Test results+sympoms+history=?

[RobynLee]

Hi.  Wondered if you could lend some insight.  I'm a 44 year old woman who has been monitoring thyroid nodules for the past 7 years.  They have stayed stable in size.  Recent thyroid test revealed elevated TPO of 541.  Bloodwork at the same time also revealed a C Reactive Protein level of 26 which is also significantly elevated.  TSH was .43, so still normal range.  
Physical symptoms include almost all that pertain to hypertyroid... insomnia, irregular fast heartrate, eye tremor, night sweats etc.  Also have had severe muscle pain/spasm and the last month chronic daily headache that persists 24/7 but responds fairly well to nsaids.  I have been told to see an endocrinologist by my family doctor.

Could you offer any insight as to what the elevated TPO might indicate in light of the nodules, CRP test, and my sympoms?  My history also includes breast cancer (age 37).  I do currently have silicone gel breast implants.   my mother had severe hyperthyroid at 51.  I have a 14 yr.  history of chronic joint/spine pain and have had lumbar fusion surgery as well.  

Thank you for any guidance/wisdom you might share

[RobynLee]

Thank you very much for your thoughtful response.  Does it seem likely that the elevated CRP of 26 is reason for major concern?  I did read an article that Thyroid autoimmuntity is often associated with spontaneous vertebral artery disection.  With my neck and head pain - I am wondering if something like this might be a culprit.  Do you have any thoughts there?  Or ...do you suppose the C Reactive protein is unrelated to the thyroid issues?  Also.. You mentioned Hashimoto's but wouldn't "Grave's" be more likely given the lowish TSH?  In addition, my T3, T4 and FT3 all came back in normal range as well.
Thank you in advance for any insight you might lend.  This is very diffiuclt for me to navigate.  I will meet my endocrinologist tomorrow, thanks to you be a bit better versed.  
RobynLee

[Mark Lupo, M.D.]

TPO elevation reflects an autoimmune attack on the thyroid - usually does not cause this significant of a CRP elevation.  The TSH is normal at this point, but should be monitored closely.  The nodules may be a reaction to chronic inflammation from the immune system attack - ie, Hashimoto's.  FNA biopsy should be performed on any large nodules - if not already done.  Would also consider seeing a rheumatologist given the elevated CRP.