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Multiple Thyroid Nodules per CT

I have three questions: 1. I have drenching sweats day and night approx half hr apart; can't sleep more than two hrs at a time, 10 yrs post menopause, on HRT (I'm 62), constantly tired, w/normal thyroid labs...would thyroid meds help anyway? 2. Could the nodules found on CT (see below) account for the symptoms? 3. Would I be better to have reg follow-ups or should I ask for removal of the nodules/thyroid or might PEI..ethanol injections shrink the nodules..?

Following a CT I had a Thyroid Ultrasound, here's my brief synopsis of the report: RT thyroid measures 4.2 x 1.3 x 1.3 cm , lower lobe subcentimeter non-cystic nodule 0.5 x 0.5 x 0.6 cm satellite nodule 0.3 x 0.3 cm (=.01inch). LT thyroid measures 4.7 x 1.5 x 1.7 cm, multiple non-cystic nodules: largest of which corresponds to CT hypodensity: measures 1.3 x 0.7 x 1.1 cm  = .512 inches (1/2inch+). IMPRESSION: Multiple bilateral thyroid nodules RECOMMEND:  Follow-up thyroid ultrasound in six months.

Any help or input is welcome and gratefully received... I don't know where to start.
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393685 tn?1425812522
no problem . Check the lab sheet and see if the complete blood panels were done.

Most likely a TSH was done - see the descriptions of "what these are too after the test.



You need to look and see if the FREE T3 - or FT3 or Triiodothyronine (T3) FREE ( it must read free to have the right test  

(Most of the T3 in the blood is attached to thyroxine-binding globulin. Less than 1% of the T3 is unattached. A T3 blood test measures both bound and free triiodothyronine. T3 has a greater effect on the way the body uses energy than T4, even though T3 is normally present in smaller amounts than T4.)

** unattached binded thyroid hormone is FREE - that is what you want to see-  


The the other is the Free T4 or FT4 or the Free thyroxine (FTI or FT4) The FTI is a shotty test so hopefully just the Free T4 is used for you. FTI is rarely used now.

(Free thyroxine (T4) can be measured directly (FT4) or calculated as the free thyroxine index (FTI). The FTI tells how much free T4 is present compared to bound T4. The FTI can help tell if abnormal amounts of T4 are present because of abnormal amounts of thyroxine-binding globulin. )


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Avatar universal
First let me thank ALL of you for such thoughtful responses. I can't post thyroid labs because last I heard they were all 'fine', I don't have copies and it was supposed to be comprehensive. The last one taken was over a year ago. I get the severe sweats problem whenever I try to come off HRT, as I did about six weeks ago ( and tried before). I didn't want to restart the HRT until I could get some thyroid tests done, but even though I've called my doc's office several times and requested them, I hear nothing back. Apparently he wants to wait for the full body ('eyes to thighs') PET CT results then have me go in and talk to him about the results and will go from there. As it happens, my daughter was diagnosed with Hashi's at age 12, when they told us she virtually had no thyroid as it was destroyed. She has to take high dosages of thyroxine to replace it. Noone else in our family( that I'm aware of) has ever had Hashimoto's) although several have had underactive thryoid. Her dad and younger sister have a very rare autoimmune disease called TRAPS, but that's on the paternal side, and thryroid has not been an issue other than her dad has low thyroid. No evidence of auto-immune problems on my side.

I understand the results of the PET CT should be at the doc's on Monday, I sure hope so.  When I get the results I'll post them. The area where I live is hard to find Doctors, mine informed his patients they have to pay a "retainer" of $386 per year (starting in Sept) to remain a patient with him.  We have no choice because there is a dire shortage of doctors in our area, and we have TriWest Standard insurance which also limits options. The doc is one of those that you can only discuss one problem at a time, or make another appointment so I have not been there any more than neccessary.  Been with him about three years.  Right now, he seems to show genuine concern and wants to follow up, so I have to go with that I guess.

One other thing I should mention, not because I didn't want to mention it, but because I didn't want to confuse and complicate matters is that I also have multiple nodules in my lungs (7), one of which is 15mm and the one of most concern. Doc says that most people who have CAT scans would show nodules, it's a matter of  size/type follow-up once they are detected.

