Nodules, asymptomatic, positive antibodies and low tsh..diagnosis?

[joeylucy]

Hi all,
I have researched about thryoid diseases for so many days now and I'm dumbfounded as to what I could have! At first I thought I had Grave's disease, and then I thought I had Hashimoto's as the antibodies came back positive, but now i'm not quite sure. Do I have both, either or none?

TSH: 0.05 Range: 0.5- 4
Free T3: 6.2 Range 3.5-6.5
Free t4: 18 Range: 10-19
Anti-Thyroid Peroxidase: 232 kIU/L Range <60
Anti-Thyroglobulin: 167 Range <60

I am asymptomatic. Even my heart rate is 60bpm.

My results of the ultrasound found:
right lobe measures: 4.6 x 1.6 x 1.8cm
left lobe measures: 5.1 x 1.2 x 1.8cm
Right lobe has:one 6mm nodule in right lower pole.
Left lobe: Multiple nodules measuring up to 8mm
Vascularity is normal
No retro-sternal extension
Conclusion on ultrasound report: Multi-nodular change.

Would seriously like people's opinion.

[joeylucy]

Hi Dr Lupo,
I have had my TSh levels tested again and my TSI is negative however my TSH is now 6 compared to 0.05 a month ago.
Do I have thyroiditis? I"m 6 weeks pregnant, what should my management be? Has my baby suffered at all?

[joeylucy]

So Dr Lupo, would you say the risk of thyroid cancer is low? I have read that hyperthyroidism along with a multi nodular goiter does not always mean that they are benign.
Are you suggesting that I have hyperthyroidism but you are not sure if it's graves? If graves is not present, would I therefore have a toxic multinodular goiter?
Cheers,
Jo

[Mark Lupo, M.D.]

You have hyperthyroidism.  Most commonly this would be Graves' disease.  The ultrasound did not show a nodule that would be "hot".  The vascularity on the ultrasound was unremarkable, typically in thyroiditis this is a low.  Classically in Graves' disease it is high but this does not exclude Graves' disease.  The antibody you've had have been negative but these are nonspecific for Graves' disease.  I would check a TSI which is more sensitive or consider I-123 uptake and scan if you have persistent hyperthyroidism.

[joeylucy]

I would really appreciate your thought Dr Lupo.