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Thyroid Diseases

Hypothyrodism Testing

02/18/2008

Question:

My TPO ab is 1810, and TSH is 0.013. Normal free T4. Ultrasound showed diffusely micronodular heterogeneous echotexture. What does that mean? I delivered a baby 5 months ago, and have been extremely busy and tired with two young kids. Is my symptom related to the postpartum at all?

Answer:

Anti-TPO antibodies can be detected in up to 90% of patients with Graves' Disease - a disease that makes the thyroid overactive. They can also be detected in up to 25% of normal individuals, or in patients with other thyroid disorders such as nodular goiter. The low TSH and normal free T4 suggest that you have a thyroid that is making slightly too much thyroid hormone. The heterogeneous texture on ultrasound doesn't really add much information to the blood tests.

Different endocrinologists would probably approach further testing in your case in slightly different ways. The general recommendation is that anyone with a TSH less than 0.1 should have a free T4, free T3, and repeat TSH within about a month. Even if the free T4 and free T3 are normal, a persistent TSH less than 0.1 would be an indication for treatment. This is because over the years, even a slightly overactive thyroid can cause osteoporosis. It would probably also be a good idea to get a nuclear medicine thyroid scan or a thyroid stimulating immunoglobulin level to be sure that you have Graves' Disease and not painless thyroiditis, which goes away by itself. Treatment can be with anti-thyroid pills, radioactive iodine, or surgery.

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Response by:

Thomas A Murphy, MD, FACP, FACE Thomas A Murphy, MD, FACP, FACE
Associate Professor of Medicine
School of Medicine
Case Western Reserve University