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One last question for Dr. Mark re: Hashimoto
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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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One last question for Dr. Mark re: Hashimoto

Dr. Mark,

Thank you for answering my initial question. I just have one more. If the FNA comes back negative, would they want to remove the left lobe anyway because there are 3 nodules? I initially went to the dr. because of hair loss, cold hands/feet, tired, weight gain, palpitations, insomnia. Was referred to a cardiologist, there's nothing wrong w/ my heart. Could this be Hashimoto, even though my labs and antibody tests are normal:

TSH = 1.594
T4 = 7.3
T3 updtake = 35%
Free thyroxine index = 2.6
Sed rate = 4
TPO = <10
Antithyroglobulin = <20
ANA = 48

Here is what the radiology report said:

"The left lobe measures 4.7x1.2x1.2cm and contains several masses. A solid, hypervascular mass that's in the lower pole and measures about 1.1x.9x.8cm. A second heterogeneous ovoid-shaped mass is in the interpolar region. It measures about 1.1x.6x.9cm. A third small solid appearing mass is in the upper pole on the left side measuring 3x3x2mm. The isthmus measures about 15mm.

IMPRESSION: There is diminished uptake evident in the left lower pole. No clear focus of abnormal uptake is evident in the upper pole although heterogeneity in this area is noted. The findings are not typical for multi-nodular goiter, these lesions should be followed as clinically indicated. Normal I131 uptake and normal TSH indicates overall normal function of the thyroid gland. If neoplastic disease is strongly suspected would suggest biopsy of left lower pole nodule."

My brother & grandmother had left lobes removed (goiter).

Thank you once again,
Lil
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The presence of nodules does not necessitate surgery - it is either a suspicion of cancer or an enlargement causing compressive symptoms when we consider surgery.  The increased central vascularity, decreased I-123 uptake and the radiation exposure as a child are concerning for that L lower pole nodule -- either follow it closely with ultrasound or go for a left lobectomy (we usually take out the whole lobe, not just the nodule).  

Regarding the symptoms -- the labs indicate normal thyroid function and antibodies -- probably not hashi.
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Dr. Mark,

I originally went to the internist with a list of complaints that she suspected were thyroid. Despite normal labs, I have symptoms and don't get how this one little nodule could be the cause with normal blood tests. Thank you for your help and putting this into better perspective for me.

Lil
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I was told by my endo that I have Hashimoto's. These are my results:

T3 uptake               32.1
T4 total                   4.8
Thyroxine Free         .9
TSH                         1.77
Thyroglobulin AB     939
Thyroid TPO             91

I am concerned about the last 2. What are considered the normal ranges?

I am not currently on any meds and dont yet have symptoms. I've been trying to get pregnant with no success despite several rounds of IVF.  Would you recommend I do more tests re the Hashi's and/or start on a low dose of thyroid meds?

Thanks for your time.
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I battled infertility for 1 year then found a homeopathic doc willing to agree that hypothyroid could be the cause (even though TSH was under 3.0).  When I added nutritional supplements to support my thyroid including a homeopathic hypothyroid formula, and added using progestrone cream the second two weeks of cycle (and then continue for 12 weeks if pregnancy sucessful), I finally became pregnant after the 2nd cycle.  

A couple of years after childbirth I noticed pain in my neck upon pressure.  Had ultrasound and determined enlarged thyroid and nodules.  Blood tests show Hashimotos.  Apparently had thyroiditis.  Mild pain went away but hypothryoid symptoms came on noticeably.  It took me 3 endo docs, but I finally convinced one that hashimotos with high-normal TSH (2.69), a ton of hypo symptoms, and another autoimmune disease (multiple sclerosis with extremely mild symptoms) actually warranted synthroid.  I think he really agreed to it to try and shrink the nodules, which it didn't do, but it definitely improved the symptoms.  It changed my life.  I feel normal again.  

Anyways, you should absolutely consider the thyroid when having infertility problems.  Change docs until you find one that will listen.  Good luck!
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