I have been reviewing other submissions concerning extremely elevated TSH level and now realize that my current level of 43.6 is not as unusual as I thought. I was first diagnosed with Hashimoto's during post-partum 1993. I was active duty USAF at the time being seen by an Army Endocrinologist. He brushed it off and sent me on my way with no treatment of any kind. Two years later on my entrance exam into the VA medical system, a RAIU confirmed a nodule goiter. My TSH was slightly high at that time with T3 & T4 normal. I was told then and by every VA doctor since then that as long as my T3 and T4 are within normal range, the VA policy is to do nothing about the TSH being abnormal. So, for 16 years I have most likely been experiencing the subclinical highs and lows associated with Hashimoto's. Now I have a TSH of 43.6. Obviously not the highest on record by any means, but still quite alarming. I recently got a second opinion from a thyroid specialist outside the VA whose physical examination of the goiter concluded it has hardened, somewhat alarming to him as he said this could mean the beginning of cancer. True?
His conclusion was that my thyroid should come out immediately due to compression against my esophagus and wind pipe, the hardened goiter, and the lab results. True? What is your assessment of this situation? How dangerous does it appear to be in your opinion? Thank you for your promptest response!
This is most likely Hashimoto's which is associated with a firm goiter which often decreases in size once the TSH is normalized (with levothyroxine treatment).
The RAIU likley showed patchy uptake -- this is commonly seen in Hashimoto's, but an ultrasound is indicated to make sure there is no discrete nodule that requires FNA biopsy. Unless the goiter is causing compressive symptoms (trouble breathing or swallowing or trouble with hoarseness) OR the ultrasound leads to FNA biopsy that shows suspicious cells.....we usually wait to see the response to treatment before considering surgery. hope that helps.
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