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Forum Name: Endocrinology Topics

Question: hypothyroidsm


 gorachand - Fri Aug 13, 2010 2:14 am

My TSH was found to be 12.02 which is elevated. My doctor measured free T4 which is 1.04 (normal). He explained that according to the flow chart used in Harrison's principles of medicine ---anti TPO antibody should be measured..This was found to be
41.38 (negative)The doctor was candid enough to admit that though there was a column in Harrison's saying TPO negative no symptoms----annual follow up, there is no option describing TPO negative with symptoms which is applicable here as I have put on a lot of weight. He refused to administer Eltroxin saying that my body has a normal T4 count as the body has compensated by negative feedback and a high level of TSH itself per se is not harmful.
What should I do?
 Dr.M.Aroon kamath - Wed Aug 18, 2010 1:02 pm

User avatar Hi,
You have not indicated what your symptoms(other than a weight gain) are and if you have a goiter and if any thyroid FNAC had been performed(and the report).

It’s estimated that TPO antibodies are detectable in approximately 95% of patients with Hashimoto's thyroiditis.Therefore,< 5% of the patients with this condition may not have elevated antibody levels.

Vitamin B12 (cyanocobalamin) deficiency occurs in about 3-4% of the general population.Pernicious anemia (PA) is present more frequently in subjects with primary autoimmune hypothyroidism with some reports indicative of association in up to 12% of patients. Non autoimmune causes of B12 deficiency also may be associated in hypothyroid patients and this association has not been studied in detail and may vary according to dietary habits in different populations.Some of the symptoms (weakness, numbness,paraesthesia, and poor memory) can occur in both hypothyroidism and vitamin B12 deficiency. Anaemia with or without macrocytosis, tends to occur later in B12 deficiency and may even be absent.In one study, a significant symptomatic improvement was observed within 3-6 months of initiating B12 treatment in hypothyroid individuals with low B12 levels.

Hashimoto's thyroiditis: Management of patients with overt hypo-thyroidism is straight forward.
In patients with an elevated TSH level and a normal thyroxine (T4) level (subclinical hypothyroidism), indications for treatment are not very clear. If the TSH level is greater than 20 mU per mL (20 mU per L) with a normal T4 level, there is a high probability that the patient will develop hypothyroidism. If the TSH level is elevated but is less than 20 mU per mL and the antimicrosomal antibody titer is greater than 1:1,600, hypothyroidism is likely to develop in 80% of patients. Therefore, in patients with a serum TSH level greater than 10 mU per mL (10 mU per L) with symptoms suggestive of hypothyroidism, and in patients with a high risk of progression to hypothyroidism (e.g., those with high antibody titers) , it is recommended that treatment be initiated. As for the others, because of the risk of developing hypothyroidism, annual assessment of thyroid function is indicated.
(Sakiyama R. Thyroiditis: a clinical review. Am Fam Physician 1993;48:615-21).

As your post lacks details, i can't be more specific.It may not be a bad idea, to have your vitamin B12 levels checked as well. I hope this information is of help.
Best wishes!

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