Thyroid Nodules

[gunnernags]

I recently was diagnosed with Thyroid Nodules.  Here is my ultrasound results.  "The large heterogeneous central area of the right lobe and has both solid and cystic components. There is a somewhat circumscribed margin. It is measuring about 1.6 x 1.1 x 1.8 cm. Caudal to this is a more solid-appearing nodule that is measuring 2.3 x 1.1 x 1.3 cm. Both of these nodules have blood flow on color DOPPLER. The right lobe appears very hypervascular on color DOPPLER.

I was told I needed blood work done and depending on the results, they would either biopsy or do a nuclear scan.  My blood work came back.  My TSH was .55 and Free T-4 was .8.  I have been catching every infection known to man the past few months and have been extremely tired.  My ENT is on vacation and will schedule biopsy when get back.  Can anyone help me understand all of this?

[898_1]

In some cases PEI can be used before surgery if nodule has cystic components

[goolarra]

Most of us who have Hashi's have multiple nodules.  Surgery is seldom recommended, the exception being if they are large enough to cause difficulty swallowing and/or breathing.  

Also, thyroid meds will often shrink both a goiter and nodules.  

I haven't had surgery, myself.  You might start a new thread to get input on that.  

[gunnernags]

Update:

So, I called the University of Michigan and I get an appointment for next Friday.  They were awesome.  They actually assign a team of doctors to address your issues.  I have to fax them my reports ahead of time and bring my films in.  They will do a full evaluation and let me know if they recommend surgery still (i am having a hard time swallowing) and need to know the pros and cons of surgery etc. They will coordinated with whatever doctor from my city that will be providing the meds (I have an intern I met with that will be perfect).  

Do you know of any people that have had to have their thyroid removed because of multiple nodules?  Do you have any insight?

[goolarra]

Congratulations on the good news from your biopsy.

Do you think your PCP would start you on meds until you can get in to see the endo?  June 27th is a long time to have to wait.  Alternatively, perhaps the ENT would prescribe if you explained the situation to him.

Yes, some people have headaches, both hypo and hyper.  My endo thinks that stress is the biggest factor precipitating the onset or exacerbating autoimmune disease.

You might google a list of "goitrogens".  These are foods that, when eaten RAW only, should be avoided because they interfere with thyroid hormone production.  

I wish I had better suggestions on what you can do in the meantime, but getting on meds is really the only thing that's going to help you feel much better.    

[gunnernags]

I had an my biopsy this week.  They tested the largest of the 3 nodules.  My ENT's nurse called today and told me it was benign.  Then she said it had a 3 percent chance of being malignant?  She then said to me "come back in a year and we will re-check you."  I am like "are you kidding me?"  I reminded her that I have 3 decent size nodules and am having a problem swallowing and have sore throat.  She told me she would speak to the ENT and call me back.  

When she called back, she was very indifferent.  She said "you can come in to be checked, but the Dr. doesnt really think the nodules are causing the problems.  I am thinking, "so isnt it the ENT's job to figure out what exactly is causing the problem?  My ENT only saw me once.  He looked in my ears nose, an only glanced inside my throat.  I have a suspicion I have another doctor that really doesn't know much about thyroid issues and Hashis etc.

I am very happy the results are benign.  I wasnt overly worried about it.  My problem is that I cant get into the recommended Endocronologist until June 27th.  I am so sick..  I have been having bad headaches daily in addition to all the other hashis's stuff.  Can Hashis cause these headaches?  I just want to see a doctor that really knows about the disease that will listen to me and treat me.  I am having a hard time being able to work at my job (which is a HUGE demand and stressor).  I cant keep going on feeling like this.  Any advice?

[goolarra]

Thanks for the update and good luck with the biopsy. It can take a while to get in to see an endo, so don't hesitate to go ahead and make an appointment.  All the best...

[gunnernags]

I wanted to give you an update:

My Thyroid uptake scan showed cold nodules and a low uptake %.  (mine was 9 %).  

I met with my ENT today.  He could feel two of the nodules on my right lobe (one is bigger than the other).  He ordered a biopsy, so hopefully can get that done in the next couple days.  I have a referral into an Endo that is supposed to be good, dont have an appointment yet.  I will keep you posted.

[gunnernags]

Okay- Great feedback!  All good stuff I needed to hear.  I will post updates.

Thanks again!

[goolarra]

Typically, you see an ENT only for a surgical consult or a biopsy.  Endocrinology is the specialty that manages ongoing care.  However, you have to beware...not all endos are good thyroid doctors.  Many are only interested in diabetes.  So, it's a good idea to get a referral from a fellow patient if possible.  If that's not a possibility, you can interview them over the phone before making an appointment.  Also, a good PCP can manage meds...it's all a matter of how interested they are, how well they keep current, which tests they order, which meds they're open to using, etc.

I see an endo, but I live out in the boonies.  So, my endo is a "generalist" and doesn't specialize in any one particular endocrine problem.

You might get some push back on ordering FT3.  So be prepared to be a bit insistent.  Some doctors don't think it's important...you want to stay away from them anyway.  Perhaps your ENT would order that this week.  If so, you should probably repeat FT4 and TSH on the same blood draw.  Be sure to get a copy of all test results.  Keep your own history; it can be invaluable later on down the road.  

I'm glad to hear you're supplementing D.  D is necessary both for the synthesis of thyroid hormones in the thyroid and must be present in cells for the proper metabolism of thyroid hormone there.  So, keeping levels well up in the range is very important.

