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Thyroid Diseases

Goiter

11/25/2008

Question:

My test reads T4= 13.4 (range 9 to 26) T3= 5.3 (range 3.5 to 6.5) TSH .08 (range .1 to 4) Tg Abs >3000 (range<55) Thy Per Abs <30 (range <35) How can Tg Abs be so out of proportion? what does that mean? I have been taking chinese medication for benign thyroid nodules (multinodular goitre) for 3 weeks incl rhizoma dioscoreae bulbiferae, thallus laminariae seu eckloniae,sargassum, spica prunellae, pericarpium citri reticulatae viride, concha ostreae, flos carthami,fructus akebiae,radix curcumae in tablet form. Could that cause the result and what does it mean? Does it mean the medication is working or making the problem worse? I had normal t4 and tsh before but my t3 and antibodies had never been tested. Thank you . I have the question of the people who sent me the medication but they are not answering.

Answer:

The thyroid gland is often attacked by the immune system - we don't really know why. The two main attacks from the immune system on the thyroid gland are Hashimoto's Thyroiditis, which can lead to low thyroid levels, and Graves' Disease, which can lead to high thyroid levels. Both diseases can be associated with positive anti-thyroglobulin antibodies and/or anti-thyroid peroxidase antibodies. Neither of these antibodies actually causes disease - they are just markers that tell us the immune system has been activated against the thyroid gland. Sometimes one antibody is elevated, sometimes the other, and often they are both elevated. Sometimes neither one is elevated! We don't know exactly why they are made, and we certainly don't know why the immune system sometimes makes one antibody and sometimes another.

Usually the highest antibody levels are seen in Hashimoto's Thyroiditis, and I would be tempted to say from your positive anti-thyroglobulin antibodies and multinodular goiter that you have Hashimoto's Thyroiditis. Your TSH, however, is slightly low. If the test is correct (the normal limits are a little different from what is published for the assays that are most commonly used) then this suggests that your thyroid gland is very slightly overactive - even though the T4 and T3 are within normal limits.

There is actually such a thing as having both Hashimoto's Thyroiditis and Graves' Disease at the same time - it is possible that this is what is going on with you. In any event, the abnormality is too tiny to warrant treatment right now. You should just have thyroid blood tests repeated periodically - maybe every 4-6 months.

The Chinese herbs you are taking have not been studied scientifically, so I can't say whether or not they are affecting your thyroid tests, though I doubt it. I also doubt that they are helping you in any way. Your thyroid tests should be checked periodically, and your thyroid should be examined periodically. If your thyroid levels get to be too high or low, there is treatment for that. If the thyroid grows bigger and bigger you will need to have the thyroid taken out surgically, but probably the thyroid will just stay the same size. There is no medicine you can take that will help prevent the thyroid from growing, Chinese or American. You just have to wait and see what happens.

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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