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How can Hashimoto's thyroiditis be treated?

Q: I am a 34 years old married woman who has been diagnosed with Hashimoto’s thyroiditis 4 years back. So I was given Thyroxine. But after 3 months, I developed palpitation. TFT showed elevated levels of T3 & T4 and a low TSH. I was told to taper off Thyroxine, which I did. Now, last month, I developed palpitations again and on testing, found TSH to be very low and T3 & T4 to be very high. I have lost 3.5 kg in a month. My weight is 44 kg and height is 151 cm. I went through some stress before I developed the discomfort. What can be the possible treatment procedure? What all further tests have to be done to come to the right diagnosis? Can Hashimoto's thyroiditis develop into hyperthyroidism eventually or I was wrongly diagnosed?

A:This is a very interesting scenario. Very rarely patients with Hashimoto’s thyroiditis may develop hyperthyroidism but more likely possibility is having thyroiditis, which behaves like hyperthyroidism but in fact there is inflammation of thyroid gland leading on to release of preformed thyroid hormone. To differentiate between these two conditions (hyperthyroidism / thyroiditis) recommended test is thyroid uptake study. If high then you have hyperthyroidism and will need antithyroid medications and if you have the low thyroiditis and treatment will be beta-blockers and observation. Please get back to me with thyroid uptake study results.


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