Aa
Help with deciphering blood / ultrasound tests please
Around Dec 9th I developed hoarsness and dry irritation cough which I still have today. Around Dec 15th I noticed a lump on the left side of my neck. This prompted me to see my physician who measured TSH and ordered a thyroid ultrasound.
My TSH on Dec 26th was 0.277L with lab reference range of 0.450 - 4.500
The ultrasound Dec 28th shows multinodular goiter
Right lobe 4.1 x 1.3 x 1.9 cm
in mid aspect is a heterogeneous hypoechoic solid appearing nodule measuring 1.6 x 1.2 x 1.3 cm hypovascular to surrounding thyroid tissue. Wider than tall.
Isthmus measures 0.2 cm in width. Just to the lateral and right of ishmus is a prominent isoechoic nodule measuring 0.8 x 2.6 x 2.5 cm wider than tall also hypovascular
Left lobe is enlarged and measures 5.9 x 2.5 x 1.4 cm
within inferior aspect is an isoechoic appearing nodule measuring 2.1 x 1.7 x 1.3 cm wider than tall. Slightly hypovascular to surrounding tissue.
Within the mid aspect is an isoechoic appearing nodule measuring 2.4 x 1.7 x 1.2 cm. winder than tall and hypovascular to surrounding thyroid tissue.
No lymphadenopathy seen within the visualized portions of the thyroid bed.
Further Blood Tests show the following:
TSH 3rd Generation .63 range .40 - 4.5
T4 Free 1. 0 range .8 - 1.8
T3 Free 322 range 230 - 420
Thyroglobulin Antibodies <20 range <20
Thyroid Peroxidase Antibodies <10 range <35
Thoughts? I have been on no thyroid medication so don't understand how my TSH is .27 and then 1 week later .63 unless they are totally different tests.
Also on the thyroid Peroxidase Antibodies what does less than 10 mean when the normal is less than 35? Is it then normal or is it low?
Does it look like I'm hyperthyroid, hypothyroid or neither? Because I feel like I've had symptoms of both at times.
What do you think the next step will be? Biopsy or Scan or nothing?
I am 39 yrs old with no prior history of thyroid issues and take no thyroid meds.
My TSH on Dec 26th was 0.277L with lab reference range of 0.450 - 4.500
The ultrasound Dec 28th shows multinodular goiter
Right lobe 4.1 x 1.3 x 1.9 cm
in mid aspect is a heterogeneous hypoechoic solid appearing nodule measuring 1.6 x 1.2 x 1.3 cm hypovascular to surrounding thyroid tissue. Wider than tall.
Isthmus measures 0.2 cm in width. Just to the lateral and right of ishmus is a prominent isoechoic nodule measuring 0.8 x 2.6 x 2.5 cm wider than tall also hypovascular
Left lobe is enlarged and measures 5.9 x 2.5 x 1.4 cm
within inferior aspect is an isoechoic appearing nodule measuring 2.1 x 1.7 x 1.3 cm wider than tall. Slightly hypovascular to surrounding tissue.
Within the mid aspect is an isoechoic appearing nodule measuring 2.4 x 1.7 x 1.2 cm. winder than tall and hypovascular to surrounding thyroid tissue.
No lymphadenopathy seen within the visualized portions of the thyroid bed.
Further Blood Tests show the following:
TSH 3rd Generation .63 range .40 - 4.5
T4 Free 1. 0 range .8 - 1.8
T3 Free 322 range 230 - 420
Thyroglobulin Antibodies <20 range <20
Thyroid Peroxidase Antibodies <10 range <35
Thoughts? I have been on no thyroid medication so don't understand how my TSH is .27 and then 1 week later .63 unless they are totally different tests.
Also on the thyroid Peroxidase Antibodies what does less than 10 mean when the normal is less than 35? Is it then normal or is it low?
Does it look like I'm hyperthyroid, hypothyroid or neither? Because I feel like I've had symptoms of both at times.
What do you think the next step will be? Biopsy or Scan or nothing?
I am 39 yrs old with no prior history of thyroid issues and take no thyroid meds.
"Thoughts? I have been on no thyroid medication so don't understand how my TSH is .27 and then 1 week later .63 unless they are totally different tests"
- were these done by the same lab (name on report)?
As you suspect, your last blood draw labs look pretty good. But you have symptoms.
Antibody tests results can be confusing, and there normal ranges look different lab to lab, but In your case, I think your reading it correctly, seem to be in the normal (there is no 'low' with antibodies, they set a 'limit').
Hopefully someone better with nodules can explain. Doctors do seem to feel the need to further investigate nodules greater than 1 cm.
- were these done by the same lab (name on report)?
As you suspect, your last blood draw labs look pretty good. But you have symptoms.
Antibody tests results can be confusing, and there normal ranges look different lab to lab, but In your case, I think your reading it correctly, seem to be in the normal (there is no 'low' with antibodies, they set a 'limit').