I'm sure you'll feel much better once you start meds.  Good luck with your ENT appointment, and let us know how it goes.

[gunnernags]

Thank you.  I guess I am an official member of the club.  It certainly explains a lot.  I haven't felt good for a long time.  I haven't had very good luck at my doctors office.  I usually get a physician's  assistant.   My Ultrasound results says right on the paper to order biopsy if my TSH and T4 were in the normal range.  They still ordered the scan.

I have an appointment with an ENT next week who is supposed to be great, so hopefully, he will order the right tests.  Do you recommend I see an ENT or Endocrinologist?

Thanks for the pointer about getting T3 checked.  I will definitely do that every time.  I started taking a vitamin D supplement about 4 months ago.
I am so grateful for this site and that you all are helping me.  Thanks again.

[goolarra]

TGab and TPOab are the two markers for Hashimoto's thyroiditis.  If either is elevated, Hashi's is indicated.  Hashi's is an autoimmune disease and the most prevalent cause of hypothyroidism (although early stages can be hyper) in the developed world.  So, join the club...many of us on this forum have Hashi's.

Your FT4 is very low.  Many of us find that symptoms persist until FT4 is around 50% of range, and yours is under 10% of range.

FT3 is the other thyroid hormone, and you should insist it be tested every time thyroid labs are drawn.  When FT4 is low, TSH is usually high.  However, your TSH is quite low.  Your FT3 level could explain that discrepancy.    

Are you supplementing vitamin D?  

[898_1]

It most likely sounds like Hashimoto's, perhaps in "flaring up" (increased bloodflow in the gland and decreasing TSH).
The nuclear scan is not needed; biopsy is suggested especially if NODULE is palpable.

[gunnernags]

I just received my test results for the thyroid antibodies (They were High):

THYROGLOBULIN AB = <20                    NORMAL RANGE:  <40 IU/mL
SO THYROID PEROXIDASE AB= 421      NORMAL RANGE=  <40 IU/mL

[gunnernags]

Thanks Capewind:

So, you said you had surgery.  What was your diagnosis.  Can you tell me a little more about what problems you were having leading up to them finding a problem?

I appreciate your support.  I am all up in my head... :)

[capewind]

First, I had to get correct seperate TSH, Free T4 and FreeT3,
then usually a bioposy, I hated mine, then they wanted another, so get smart and speak uo is my opinion, based on my experience, Now 4 years after my surgery i am understanding why you have to know numbers and ranges sso ask for copies of all blood test, it is your right, I have my last 2 1/2 months now and the medication you may need down the road is tricky. the ranges are small, different, controverial and to each their own range. So my TSH  is bouncing up and down, soooo sick then soooooo speedy X 1,000.

I got very scared at first, then I took action like you writing here. There are many resources. I calmed down when I said to my self that: "you have the choice, you can ask questions, you can change your mine, you decision is only about you"
Then , I felt empowered and looked up everything just like when I was pregnant, but  still WIP, work in progress.

[gunnernags]

The FT4 Range is .76 - 1.46

Symptoms:  I noticed some hair loss in Oct. 2013.  Dr. did a TSH test only and at that time it was 1.8.  They told me i needed more vitamin D.

December, 2013:  I had a bronchitis.
January, 2014:  I contracted the H1N1 virus.
Late January 2014:  I had a bad sinus infection.

In Mid February I started to feel better, but never 100%.   Extreme fatigue, headaches and low grade fevers.  

March 2014:  I get a bladder infection- I take antiobiotics, but still running a low grade fever, headaches and exhaustion.  I went back to Dr. and he says my bladder infection was gone.  Thats when I asked him to look at my Ears, Nose and Throat.  He finds my thyroid appears enlarged and ordered the ultrasound (this past monday).  

I have been exhausted all week.  Every time I exert myself, I get a low grade fever and headache.  I didnt go to work on Thursday or Friday and have been resting.  

Since Wednesday I have a sore throat and cough and slight difficulty in swallowing (occasionally).  On Thursday I notice white transient like bumps and lines on both sides of my tongue.  

I dont know what is happening to me.. I am normally very heathy and rarely am sick.  My hair is still falling out (a little).

Can thyroid problems weaken your immune system?  

[gunnernags]

Here is the rest of the ultrasound reading:

There are some focal areas of heterogeneity within the left lobe. There is a dominant nodule that has a cystic component within it. The left lobe also appears very hypervascular.

IMPRESSION:

* Multinodular appearance of the thyroid. The thyroid is mildly enlarged. His TSH levels are low then compare this study with a nuclear medicine thyroid uptake and scan study. This is to determine if there are had nodules that would suggest hyperfunctioning adenoma.

* His TSH levels are normal or high then consider consultation with interventional radiologist for possible biopsy.

****MY QUESTION:  What is the significance of the TSH and T4 as it relates to whether I have a biopsy performed or a nuclear uptake scan?  Although my TSH and T4 were not "officially" low, the were at the very low end range of low.  My TSH level dropped from 1.8 (5 months ago), to .5 (recently).

[goolarra]

What's the reference range on your FT4?  Ranges vary lab to lab, so you have to post both together.  It looks like your FT4 is very low.

Do you have symptoms?

[898_1]

Both of these nodules have blood flow on color DOPPLER.
Blood flow within the nodules is not uncommon. The chance of cancer is between 10 and 15%.
The biopsy must be preformed under the live ultrasound to avoid blood contamination of the sample.
The right lobe appears very hypervascular on color DOPPLER. can be sign of inflammatory process (one-sided thyroiditis)