Thyroiditis/Nodule

[Susan615]

Hello!
  I was diagnosed as hypo 30 years ago after treatment for a goiter.  I do not remember all the details, I was 18 and I am not sure I was really told all the details.  I do remember taking some sort of iodine drops.  Since then I have been on various types of thyroid meds.  I now take Levoxyll .2 plus a .025.  Over the last 2 years I have had problems with swollen lymph nodes and even had one large one removed that was non-cancerous.  Also this year my TSH has had large swings from 38.66 to .19.  The last test had it at 1.22 which I was told was finally normal.  I have been experiencing a racing heart feeling off and on as well as extreme fatigue.  I went for a FN Ultrasound biopsy for another enlarged lymph node and the doctor doing the procedure told me my thyroid was heterogenous and the left lobe was enlarged with a singular nodule.  She went ahead and biopsied the lymph node and it was benign but told me I would need follow up on the thyroid.
My questions are, could my lymph node problem be from my thyroid?  Do I need to see an endocrinologist for the thyroid swings/enlargement/nodule, and why would she not biopsy the thyroid/nodule at the time of the lymph node biopsy?  I guess also a question would be she asked me if I was ever told I had Hashimoto's disease.  I said no because I just get mey blood tests and the doc adjusts my meds.  I have never really been told more than that.  I do know I can tell when my numbers are off.  I do feel like my neck is "stuffy" now and I also have days with the racing heart and days without it.  I have lost 50 lbs, on purpose, but I am now stuck and can't seem to drop more.  Two weeks after my last med adjustment I felt very strange, like I crashed or something and I began having swelling in my knees and was sore all over for about 4 days.  No other symptoms but it was certainly different.  Is any of this related?
Thank you for your time!

[Susan615]

Thank you for answering my question!  Do you think follow- up other than TSH testing is needed?  Should I see an endo or keep seeing the ENT and PCP?

Thank you,

[Mark Lupo, M.D.]

A heterogeneous thyroid w/ this history points towards Hashimoto's -- which can cause the nearby lymph nodes to "react" (get larger in a benign way).  Keeping the TSH in range (0.5-2.5) is the goal -- this is done by adjusting the levoxyl med as necessary.