“Thyroid problems?”

Your T4 is significantly elevated suggesting thyrotoxicosis, which could be multifactorial, due to inflammation of the thyrocytes releasing thyroid hormone, and the oral thyroid hormone supplement. The elevated TPO antibody suggest the presence of underlying Hashimoto’s Thyroiditis. I would suggest stopping the levothyroxin until results of further tests are in: ESR, TSH, free T3, freeT4. Stop any bioten 7 days prior. Has the patient had amiodorone, recent iodine contrast or viral infection? See an endocrinologist to help sort out the etiology and the appropriate treatment.

There are different kinds of antibodies which could be measured. Some of them could be directed against the thyroidYou need to check thyroid hormone levels to determine whether the thyroid gland and or the thyroid Med could be contributing to these symptoms. You might want to get a nuclear thyroid scan to get an additional indication of thyroid function.

Your description of symptoms suggests thyroid inflammation. You should check to see the names of the antibodies reported on your tests. TPO and antithyroglobulin antibodies are seen in thyroiditis. Rheumatoid arthritis features antibodies as well (ANA, RA) and is frequently associated with thyroiditis. You have been prescribed a thyroid supplement, which means you have already been diagnosed with hypothyroidism. Painful thyroiditis, however, may require short-term treatment with anti-inflammatory medications, including steroids for relief. Treatment for rheumatoid arthritis, if present, involves long-term management with anti-inflammatory medications.

You need to have the TSH results the T4 sounds high, but we need normal range, thyroid antibodies high and sonogram results seems like you have Hashimoto's thyroiditis, which is treated with synthroid, but you might be taking too much. TSH is really needed!

Dear Patient,

I am not sure of numbers: is it a free T 4 of 24, tpo antibodies of 256 associated with thyroiditis on scan? A tsh would be helpful, but I am sure it is very low. These numbers indicate that you are in hyperthyroid stage of thyroid inflammation due to the inflammation causing the thyroid to unload its stored thyroxine into blood stream causing symptoms. You should see your doctor, perhaps be referred to endocrinologist consider stopping thyroxine and starting beta blocker to control symptoms.

Best Wishes,

Marvin A. Leder, MD FACP FACE