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Thyroid Cancer, Nodules & Hyperthyroidism (Expert Forum)
Lab results/US results--Hashimotos and if so, to what degree? Mild, severe, subclinical?
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
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.
Lab results/US results--Hashimotos and if so, to what degree? Mild, severe, subclinical?
by JBSRI, Apr 15, 2007 12:00AM
Actual lab results are as follows Thyroglobulin antibodies 256 H
T-4 Free 1.0
TSH 6.43 H
Ultrasound results verbatum
Clinical Indication: Hyperthyroidism.
Findings: The right lobe of the thyroid gland is normal in size measuring 4.6 x 1.5 x 1.8 cm. There is mild heterogeneous echotexture without discrete nodule.
The left lobe of the thyroid gland is normal in size measuring 5.1 x 1.9 x. 1.7. There is mild heterogeneous echotexture without discrete nodule.
There is mild prominence of the thyroid isthmus that measures 5.8 mm in AP dimention.
IMpression: Slightly heterogeneous appearance of the thyroid gland with mild prominence of thyroid isthmus. The findings are nonspecific but could represent early manifestations of the thyroid goiter. developing thyroiditis could present in similar fashion. Clinical correction is suggested and if indicated, further investigation with radionuclide throid image uptake and scan could also be of additional use.
Two questions:
1. What is your diagnosis? My guess Hashimoto's. But is it mild enough to watch and NOT TREAT. NOT SURE a 41 year old man wants to get on hormones...
2. If TSH is down, and antibodies remain present at next blood draw, is it still considered Hashimoto's Disease? It seems as though Thyroid treatment is a bit like Italian cooking--not by the book, outcome dependent on the chef...
3. What happens if I do nothing? Symptoms basically cramping/nerve pain in hands, feet legs. Comes and goes.
T-4 Free 1.0
TSH 6.43 H
Ultrasound results verbatum
Clinical Indication: Hyperthyroidism.
Findings: The right lobe of the thyroid gland is normal in size measuring 4.6 x 1.5 x 1.8 cm. There is mild heterogeneous echotexture without discrete nodule.
The left lobe of the thyroid gland is normal in size measuring 5.1 x 1.9 x. 1.7. There is mild heterogeneous echotexture without discrete nodule.
There is mild prominence of the thyroid isthmus that measures 5.8 mm in AP dimention.
IMpression: Slightly heterogeneous appearance of the thyroid gland with mild prominence of thyroid isthmus. The findings are nonspecific but could represent early manifestations of the thyroid goiter. developing thyroiditis could present in similar fashion. Clinical correction is suggested and if indicated, further investigation with radionuclide throid image uptake and scan could also be of additional use.
Two questions:
1. What is your diagnosis? My guess Hashimoto's. But is it mild enough to watch and NOT TREAT. NOT SURE a 41 year old man wants to get on hormones...
2. If TSH is down, and antibodies remain present at next blood draw, is it still considered Hashimoto's Disease? It seems as though Thyroid treatment is a bit like Italian cooking--not by the book, outcome dependent on the chef...
3. What happens if I do nothing? Symptoms basically cramping/nerve pain in hands, feet legs. Comes and goes.
Doctor's Answer
by Mark Lupo, M.D., Apr 15, 2007 12:00AM
, Apr 15, 2007 12:00AM
Scan is useless in this setting.
The US is classic for hashimotos and the antibodies support this diagnosis.
Technically it is subclinical HYPOTHYROID (due to hashi) as the TSH is elevated with normal T4. Would treat IF you have some symptoms, but the cramping, etc may not be thyroid. There is no data to support treating everyone with TSH from 4 to 10, but I often offer a trial to patients to see if it helps any subtle (or not so subtle) symptoms.
If you do nothing, then monitor TSH at least every 6 months and treat when above 10.
The US is classic for hashimotos and the antibodies support this diagnosis.
Technically it is subclinical HYPOTHYROID (due to hashi) as the TSH is elevated with normal T4. Would treat IF you have some symptoms, but the cramping, etc may not be thyroid. There is no data to support treating everyone with TSH from 4 to 10, but I often offer a trial to patients to see if it helps any subtle (or not so subtle) symptoms.
If you do nothing, then monitor TSH at least every 6 months and treat when above 10.
Member Comments (2)
by JBSRI, Apr 15, 2007 12:00AM
Thanks, Doc. I should've gone to med school, but my parents thought Barber College was a better career choice. But that's for another forum...
