My TPO is high 2168 but thyroid hormones normal. Do I need treatment?

[crm13]

My TPO is high 2168 but all my thyroid hormones are normal. Do I need treatment? Is it Hashimoto?

TSH 3.480 normal
T4 thyroxine 11.2 normal
Total T3 113 normal
Free T3 2.7 normal
Free T4 0.95 normal
Thyroglobulin Autoantibodies <15
Thyroid Peroxidase Autoantibodies 2168 high

Total Protein in serum is also high 8.7
Vitamin D low (20)

My TSH has been up and down before (from 0.01 to 31.6) and TPO was 384 1 year ago and 149 2 months ago. What can cause TPO to be extremely high in such a short period?

Symptoms:
Extreme fatigue and weakness
Memory loss and poor concentration
Blurred vision
Sensitivity to cold
Irregular heart rate, palpitations, hand shake
Numbness, tingling specially on left leg, arm and face
Stiffed muscles (legs)
Swollen lymph node on left side of neck
Puffy face and eye lids
Joint pain and swollen ankles
No menstrual period (since I was 29, now I'm 42)

I already saw many doctors: rheumatologist said it's not lupus, fibromialgia, Sjogren or arthritis, neurologist doesn't know what it is rule out MS, Lyme, Sarcodiosis, Miastenia Gravis, Citomegalovirus but still trying to find why I have abnormal reflexes and slow nerve velocity and Oligoclonal Bands in my CSF and serum. My neurologist suggested I should go to the Mayo Clinic in Rochester, MN for help because they can't find any answers.

The only thing they all tell me is that I have an autoimmune disease but can't find which one.

CT scans and MRI's in the brain, face, soft tissues, neck came out normal. Only thing abnormal was an athropic parotid gland on left side.

I will appreciate any comments. Thanks!

[Mark Lupo, M.D.]

You do have autoimmune thyroid disease with currently normal thyroid function with a history of fluctuating thyroid status which sometimes happens with autoimmune thyroid disease.  This is likely Hashimoto's thyroiditis predominantly.  With the current normal TSH there is no clear indication for medication but a low dose of levothyroxine may be appropriate in certain settings.  I would discuss this with your Dr.  This would not likely explain all of your symptoms and a unifying diagnosis at a center such as Mayo Clinic may be a reasonable idea depending on the impact of your symptoms on day-to-day quality-of-life.

[crm13]

Thank you very much for your response. I had a thyroid ultrasound today and I'm waiting for results.

My neurologist checked my TSH 2 days before than these blood results and TSH was 4.52. I can believe how my body in 2 days can lower TSH from 4.52 to 3.48. Your advise for a low dose of levothyroxine sounds really a good option. It will probably help me with my weight. I just went on vacation for 10 days and gained 7 pounds, now I'm struggling to lose them. Now, a week later I just lost 2 pounds.

I will discuss this treatment with my endocrinologist.