Hopefully someone better with nodules can explain. Doctors do seem to feel the need to further investigate nodules greater than 1 cm.
Hi oscarmaya, I think I responded to one of your other posts, but for the benefit of others here (and forgive me if I have already shared this story someplace else) I too have multinodular goiter, In my case I have "Toxic multinodular goiter " So my blood work looks fairly "normal" except for the Low TSH
The Toxic apart of "Toxic Multinodular Goiter" means that I have several fairly small nodules in my thyroid that are acting like mini thyroids within my thyroid producing hormone on their own, and this hormone from the nodules can not be regulated by the Pituitary gland / TSH. These extra hormones are different every day and out of control. It is very possible that my labs look totally normal one day then for lunch I have seafood and lots of iodized salt on my fries and bingo, I feel like crap and wala my numbers are then all wacky. In your case you may not have toxic nodules at all.
So form your post I am not sure if your Multinodular Goiter is "Toxic" or not, but if it is, then that would explain some of it, You have a solid nodule so that would appear to be a bit different than my case.
I would encourage you to read and learn as much as you can. I am now taking Methimezole to help regulate the thyroid hormone, which is considered temporary treatment. I opted to do this rather than have surgery or RAI radiation so I could make sure I know all my options. I have labs and more ultrasound next month to see where I stand. My nodules in November anyway were much smaller than yours. I could not feel them then but now I can so I assume they have grown some.
How do you feel physically ? Did the radiology report suggest you get a FNA , Fine Needle Aspiration or Biopsy ?
I am not sure if I helped any or not. The Mayoclinic website has some good definitions of Nodules and if you Google some of the specific terms in your report like "Slightly hypovascular to surrounding tissue" I am sure you will find so good information to help you understand what is going on.
I hope others in the group who have nodules will chime in with some thoughts for the rest of your questions.
Best of luck to you.
McMillan
The Toxic apart of "Toxic Multinodular Goiter" means that I have several fairly small nodules in my thyroid that are acting like mini thyroids within my thyroid producing hormone on their own, and this hormone from the nodules can not be regulated by the Pituitary gland / TSH. These extra hormones are different every day and out of control. It is very possible that my labs look totally normal one day then for lunch I have seafood and lots of iodized salt on my fries and bingo, I feel like crap and wala my numbers are then all wacky. In your case you may not have toxic nodules at all.
So form your post I am not sure if your Multinodular Goiter is "Toxic" or not, but if it is, then that would explain some of it, You have a solid nodule so that would appear to be a bit different than my case.
I would encourage you to read and learn as much as you can. I am now taking Methimezole to help regulate the thyroid hormone, which is considered temporary treatment. I opted to do this rather than have surgery or RAI radiation so I could make sure I know all my options. I have labs and more ultrasound next month to see where I stand. My nodules in November anyway were much smaller than yours. I could not feel them then but now I can so I assume they have grown some.
How do you feel physically ? Did the radiology report suggest you get a FNA , Fine Needle Aspiration or Biopsy ?
I am not sure if I helped any or not. The Mayoclinic website has some good definitions of Nodules and if you Google some of the specific terms in your report like "Slightly hypovascular to surrounding tissue" I am sure you will find so good information to help you understand what is going on.
I hope others in the group who have nodules will chime in with some thoughts for the rest of your questions.
Best of luck to you.
McMillan
COMMUNITY LEADER
I can't answer about the ultra sound report either.
Your thyroid levels look relatively good, and although your frees are in the "normal" range, they aren't at the high end of the range, so I wouldn't say that you are hyper just based on the TSH, which is a pituitary hormone and can vary greatly even within a day's time. By the way, the range used by your lab for TSH is old -- several years ago, the AACE recommended that reference ranges for TSH be lowered to 0.3-3.0; however some labs and therefore, doctors are still using outdated ranges.
It's true that nodules can "leak" hormone and I'm not sure how that would affect your blood work, especially the frees -- I would think it would raise them unless they happen not to be leaking at the time of the blood test.
The antibody tests are pretty straight forward -- in your case, anything < 35 on the TPOab and < 20 on the TGab is negative. Therefore, according to your tests you do not have antibodies, which indicates that you don't have an autoimmune issue; at least not Hashimoto's. I think the main test used to diagnose Graves is a TSI and it doesn't look like they ran that. That could also tell you if your nodules are toxic.
Like McMillan, I hope someone comes along who can answer the questions about the ultra sound.
What symptoms do you have? Don't forget also that some symptoms can apply to either hyper and hypo, such as fatigue, weight issues, etc.
Your thyroid levels look relatively good, and although your frees are in the "normal" range, they aren't at the high end of the range, so I wouldn't say that you are hyper just based on the TSH, which is a pituitary hormone and can vary greatly even within a day's time. By the way, the range used by your lab for TSH is old -- several years ago, the AACE recommended that reference ranges for TSH be lowered to 0.3-3.0; however some labs and therefore, doctors are still using outdated ranges.
