Hashimotos Thyroiditis

[luv2sew]

I had written to you before concerning our 18 year old daughter who I questioned might have Riedels.  Well, we saw Dr. Baskin & here is what he's report said: Ultrasound: Real-time ultrasound exam of neck found hypoechoic thyroid gland typical of thyroiditis with an 8x4mm hypoechoic nodule in isthmus (this is why it's been difficult for her to talk). Englarged cervical lymph nodes seen bilaterally". "Because her Sed rate is only 15 I BELIEVE this represents Hashimotos's Thyroiditis without any de'Quervain or sub-acute thyroiditis ALTHOUGH a fine needle aspiration biopsy would be necessary to completely rule out "granulomatos disease". Her lab findings: Sensitive Thyroid Stimulating Hormone (0.3-3 OuIu/ml): 9.2, Sed Rate: (<20): 15. He did not repeat the prior lab test-TPO AB=37 and TG AB=668. He also states she begin taking Synthroid @ .50 & re-check TSH in six weeks. Her regular endo doctor had Dr. Baskins report, but started her on .50 for 2 weeks then now has her on .75...why?  I didn't get Dr. Baskin's report until after her regular Dr. visit.  Oh, & Dr. Baskin is retiring 9/1/06.  I did make a follow up appt. with Dr. Baskin for 8/3 and I just have this nagging feeling that a FNA needs to be done. Should I request Dr. Baskin to do a FNA, or should I just cool down and wait?  Since she's 18 our insurance will only cover her tell 1/07.

[lhowell]

Hi, I doubt you'll see this message, but I'm curious as to how your daughter is doing now.  I hope she's getting better!

[luv2sew]

Might I also add that her Vit D & Magnisuim is still low even though they've had her on Vit D & Magnisium pills

[Mark Lupo, M.D.]

Most likely this is Hashimotos and not any other type of thyroiditis.  I would treat with Synthroid and repeat u/s in 4-6 months then consider FNA of persistent/enlarging nodule if present.  I am not sure the isthmus nodule of 8mm is making it difficult for her to talk, but it is possible.  I am aware of the 9/1 retirement....still, in most cases can wait on the FNA as mentioned above.  The 75mcg dose is fine for her age/situation and may help shrink the goiter/nodule faster (ie, TSH lowering).  Would be happy to see her in Sarasota for follow-up.