Thyroid Ultra sound results

Here I am again.  I received my new lab work and Ultra sound results:
US:  The right lobe measure 1.3x5.1x1.3 cm. The left lobe measures 2.3x4.9x2.3cm.  The isthmus measures 3mm.  Both lobes and the isthmus demostrate uniform echotexture.  There is a 6mm hypoechoic solid nodule centered in the right lobe.There are two large nodules within the left thryoid lobe.  The larger, more superior lesion measures 2.0x2.1x2.2 cm and is a mixed cystic and solid not nodule.  The slightly smaller, more inferior nodule is an extirely solid isoechoic mass that measures 1.6x1.5x1.4cm.  No abnormal vascularity.  No suspicious calcifications.

Blood work:
Bun/Creatinine 34  ref range 8-27
T4 Free 1.38  ref range 082-1.77
TSI: 213  ref range 0-139
TSH: 0.006 ref range .450-4.5   Test done in June was TSH of 0.01
Thyroid peroxidase TPO:  35  ref range 0-34

I just had an uptake done last week.  I go back to my endo on the 21st of Oct.  When I saw the endo last week he told me that I have Graves and Hashimoto and called it hashitoxicosis.  But he still says I am hyperthyroid.  I don't understand all of this.  I have symptoms of both hypo and hyper.  

What kind of questions should I be asking at my next vist?

Thanks

[stella5349]

Hashitoxicosis should be the dx here. and you will have the swings of both hormones causing symptoms.

Right now I can assume based off the labs you had - you are in hyper phase. you need to have the Free T3 tests done to best tell how much hormone you have each time you are tested with the other labs.

Was an FNA offered to see anything more on these nodules?

[katbid]

I am pretty sure he will be doing that after the results of the uptake.  So does this mean I will have to take medicine?  Seems like it would be hard to get on the right medicine if I am both hypo and hyper.  

Thanks for your reply.  I just want to know if this can be fixed?  I can't afford to gain weight because I am in the army.  What do you think the best treatment would be

[stella5349]

In many cases the hyper condition will be what they vocus on first. Usually will ablate the gland. Then replacement therapy for the lost function.

[katbid]

Well not to good news. My uptake showed Photopenia (cold nodule) and the thyroid uptake was 45% with normal being 10-30. He is not doing an FNA and does not think RAI would be bennificial. He wants to do a total thyroidectomy. I am suppose to start taking 90mg of Tapazole today with repeat labs in 5 weeks. He said that I he has to get me out of the hyper stage before surgery can be performed. I don't know, I'm really scared and don't know what to do. I haven't taken my first dose yet because I'm actually contiplating "doing nothing". I'm scared to take the drug because of possible side effects. I'm afraid to have a total thyroidectomy. I'm in the Army reserves and I am also full time civilian for the Army. If they kick me out of the reserves, I will loose my civilian job too. I just don't know what to do at this point. I don't want to blow up like a balloon either. I asked the dr why he couldn't just remove the nodule or do a partial. He said that the nodule would probably come back. Final DX was Graves with Toxic Multinodule Goiter. So my question is? What happens if I do nothing? My blood pressure is fine and I haven't lost weight. My main complaint right now is I just have the shakes. I can live that. I saw an ophthamologist and he said my eyes are fine. He said I may have a little problem with the muscle in my left eye but it wasn't anything serious. He also told me that if I have a total, that it could make my eyesight a lot worse. He said I should go on steriods two weeks before the surgery. I'm so lost right now and even though I do have support from my family, I feel alone.

[katbid]

Hello to all!  I had my TT on the 31st of December due to Graves and Toxic Multinodular Goiter.  I received my path report a few days ago.  The right side of thyroid was only enlarged but the left side contained a 3cm lesion diagnosed as Follicular variant of papillary carcenoma and another .2cm lession diagnosed as classic papillary carcinoma.  I am now waiting to see the oncologist and have a PET scan done.  I have tried to do some research on this but I feel like I end up going in a circle everytime I read an article.

[898_1]

It is very very uncommon to thave cancer in toxic multinodular goiter

[katbid]

It's funny you say that.  My Endo said that my entire case has been unusual and rare.  I'm a little scared about the treatment and outcome.  

[898_1]

as far as I remebering the radioactive iodine is used to check for papillary cancer as it can show the traces of thyroid tissue left over after surgery as well as somewhere in the body. PET scan shows the spread of cancerous tissue but cannot specify what organ it came from

[898_1]

Forgot to ask how old are you?

[katbid]

I will be 46 next month.