Q: I am a 41 years old male suffering from hyperthyroidism for the past three months. My initial levels of TSH were 0.005 and Free T4 - 48.83. The doctor asked me to take neomercazole (45 mg) daily and after a month, TSH measured 0.06 and Free T4 - 29.73. The doctor then reduced the dosage to 20 mg. After another month, the results were: TSH - 0.06 and Free T4 - 10.12. The doctor asked me to continue with the same dose of neomercazole. Now, the latest report states TSH as 41.14 and Free T4 as 5.77. The doctor has now asked me to stop the medicine for two weeks. Am I on the right mode of treatment?

A:Your initial reports of thyroid profile were suggestive of thyrotoxicosis not necessarily hyperthyroidism. Thyrotoxicosis is a broad term and means signs and symptoms due to high circulating thyroid hormones. Hyperthyroidism means that thyrotoxicosis is due to hyper function of thyroid gland and this can be easily demonstrated by doing thyroid uptake studies. Other cause of thyrotoxicosis is thyroiditis and your profile can be easily due to thyroiditis. I suggest you to stop the neomercazole for the time being and repeat your TSH and fT4 after two weeks and four weeks. Once TSH is low get a thyroid uptake study done and if uptake is high then you have hyperthyroidism otherwise thyroiditis. Treatment for hyperthyroidism is either medications like neomercazole or radioablation or surgery (if gland is very big). If uptake is low then you are likely to have thyroiditis for treatment is symptomatic and observation. In case your TSH remains high even after four weeks then you have hypothyroidism and will need thyroxine as treatment. Anti-TPO is a good test to differentiate between these two conditions.