It's true that nodules can "leak" hormone and I'm not sure how that would affect your blood work, especially the frees -- I would think it would raise them unless they happen not to be leaking at the time of the blood test.
The antibody tests are pretty straight forward -- in your case, anything < 35 on the TPOab and < 20 on the TGab is negative. Therefore, according to your tests you do not have antibodies, which indicates that you don't have an autoimmune issue; at least not Hashimoto's. I think the main test used to diagnose Graves is a TSI and it doesn't look like they ran that. That could also tell you if your nodules are toxic.
Like McMillan, I hope someone comes along who can answer the questions about the ultra sound.
What symptoms do you have? Don't forget also that some symptoms can apply to either hyper and hypo, such as fatigue, weight issues, etc.
Thank you all for responding. I've felt like I've had thyroid symptoms for 10 yrs since I had my first child. I had 8 early miscarriages over the years, very very heavy menstrual bleeding which required 2 endometrial ablations and finally a hysterectomy this year (which I'm wondering if that triggered anything as I'm not on hormone replacement therapy) I've always felt really warm and in the last year even before hysterectomy have had what I'd call hot flashes where I started to sweat out of seemingly no where. I've had trouble falling to sleep for a long time and have been on ambien for almost a year now but lately even after taking the ambien I'm still up for a few hours. I'm always tired but have trouble sleeping. My eyes close and my head drops when I'm reading or doing computer stuff (work at the office) and I just want to stay in bed all day. The last few months I've had trouble remembering things and I make extremely stupid mistakes because I completely forgot about something basic or wasn't thinking clearly. My feet cramp, my muscles hurt, my skin is very dry and my hair is thinning. My eyes are gritty and my vision has deteriorated a bit recently. I feel anxious and shaky and when I was in the drs office she asked me to hold out hands and turned out I did have a bit of a tremor. I've been going through a ton of stress recently too so put down my symptoms to that until the goiter appeared.
oscarmaya, I has every symptom that you mention except of course the menstrual thing. My biggest problem was forgetting things .. people at work would say I told them something and I would say , I never said that .. when I guess I did but I had no recollection of any of it. One of the key things on your case that makes me think that you may have "Toxic" Multinodular Goiter, is
a) Your symptoms. feeling hot, sweating memory etc.etc. a lot of those symptoms when you swing hyper, so you ask , how could I be hyper if my antibodies look good and my Free Ts look good?
b) Your antibodies and Frees are normal but your TSH is LOW
If you have "toxic" nodules that is different than people that have Hashis for example who say "my nodules are leaking" In the case of multinodular goiter, or TMNG, you swing back and forth a lot because then nodules themselves are producing hormone the second Iodine hits your blood stream and this hormone can not be regulated by TSH or the pituitary gland. so they go nuts and make you fall asleep at work so you can be wide awake and dead tired at the same time. So in the case of TMNG you have extra hormone all the time in your blood stream whenever you give it iodine your thyroid is suppressed (low TSH) because the nodules are working on their own and if you are like me, often producing too much hormone. With me there is a very fine line there and I have learned what to avoid eating if I don't want to go hyper etc.
If you had goofy antibodies or odd FT numbers I would more likely suspect Hashis. But you have at least one slid nodule that needs to be looked after. that is likely not producing anything.
I am sure that having a hysterectomy and not having a replacement like estradiol or something. (again that area is not my area of expertise :-)
-McMillan
a) Your symptoms. feeling hot, sweating memory etc.etc. a lot of those symptoms when you swing hyper, so you ask , how could I be hyper if my antibodies look good and my Free Ts look good?
b) Your antibodies and Frees are normal but your TSH is LOW
If you have "toxic" nodules that is different than people that have Hashis for example who say "my nodules are leaking" In the case of multinodular goiter, or TMNG, you swing back and forth a lot because then nodules themselves are producing hormone the second Iodine hits your blood stream and this hormone can not be regulated by TSH or the pituitary gland. so they go nuts and make you fall asleep at work so you can be wide awake and dead tired at the same time. So in the case of TMNG you have extra hormone all the time in your blood stream whenever you give it iodine your thyroid is suppressed (low TSH) because the nodules are working on their own and if you are like me, often producing too much hormone. With me there is a very fine line there and I have learned what to avoid eating if I don't want to go hyper etc.
If you had goofy antibodies or odd FT numbers I would more likely suspect Hashis. But you have at least one slid nodule that needs to be looked after. that is likely not producing anything.
I am sure that having a hysterectomy and not having a replacement like estradiol or something. (again that area is not my area of expertise :-)
-McMillan
Have an Answer?
You are reading content posted in the Thyroid Disorders Community
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
