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Elevated TSI and sub centimeter nodule in child
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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Elevated TSI and sub centimeter nodule in child
I was hoping I could ask your opinion if at all possible.  My daughter is 10 years old and had routine bloodwork performed several weeks ago.  We received a call from the pediatrician telling us she needed an ultrasound because her TSI levels were 188.  We had the ultrasound immediately which revealed a subcentimeter nodule on her left lobe.  Her other levels appear to be within the normal range of TSH 1.19 (0.05-4.30) and T4 1.1 (0.9-1.4)(no T3 performed).  We have a very strong family history of thyroid disorders (my mother has had hyper/hypothyroidism for over 40 years and my sister was diagnosed with hyperthyroidism at the age of 12, which required removal of most her thyroid then in turned turned into hypothyroidism. I have an autoimmune disease (Lupus).  I am calling around to pediatric endocriniologists, however the soonest appointments they have is over 4 months away for the 2 that do accept my insurance.  I am just wondering if there is something going on here and I should try harder to get into a doctor sooner or its not as bad as I think .  Should I be concerend that she has Graves Disease/Hyperthyroidism?
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TSI is a marker for Graves, so this does need to be monitored by a pediatric endocrinologist but from what you describe it is not urgent and the ultrasound shows a small nodule that usually would be followed w/ repeat ultrasound in 6-12 months.  Current thyroid function is normal so treatment would not yet be indicated.  Would have her stay away from second hand smoke which can worsen graves.
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