Hashimoto's Thyroiditis/Nodules/Lower Back Pain

[corky13]

Hi Doctor,
I have been issues for over a year that include intermittent nausea, headaches, and lower back pain. I have had a multitude of test done (abdominal/pelvic cat scans, transvaginal ultrasound, blood tests, lumbar mri) Everything has returned normal with the exception of a very small protruding disc on the lumbar mri and the TPO test elevated at 152 (ref. range <35). I was referred to an Endo and she diagnosed me with Hashimoto's thyroiditis after feeling a goiter. I was sent for an ultrasound and the results were consistent with the diagnosis, but also show multiple nodules. I am not sure of the sizes, but I believe she said "like a half of an inch). She doesn't want to do a FNB, because she doesn't feel that it would reveal any additional information. I am extremely worried that these nodules may represent thyroid cancer and that the lower back pain could represent a cancer that has spread. Would the mri that I had back in October of 08 rule out this possibility? I appreciate your expert opinion on this matter as I am in a constant worried state. Also I would like to have another child and I am 38 years old. I had a miscarriage before this all began. Is this related to the thyroid issue? Thank you for your help.

[Mark Lupo, M.D.]

This is hashimoto's with nodules -- the nodules should under FNA biopsy to ensure they are not cancer.   If the TSH is >3, treatment w/ levothyroxine in this setting may be indicated.

[corky13]

Here are my ultrasound results:

The right thyroid lobe measures 5.3 x 2.0 x 1.8 cm. The left thyroid lobe measures 5.5 x 1.4 x 1.7 cm. The isthmus measures 5mm. The thyroid gland is diffusely heterogeneous with more focal areas of altered echo texture identified. For example, in the medial right thyroid lobe is a mixed cyst and solid nodule which measures 2.2 x1.5x1.2 cm. Within the inferior left thyroid lobe and mid medial left lobe is a second nodule with similar appearance demonstrating mixed solid and cystic components measuring 1.8 x 0.8 x 1.0 cm. Inferior to the left thyroid lobe is a 2.2 x 0.6 x 0.8 cm nodule which demonstrates also similar appearance of cystic and solid component with a pattern most suggestive of an exophytic inferior left thyroid nodule.

Impression: Enlarged diffusely heterogeneous thyroid gland identified with multiple mixed cystic and solid nodules, as described above. Clinical correlation is advised and if clinically indicated a fine needle aspiration with ultrasound guidance can be performed.