Small? Thyroid and Nodule

[Searching999]

I'm a 39 yr. old female.  I recently had a neck CT scan looking for something that turned out not to be an issue.  The radiologist, however, reported (incidentally) that my thyroid is "symetrically small" and said there is a 5.9mm nodule of the left mid lobe "requiring sonographic characterization."  I hadn't seen the report yet when my Dr. called to tell me my scan was normal.  He didn't even mention the nodule.  Is this something that should be looked at further - should I be getting an ultrasound?  And what could a "small" thyroid mean?  I haven't felt well for years, but thyroid testing is always normal.  I have POTS syndrome, but feel there may be more going on.  Thanks

[Searching999]

Ok, thank you.

[Barb135]

It wouldn't hurt to go ahead and ask for an ultrasound, since the CT report said "requiring sonographic characterization.".  At 5.9 mm the nodule is very small and quite likely nothing to worry about; however, it's always better to be sure.

[Searching999]

Thanks for all the information!  Still not clear though whether I should be asking for an ultrasound to look more closely at the nodule?

[Red_Star]

Ord's Thyroiditis (atrophic autoimmune hypothyroidism) is a possibility.  Ord's Thyroiditis is a disease similar to Hashimoto's Thyroiditis, although it is associated with a reduced (atrophy) of the thyroid gland.  Thyroid peroxidase and/or thyroglobulin antibodies cause gradual destruction of follicles in the thyroid gland.  In Europe, Ord's Thyroiditis is more common than Hashimoto's Thyroiditis.

It a smaller % of people, thyroid antibodies are negative with autoimmune thyroid disease.  A FNA biopsy can be used to diagnose autoimmune thyroid disease in the absence of positive antibody tests. In Ord's Thyroiditis, results will show invasion of the thyroid tissue by leukocytes, mainly T-lymphocytes. Ord's thyroiditis usually results in hypothyroidism. Transient hyperthyroid states (hashitoxicosis) which occurs in Hashimoto's Thyroiditis is rare in Ord's Thyroiditis.

Thyroid nodules are fairly common and are found on physical exam in about 5 - 8% of patients and in up to 60% of patients undergoing imaging studies.  More than 90% of thyroid nodules are benign (not cancerous).  Often small thyroid nodules (less than 1 cm in diameter) and no risk factors for thyroid cancer can be re examined or imaged by sonography to be sure the nodule is not enlarging.  

Signs and symptoms that increase the risk of thyroid cancer: rapidly growing nodule, family history of thyroid cancer, family history Multiple Endocrine Neoplasia 2 (MEN-2), young age at diagnosis (less than 20 years old), male gender, history of head or neck irradiation, and compressive symptoms such as problems swallowing or breathing.  

[Barb135]

Have you been tested for thyroid antibodies to see if you have an autoimmune thyroid disease?  Many of us with Hashimoto's have nodules on our thyroid and they are usually nothing to worry about.  I, personally, have quite a few nodules on my thyroid.  Most likely, your doctor didn't mention the nodule, because it's not anything to be concerned about, at this point.  

The antibody tests you should get are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TGab).  

Hashimoto's is an autoimmune thyroid disease in which the body sees the thyroid as foreign, and produces antibodies to destroy it.  In the early stages of Hashi's, it's not uncommon to have normal thyroid hormone results, because the thyroid is still able to produce adequate amounts of hormones; however, as the destruction becomes greater, thyroid production will diminish and you will eventually become hypo.  

I don't know that the physical size of the thyroid is all that important, unless it's swollen and/or inflammed.  An ultrasound would determine whether there was inflammation or swelling.  

Along with the TSH, Free T3 and Free T3, that gimel recommended, I'd also recommend the TPOab and TGab.  

[Searching999]

Thanks for taking the time to look at this.  Yes, I have a lot of those symptoms, but I doubt the endocrinologist would do anything with numbers like this.  Maybe if I see someone about the nodule, I'll ask to re-test.  Thanks again.  :)

[gimel]

The only thing there that I see that is cause for more testing would be the Total T3.  It is in the lower half of its range.  If you look at this list of hypothyroid symptoms, do you have any?  That is really the most important consideration.

http://thyroid.about.com/cs/basics_starthere/a/hypochecklist.htm

If you have some hypothyroid symptoms, then you should definitely get tested again for Free T3 and Free T4, along with the TSH that they always test.  If your Free T3 and free T4 are in the lower half of the range and you have hypo symptoms, then that would indicate potential benefit from thyroid meds.

If you don't have any hypo symptoms, then you should just focus on learning more about the nodule issue and what, if anything more, is needed right now.  Hopefully some other members will respond on that issue.

[Searching999]

Had to do some diggging.  These are from 2005, but was feeling just as crummy then.

TSH- 1.713                         RR  .350-5.500
Thyroxine (T4)- 9.6              RR  4.5-12.0
T3 Uptake- 32                     RR  24-39
Free Thyroxine Index-  3.1    RR 1.2-4.9
T3- 124                               RR- 85-205

Does it mean anything?

[gimel]

I'll leave your question about the nodule for someone that is more experienced in that area.  As for the tests, your Total T4 is right in the middle of the range, which doesn't reveal a lot.  The T3 Uptake is an outdated test.  I wouldn't bother with that again.  It would be far better to be tested for the most important thyroid hormone, which is Free T3.  Free T3 largely regulates metabolism and many other body functions.  

I am puzzled by the Free T4 test result and the reference range shown.  I have never seen a reference range for FT4 that was anything like that.  Would you please double check your FT4 result and reference range?

[Searching999]

I don't think I have a thyroid disorder because it has tested normal multiple times, including anti-TPO which was normal - don't have that result in front of me.  I am mostly questioning whether this nodule should be looked at further, but am curious about the small thyroid too.  This was from 2010:

T4 - 8.1                     Ref R 4.5-12.0
T3 Uptake - 30           Ref R. 24-39
Free Thyroxine - 2.4    Ref. R 1.2-4.9

[gimel]

To help members respond to your post, please post those "normal" thyroid test results and their reference ranges as shown on the lab report.