Bleeding, Immune?

[PeggyS512]

Hello Dr. Lupo,

I am very happy that my FNAB of 3 nodules came back benign.
- follicular cells, punctate calcifications, colloid, pseudocellular hemorrhagic colloid,
hemorrhagic colloid, hemosiderin-containing macrophages, finely granulated cytoplasm,
Hurthe cells, consistent with hyperplastic nodule

I am confused about the fact that they were able to measure 27 cysts/nodules on my thyroid
(largest were 1.45x.71x1.38 and 1.2x.81x1.19) but the overall size of my thyroid is 'normal'
(Rt 5.38x1.64x1.37, Lt 5.36x1.55x1.54, Is .28).

Is my thyroid tissue 'dissolving'?

"Hemorrhagic", "Hemosiderin" - what causes bleeding in the thyroid? This was my first FNAB.

I have an immune system disorder (not fully understood by several doctors) where I am not creating antibodies (pneumococcal vaccine) and losing antibodies (HIB, rubella). Do you think there could be some relation between my immune system disorder and having 27 cysts/nodules on my thyroid? Is 27 a lot?

Thank you,
Peggy

[Mark Lupo, M.D.]

Most of us don't count beyond 6-8 nodules -- having 27 though would not be unheard of -- however, the description of "countless" nodules/cysts brings up the possibility of Hashimoto's thyroiditis (although lymphocytes not mentioned on FNA report).  This is an autoimmune system attack on the thyroid.  Would test TPO antibody and TSH.

The thyroid is very vascular - so small amounts of spontaneous bleeding into a cyst or nodule is not uncommon.

[PeggyS512]

I misread a word on the (faxed copy) of my pathology report.
It does not say "pseudocellular hemorrhagic colloid", it says
"paucicellular hemorrhagic colloid."

Peggy

[PeggyS512]

Dr. Lupo,

Thank you for your response. All of my thyroid tests have been "within range."
I have significant fatigue, low body temp., headaches, dizziness and nonrefreshing sleep.

Thyroid Peroxidase Antibody  <10 (range <30)
Thyroglobulin Antibody              2  (range <7)
Thyroxine Binding Globulin       43  (range 41 - 101)

            June 2008                     Sept 2008
TSH        .7      (.45 - 4.1)               1.3
T4         5.74    (4.5 - 12.5)
T4 free     .94    (.73 - 1.95)             .99
T3         76.4     (60 - 180)
T3 free    2.7      (2.3 - 4.2)

Should I ask about lymphocytes in the FNAB?
My blood lymphocyte subsets are off:
CD4 % and CD4/CD8 ratio are high,
absolute CD8 and CD16+56 counts are low.
IgG 1 % is low and IgG 2 % is high.

Could this be Hashimoto's?
Also, what does paucicellular mean?

My Endo said that since the FNAB was benign she would "monitor (me) conservatively and re-ultrasound in 8 months."

Thank you,
Peggy

[PeggyS512]

Dr Lupo,

I went to mt Endo today to follow up on blood work she did because of episodes of high blood pressure. I would like your opinion on one of the tests:

I sat for 10 minutes before sitting blood draw.
Aldosterone, serum   14.1  ng/dL
Renin Activity            0.4  ngmLhr
Vitamin D, 25 OH      28.4  ng/mL  (range 30 - 60)

previous results from blood work earlier this year:
Potassium     3.3   3.7   3.7   4.1   meq/L  (range 3.5 - 5.3)

She said that if Renin were non-existant and Aldosterone over 15, she would do further testing. Since I already take Vit. D supplements, she recommended more sunshine.

I have seen several references to the Aldosterone/PRA Ratio (she did not mention this). Mine would be 35.25.  ARUP Lab says "greater than 25 is suggestive of hyperaldosteronism" and Quest says >18.2 is Primary Hyperaldosteronism.

What do you think?

[PeggyS512]

My Aldosterone/PRA ratio of 35.5  
(Aldosterone is 14.1, and Renin is 0.4 - on a day when I was not having bad symptoms) See more info above.

My a.m. Cortisol is 29, Autonomic Nervous System testing is slightly abnormal, and I am having immune system problems (not making / losing antibodies).

Is there a possible adrenal problem? My Endo is not planning any further testing because Aldosterone is not over 15.