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Very High Thyroglobulin, Enlarged thyroid with Large Nodule, Normal Thy...
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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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Very High Thyroglobulin, Enlarged thyroid with Large Nodule, Normal Thyroid funcation results.

My husband's physician found his thyroid palpable and enlarged.  He ordered an ultrasound and some bloodwork.  I would love some opinions on the results.

The ultrasound revealed the following:  The thyroid was diffusely heterogeneous with multiple nodules bilaterally.  The largest on the right measures .880 X .986 X .854 cm.  
The left lobe has a large nodule in the lower pole measuring 5.10 X 3.99 X 5.27 cm. A nuclear medicane scan and uptake should be considered.

The thyroid measures RIGHT 1.37 X 1.48 X 4.74 cm  LEFT 3.33 X 2.79 X 7 cm.

The bloodwork results are:

                                           RESULT                               REFERNCE INTERVAL
Thyroxine (T4)                       8.1 ug/dL                                      4.5-12
T3 Uptake                               34%                                           24-39
Free Thyroxine Index                2.8                                            1.2-4.9
Thyroid Peroxidase (TPO)       6 IU/mL                                         0-34
TSH                                    .550 uIU/mL                                   .45-4.5
Thyroglobulin Quantitative      694 ng/mL                                     0.5-55
Antithyroglobulin Ab              <20 IU/ml                                        0-40

I am very concerned about the thyroidglobulin levels and size of the nodules.

Can you please give me some guidance as to what could cause these elevated thyroglobulin levels when all the other tests seem fine?  Also can you tell me how high the levels are for his thyroglobulin?  (ie, extremely high, moderately high, etc.)  The soonest we can see an endocrinologist is 4 weeks from now so we are slightly on edge to make more sense of these results and what the common percentages of causes are given his profile. He is also a 40 year old male with no health problems, although his bloodwork did reveal elevated cholesterol levels (not sure if this matters).
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The large nodule would cause this degree of Tg rise.  It does not predict cancer risk.

Given the size, the recommendation would be surgery to remove the large nodule / left lobe.  We would do FNA biopsy first to determine if there is a high risk of cancer -- in which case, the surgery would be more involved (total thyroidectomy and lymph node evaluation).  

I-123 uptake / scan is NOT indicated.
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