What options?

[RenKat]

Dr. Lupo,  Please respond and advize!
5 years ago, my 15 years of Hypothyroidism developed into Hashimotos, w/nodules.  2= cm or more, w/ TPO levels off the charts.  Numberous endos & primaries in my medicaid hmo coverage over medicated with synthroid, in their treatment to "shrink" the nodules, and "monitored" with US every 6 mos..  
The FNA Biopsy in 2007 was inconclusive due to placement & density .  At that point, I was told the nodules "disappeared".  
A decent Endo stepped in and my Synthroid was reduced to an 88 mcg 6 x a week, from 175 mcg 7 x weekly, over the course of some months. I went from 185 lbs, back to 155 lbs, and no chest pains.
You'd responded at that time, with a concern about this radical reduction.,
Recent (tsh 4.7, tpo 158, T-3 37 and T-4 9.6, Free T4 3.6), the primary ordered an increase of 112 mcg 6 x weekly and an US.  The "Shrink through Meds" approach and the magical disapperance of nodules has since been revealed as simply not true.  
This recent US reveals nodules, but the gland is too scarred and dense to measure.  Choices I face:  Remove this gland, before it turns into something worse, or RAI..  I am exhausted with confusion and pain and losing hope.  Please help.

[Mark Lupo, M.D.]

Would consider seeing an endocinologist who does his/her own ultrasound and re-evaluate this situation.  Most likely it's autoimmune changes showing the abnormal ultrasound appearance.  The current TSH is a bit on the high side, but fine-tuning may not help the "nodules" much, however would target a TSH in the 0.5-2.5 range. The main indications for surgery are suspicious biopsy are compressive symptoms -- you did not mention either.

RAI is not very helpful for Hashimoto's with associated goiter, but sometimes works.

[RenKat]

I have one last question or two.  I am about to do a 24 hr. Iodine Urine test,as well at additional blood testing for wheat allergies and adrenal testing.  Previous reactions to contrast iodine have me apprehensive to take this Iodine.  What is the importance and purpose of this test?  
Also, do nodules disappear with Hashimotos??
Again, I am thinking to abliterate the Thyroid would eliminate some of these problems, including taking the nodules that may or may not be there.  What are your thoughts on this?  Please respond.

[RenKat]

The Dr. I found has told me that with Hashimoto's, nodules can disappear.  Is this true? He also said that a removal or an obliteration isn't going to make anything simpler.  
Note too, that I am hypoglacemic, and the recent order is for an ATCH Adrenal Insufficiency cotrosyn stim test. Could this explain what is wrong with me?  I never seem to get a straight answer, know the real truth, get a level lab or feel better.  What do you advize?

[RenKat]

Thanks for the response.  I am again, on the quest, for an endo that will treat me..