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Thyroid Cancer, Nodules & Hyperthyroidism (Expert Forum)
hypo then hyper
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.
hypo then hyper
by running_man, Jun 14, 2007 12:00AM
Hi,
I'm a 41 year old male.
Here's a recap of my saga:
2 nodules: 6.5 x 7.2 x 9.1 mm lesion inferior to the left aspect of the isthmus with a smaller adjacent 9.3 x 4.5 x 6.5 mm lesion."
TBG 11.9 mcg/mL (Low)
Thyroid Peroxidase anti TPO None
Thyroglbulin ABS 39 IU/mL (High)
Thyroglobulin 44.9 ng/mL (High)
T3, Free 364 pg/dl (range 230-420)
TSH 6.52 mIU/L (High)
Thyroxine, Free, direct 1.34 ng/dL (range .8 - 1.8)
So my ENT started me on 75mcg of Synthroid and referred me to an Endo to biopsy the nodules.
Went to see my endo, she tried to stick the smaller nodule but couldn't. She felt that the larger one was not actually attached to my thyroid and may be a lymph node.
After 8 weeks of synthroid:
TSH .01 (Low)
T3, Free 620 pg/dL (high)
Thyroxine free direct 2.81 (High) (Range .8-1.8)
So my endo told me to stop the synthroid. She didn't think that 8 weeeks of 75mcg could push me into being hyper without my thyroid kicking in.
She examined my neck and thought a lymph node on my right side was enlarged. Because of that she wanted to try a biopsy on my smaller nodule again. Once again no success.
At this point she wants to get a cat scan or an MRI of my enlarged lymph node and possibly have it biopsied as well.
Does it seem like my endo is going about this the right way? I'm a little anxious to get this stuff resolved and it seems to be taking forever.
I'm a 41 year old male.
Here's a recap of my saga:
2 nodules: 6.5 x 7.2 x 9.1 mm lesion inferior to the left aspect of the isthmus with a smaller adjacent 9.3 x 4.5 x 6.5 mm lesion."
TBG 11.9 mcg/mL (Low)
Thyroid Peroxidase anti TPO None
Thyroglbulin ABS 39 IU/mL (High)
Thyroglobulin 44.9 ng/mL (High)
T3, Free 364 pg/dl (range 230-420)
TSH 6.52 mIU/L (High)
Thyroxine, Free, direct 1.34 ng/dL (range .8 - 1.8)
So my ENT started me on 75mcg of Synthroid and referred me to an Endo to biopsy the nodules.
Went to see my endo, she tried to stick the smaller nodule but couldn't. She felt that the larger one was not actually attached to my thyroid and may be a lymph node.
After 8 weeks of synthroid:
TSH .01 (Low)
T3, Free 620 pg/dL (high)
Thyroxine free direct 2.81 (High) (Range .8-1.8)
So my endo told me to stop the synthroid. She didn't think that 8 weeeks of 75mcg could push me into being hyper without my thyroid kicking in.
She examined my neck and thought a lymph node on my right side was enlarged. Because of that she wanted to try a biopsy on my smaller nodule again. Once again no success.
At this point she wants to get a cat scan or an MRI of my enlarged lymph node and possibly have it biopsied as well.
Does it seem like my endo is going about this the right way? I'm a little anxious to get this stuff resolved and it seems to be taking forever.
Doctor's Answer
by Mark Lupo, M.D., Jun 17, 2007 12:00AM
, Jun 17, 2007 12:00AM
hard to say without doing a real-time ultrasound to check these lesions out. The Tg-Ab is borderline positive with negative TPO so may be mild hashi -- the tsh response to 75mcg did seem exaggerated, but would try to keep tsh around 0.5-1.5 perhaps (ie ?50mcg) -- if this is a lymph node, it may be reactive (ie, to hashi) -- US is best in my mind to track these things, but sometimes CT can see deeper nodes and nodes hiding behind other structures that US cannot.
