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hypothyroid with high TSI

I have been diagnosed as having hypothyroidism for over 10 years now, going along just fine, though always fighting weight. In May TSH was low (0.052 miu/ml, Free T4 wnl, lowered dosage of levothyroxine from 200mcg to 175mcg, July TSH 0.08, and Free T4 1.65 ng/dl, lowered again to 150mcg, TSH normal so back up to 175mcg of levothyroxine, however experiencing pain in neck so had a sonogram. Sonogram indicated 2 masses in neck, maybe parathyroid adenoma.  Nov PTH tested normal. Oct TSH sensitive 0.37 uiu/ml (wnl). CBC etc all normal. November CT of neck with contrast indicates irregular focus of hydensedensity within the posterior aspect of the right lobe measuring approx. 8x6 mm in greatest transverse dimensions, as well as 4 enlarged lymph nodes of approx 1 cm in short axis. Dec tested THYROGLOBUL AB 23.1 U/ml (wnl), and THYROID PERO AB 27.0 (wnl), and TSI of 156, indicated as high (normal 0-129). What's going on? Scheduled appt with surgeon for biopsy of lymph nodes on Jan 15 and appt with endocrinologist on February 1. Are there other tests I should have done before seeing the endocrinologist? I don't know if this is Hashimoto's, Latent Graves (though no hyper evidence whatsoever), or..... Can anyone help point me in the right direction?
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Avatar universal
TSI suggest Graves' Disease.  I would have also done TRAB - TSH receptor antibodies: Blocking TSH receptor antibodies for Hashi.  You might be both Graves' and Hashi. One will dominate over the other for a period of time, then the other will take over and be dominate.  You will only feel or have possible symptoms of Hashi when its dominate and only feel or have possible symptoms of Graves' when its dominate.  You can not have both at the same time.  That is a possibiliy why you are not feeling hyper, if you are indeed both Graves' and Hashi.

Follow through on you FAN and good luck!
Avatar universal
Thank you for your response. I am having a FNA of one at least one of my enlarged lymph nodes done tomorrow. Have you heard of any relationship between enlarged lymph nodes and the thyroid? Still trying to see if they are related. I feel fine, expect for some discomfort in my neck. Of course I have been hypo for so long, that fine for me may not be fine for most people.

I asked for some broad spectrum antibiotics a few weeks ago to see if that would affect lymph nodes, but still have the discomfort. Of course tomorrow when they give me the ultrasound for the biopsy I'll see if there is any noticeable change.

Endocrineweb site you've recommended to others was helpful.

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