Lab Interpretation

[Gloworm358]

I see a lot of good interpretations of labs on here and I am looking for some input. I know I have hashis, and I am currently on 50mcg synthroid with bloodwork (TSH and T4 free) scheduled for 4 weeks from now. Thyroid issues discovered in May of this year.


5/27/14
TSH 4.19
T4 Free 1.06
Thyroid Ultrasound (Left 1.8x.8 cm, Right 5x4x3 mm, Right 6x5x4 mm)-Endo says scar tissue and is keeping an eye on measurements; OBGYN (found initial thyroid problem) wants me to consider a surgical consult)

6/12/14
Thyroglobulin, Antibody 1.4
Thyroid Peroxidase (TPO) Ab 535

9/19
TSH 4.77
T4 Free 1.10

[Barb135]

Sorry, I didn't see your comments earlier or I would have responded.

Hmmm - as I said, ultra sound readings aren't my first area of expertise, but I'm learning. I believe that caution is always the best policy.

Multinodular goiter is very common with Hashimoto's and is, typically, nothing to worry about.  I have that, myself.  The fact that yours is growing and the size of the nodules would be a concern for me.  While it's very possible, even probable, that all of this is scar tissue as your endo believes, and if it is, where is it coming from?.  I'm, also, not sure that scar tissue would grow like that.  Those might be questions to ask your endo.

If it were me, I'd go with the suggestion of the OB/GYN and seek another opinion - it doesn't necessarily have to be a surgical opinion - just a second opinion.  You always have that right and should exercise it.

[Gloworm358]

Bump for Barb.... :)

[Gloworm358]

I've got the second report from 9/27/14
The right lobe is enlarged measuring 5cm in length. Mweasures 2cm in transverse dimension and 2 cm in anteroposterior dimension. The left lobe is enlarged measuring 5cm in length and measuring 2cm in transverse dimension and 1.7 cm in anteroposterior dimension. All these measurements are enlarged when compared to 5/27/14. Multiple nodules identified in both lobes. these are solid. The largest on the right measures 1.2x2.5 cm. The largest on the left measures 1.3x1.3 cm. These were also more prominent when compared with 5/27/14.
Impression:
Findings described above would suggest the presence of multinodular goiter. The size of the thyroid gland as well as the nodules have increased in the interval when compared to 5/27/14. Recommend clinical correlation further evaluations might be indicated in view of interval change.

[Barb135]

Forgot to mention that once you've been on the Synthroid for a while, your nodules may begin to shrink.

[Barb135]

So this is the first of 3 ultrasounds? and you don't have reports for the other 2?

The "questionable" nodule would be a concern for me, along with the size of it.  It could be inflammation from Hashimoto's, but I'd want to know for sure.

Is there nothing on the report that indicates a for follow up?  All of my reports have section that say:  Conclusion:  Follow up with ultrasound in six months.  Or some might say to follow up with FNA, etc...

I'm sorry, I'm still learning the particulars of the ultrasounds, so I'm pretty cautious, there.  If you can get those other 2 reports, maybe they will be more helpful.

No, there are no revise options... once you post something, you're stuck with it.  The only way it can be changed is to contact the mods - that can turn into a pretty big deal.

[Gloworm358]

My apologies. The 2nd and 3rd ultrasounds were performed in September.
No revise option on posts? I need to be more careful!

[Gloworm358]

I have had 3 ultrasounds done. Below is the first one (5/27/14) performed at the Hospital per my OBGYN, who found the thyroid enlargement at a regular visit. I had 2 more done in November, a few days apart. The 2nd one was a follow up at the hospital per my OBGYN that I did not receive results for (I'm calling today to get those). The 3rd one was performed a few days later by my Endocrinologist (1st visit to her).
The Endo believes all findings to be scar tissue and is monitoring the tissue with a follow up ultrasound scheduled for February.

Findings: The right lobe measures 4.4x1.6x1.6 cm and the left lobe measures 4.5x1.6x.18 cm. The isthmus measures 0.19 cm.
Heterogenous thyroid echotexture bilaterally. There are two adjacent hypoechoic solid nodules within the right lobe measuring 5x4x3 mm and 6x5x4 mm. 1.8x1.2x0.8 cm questionable nodule within the left lobe. There is mildly increased vascularity to the thyroid gland bilaterally.
Impression:
1: Mildly enlarged and heterogenous thyroid gland with increased vascularity.
2: Two small sub centimeter hypoechoic solid nodules within the right lobe.
3: 1.9x0.8 cm probable nodule within left lobe.

[Barb135]

Will be able to tell more once we see that report... will look forward to seeing it.

[Gloworm358]

I have a full ultrasound report at home. I am on a short trip. I will type it up hopefully later today. Thank you!

[Barb135]

The TSH is actually high, at 4.77... It should be below 3.0.

[MelissaMil]

Your TSH level seems low. I have had several endos and even the not so good ones and the great ones all agreed on one thing. It is best to have the TSH below 2.0

[Barb135]

The Thyrglobulin Antibodies (TgAb) and Thyroid Peroxidase Antibodies (TPOab) being elevated are the basis for the Hashimoto's diagnosis.  Once you're diagnosed with Hashimoto's, the antibodies don't have to be tested all the time, because you have it, you have it for life.

Your TSH is elevated, indicating that you're hypo.  While your FT4 is "in range" it's very low in the range, also indicating hypothyroidism - do you have symptoms of hypothyroidism?

Were there any observations on the ultrasound report, other than the sizes of the nodules?  There wouldn't be reason for a surgical consult unless characteristics were unusual causing concern for cancer, etc.  The report should discuss the characteristics of the nodules.  There should also be a "conclusion" on the ultrasound report, indicating a need for follow up, if the radiologist feels it necessary.

[Gloworm358]

Hmmm, let me try again. I think the notations before the ranges are making them invisible.

5/27/14
TSH 4.19 - 0.450-4.500 uIU/mL
T4 Free 1.06 - 0.82-1.77 ng/dL
Thyroid Ultrasound (Left 1.8x.8 cm, Right 5x4x3 mm, Right 6x5x4 mm)

6/12/14
Thyroglobulin, Antibody 1.4 - 0.0-0.9 IU/mL
Thyroid Peroxidase (TPO) Ab 535 - 0-34 IU/mL

9/19
TSH 4.77 - 0.450-4.500 uIU/mL
T4 Free 1.10 - 0.82-1.77 ng/dL

[Gloworm358]

I apologize. Ranges below:

5/27/14
TSH 4.19
T4 Free 1.06
Thyroid Ultrasound (Left 1.8x.8 cm, Right 5x4x3 mm, Right 6x5x4 mm)

6/12/14
Thyroglobulin, Antibody 1.4
Thyroid Peroxidase (TPO) Ab 535

9/19
TSH 4.77
T4 Free 1.10

The thyroid measurements are either nodules or scar tissue. There seems to be some disagreement between my OBGYN and endocrinologist on that issue.
I have been on Synthroid since 9/25.

[Barb135]

What is the reference range for the Free T4?  Ranges vary lab to lab and have to come from your own report.  You should also be tested for Free T3, which is the hormone actually used by individual cells, while FT4 must be converted to FT3, prior to use.

How long have you been on the 50 mcg Synthroid?

You have 2 measurements for the right lobe; can you explain those, please? Looks like you might have some nodules?  Nodules are quite common with Hashimoto's and may shrink once adequate levels of thyroid hormones are provided.