Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
i need help
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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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i need help

my calcium levels are ok (2.35)     (TSH .96)    ( T4 14.9) (  PTH 2.17)

I think I am going crazy, because the symptoms i have don't reflect the test. so here is exactly what my ultrasound report says word for word.. requested a copy from my doc.
In the right lobe there are 3small sonolucent nodules varying between 2 and 3 mm. At the left  thyroid lobe there is a 1 to 2 mm nodule in the upper portion.  At the medial inferior pole of the left thyroid , immediately adjacent to the thyroid tissue ,and moving up and down with the thyroid upon swallowing  is a structure which could either be a lymph node or a parathyroid lesion .I favor this being a parathyroid adenoma. There are a few lymph nodes in the anterior neck, the largest at the upper left anterior aspect measuring 16mm by 12mm by 8mm, i do not see an echogenic hilum, but the good definition and oval shape strongly suggest it is a benign lymph node.
A lesion at the medial lower pole of the left thyroid lobe is probably a parathyroid lesion ,most likely an adenoma additional investigation of this is stongly recommended. I have alot of symptoms, including high blood pressure. I don't understand if everything in my blood test say otherwise ...why do i feel this way.
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97953_tn?1193367871
Labs are the key to hyperparathyroidism, not the possible presence of an adenoma.  If the calcium and PTH are normal -- don't know your reference ranges, but you state they are normal -- then this is not parathyroid over-activity.  The TSH is certainly normal - so it is not thyroid.

Parathyroid adenomas are usually not medial, I think this is likely a lymph node in the paratracheal region -- would consider testing thyroid antibodies as an early case of hashimotos can cause lymph nodes in this region (esp on the left side) that many radiologists interpret as parathyroid.  However, US can be suggestive but can not definitively discriminate between these in some cases.
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97953_tn?1193367871
Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
Sarasota, FL
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