I will call his office tomorrow morning and make another request for thyroid labs. Can you tell me what test I should specifically make sure I have done? As soon as I get the labs done I'll post the results as well. btw: I do get shooting ear to head pain on the left side and have a little trouble swalowing, but there was nothing "palpable" on doc exam.

Again, I can't thank you enough. it means so much to me just to be able to ask the questions out loud.
Helpful - 0
393685 tn?1425812522
The labs posted here would certainly help making suggestions.

Without labs and looking at the cystic nodule base - it "could" - if giving a personal patient guess... "again could" be a hyper/hot nodule base that "could" be releasing hormone, but the body is not as one-sided as a nodule causing all this disturbance. You're going into alot of thought here with PEI injections assuming this is whats causing hyper already. Can you be more detailed on what your doctor talked to you about after the US scan was done?

Again do you have any thyroid labs you can share?

In your age catorgy as you have said you are post menopausal and also taking a synthetic estrogen base medication. With your symptoms of sweating and knowing the correlations of estrogen with HRT - are you sure you are not experiencing some side effects from this? Is this a new dosage or have you changed recently to a patch will this treatment?

Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
Without knowing what your actual blood test results are, it's impossible to make a determination that would be helpful.  

ThyroidHunter says the sweating, sleeplessness are symptoms of hyperthyroid; however, I'm hypo with Hashimoto's and I had those same symptoms before my thyroid levels got to a good point for me.  I also had those symptoms worse when I was on estrogen/progesterone replacements (post hysterectomy).  I stopped taking any of those approx 5-6 yrs ago.  

It's rare for a thyroid to be removed because of nodules, unless they are suspicious for cancer or in the case of Graves Disease, etc.  Many of us who are hypo/Hashi's have nodules and they only bear watching.  I have several of them and as long as they don't grow, they are left alone.

It would be helpful for you to have antibody testing to determine if you have an autoimmune thyroid disease, in which antibodies attack and eventually destroy the thyroid.  

Depending on your blood test results, you might very well benefit from thyroid replacement hormones.  Even if your blood tests shows your levels in the "normal" range, that may not be good enough for you.  We are all different and we all need different levels.  

I'm on synthetic thyroid replacement hormones and doing very well. I started out on synthroid, went to generic levo, which worked better for me than synthroid.  I have recently been started on the new Tirosint and doing much better.

Once again, please post your actual thyroid blood tests, along with the respective reference ranges, since these are lab specific and must come from your own lab report.  
Helpful - 0
1425146 tn?1282761884
Barb135's comments are accurate about blood tests, your CT scan tells me the story. You could have any combination of Graves, Hashimoto's (my disease), or simply hypethryodic. All of these can, (and should already have been) treated.

Waiting 6 months to feel better doesn't seem like a good option to me. I would find a new General Practice doc. Show them the results, and see if beta blockers with a baby sized dose of Xanax shows any improvement. If it does, you've probably hit the jackpot on diagnosis of hyperthyroid impairment, then it becomes a matter of which diesease it is. It took over a year for my doctor to make a fully correct diagnosis once the tumors and cysts had been discovered. I had to be watched for what worked and what didn't.

I have fought for 18 months to keep my gland, I think it's better than synthetic. I started a Foundation for sufferers and most of emails from patients who are synthetic are not that positive. It is difficult to maintain correct dosage for many, but for some not. Why this is, we don't know yet - but it's a fact.

The sweating, sleeplessness, and minor anxiety I read into your note are all related to many of the hyperthyroidic diseases. Don't be afraid to strike out with a new doc, and remember, it's YOUR health and how YOU feel that matter. Everyone knows it's still the "practice" of medicine, there are no perfect docs.

Best.
Helpful - 0
649848 tn?1534633700
COMMUNITY LEADER
What are the actual numbers for your most recent thyroid tests?  Can you post them, along with the lab's reference ranges, since these vary from lab to lab, so must come from your own report.  

Normal on the lab report, may not be normal for you.  
Helpful - 0
929504 tn?1332585934
AS far as the nodules are concerned...the most important thing to do for any nodule over 1cm is to have it biopsied to rule out any abnormalties. Nodules may cause a choking sensation in the throat if they are large, sore throat, and pain in the neck area..other than that, the other symptoms that you described could be unrelated.
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