or requirement of going through Ultrasound of Thyroid now? Doc says it may be painful. I mean is there anything that remains to be known/ understood? Thank you once again.