Thyroid "firmess" one side, worried.

[HelloBeeK]

Back in end of 2012, at my ob/gyn appt she felt my neck for what seemed like an hour. It was weird because it felt out of the blue. I've had seen this woman for at least 6 years with no issues. She told me to get an ultrasound of my neck right away. I had lost my mom to a heart attack and she battled ovarian cancer twice, I sat in her office and cried from the amount of worry she had on her face. I went to my doc (there are two in the practice and saw the one I normally do not see but I trust him), who said he felt the same firmness, especially on the left side. Had bloodwork (had to be TSH, CBC, T4) .. all normal. Ultrasound showed a tiny 3mm nodule. They all acted like "no big deal" and I left. The OB/GYN went silent when I told her and offered nothing further.

Skip ahead to now- went to the doctor Friday and had the other doc feel neck. Same deal, Ultrasound, blood work, etc. I couldn't help but feel that same "great something is really wrong". I feel like I am spinning my wheels with doctors. My hair is thinning, mood swings, heavy cycles, intense flare-ups of joint pain, ibs for 25 years, extreme heat and cold intolerance, weight gain, blurry vision. Had my TSH and t4 tests and levels are fine. I emailed her and asked her to test me for Hashimotos. Not sure if that would apply but now I am between feeling like that or I have cancer. Especially because of the one side being larger. It really does feel "firm". Does anyone have any advice on this? Should I go see a specialist? It is normal to have a small nodule and a firm thyroid in one area?

Thanks.

[HelloBeeK]

My PC keeps letting me write and the will go to another page and I lost everything, sorry.

At this point, I'm preparing myself. This thing wasn't hear 2 1/2 years ago and now I have a large nodule. So then my brain is going to if I have anaplastic thyroid. I just need to get some answers and to a doc who can help.

[HelloBeeK]

I got info on it.
16mm, vascular hypoechoic nodule, No thyroid enlargement. Doctor said its a 50/50 chance of cancer...

[HelloBeeK]

Thanks

[Barb135]

Unfortunately, too many doctors are over their head with this type thing so they tend to clam up.  At this point, I'd probably make an apptt with the endo, get through the FNA, then go through with that vacation just to get your mind off the whole thing for a while.  

Hang in there it will work out.

[HelloBeeK]

At this point, even if it's not cancerous I still have questions my GP probably won't answer. I think that is why I have just been so confused and scared. She did finally upload my results of the other tests:

THYROID PEROXIDASE ANTIBODIES <9 IU/mL         <1
Thyroglobulin Ab < or = 1 IU/mL                         <1
Thyroglobulin 2.8 - 40.9 ng/mL                                 15.9

Thank you for your kind words and helping me. I was supposed to go on a vacation and now feel like maybe we should wait. I'm just all over the place mentally. I know, I see it's easy to cure if that was the case but it's still a scary process.

[Barb135]

Well, I don't have a lot of faith in your GP, anyway.  We've had members who have been diagnosed with Hashimoto's based on inflammation/swelling/nodules on the thyroid, even though they were negative for thyroid antibodies.  I didn't really understand that, but they got the dx  anyway.  It's possible, too, that your antibodies just haven't ramped up yet.

I could say a lot more about the tech, but I won't except that I don't trust her any more than I do your GP, but if there's a possible good thyroid doctor near you, it's well worth check into, I doubt seriously that you'll get in to see an endo before the 17th, as it, typically, takes several weeks, if not months to get an appointment.

Just remember that less than 5% of all thyroid nodules turn out to be cancer and thyroid cancer is one of the easiest to cure, as the thyroid is removed and the cancer with it.

[HelloBeeK]

That's interesting because according to my GP, I don't have Hashis. And not saying I do- but she is looking at the most basic areas.

The "tech" have a me a thyroid doc locally that is an endo, she said he was wonderful. She probably shouldn't have told me anything but she was trying to calm my nerves. My regular GP usually takes forever to get back to me.

The FNA is now on the 17th, I'm pretty nervous about the test and the results. I might try to see that endo before.

[Barb135]

It's not surprising that this is a new nodule and I still content that "the girl" (aka the tech) should not have said ANYTHING to you about anything, so I'm glad you talked to the doctor.  

I don't think you understood what I said... just because your Hashimoto's antibody tests were negative doesn't mean you don't have it... we've seen people be diagnosed, based on characteristics of their thyroid gland as seen via ultra sound.  

I agree that you might be spinning your wheels with your current primary care doctor, but an endo isn't always the answer either, as many endos specialize in diabetes and are not good thyroid doctors. If you decide to go to an endo, make sure the one you choose is well versed in thyroid.  Depending on your location, we might be able to help you find a good thyroid doctor.

[HelloBeeK]

Oh and by "her" I meant the doc not the tech. I really appreciate you helping me. I think I am going to see an endo and get some better answers. I'm spinning my wheels on my current GP.

[HelloBeeK]

Barb, I actually just spoke to her and it's a NEW nodule. It wasn't their 2 years ago. The older one must have not grew and the girl didn't mention it.

and they do want to do a FNA on it. She said all my hashi tests were negative. I'm so confused.

[Barb135]

Possibly they will want to do an FNA, but the tech can't make that decision and should not have told you that... That decision will be made, based on other findings of the ultra sound. The radiologist may be able to tell from the characteristics of your thyroid and the nodule exactly what is going on.  He may actually be able to diagnose Hashimoto's from it.

Try not to stress.  Just because the nodule grew, doesn't it's cancer.  

[HelloBeeK]

I just got back from the Ultrasound and the nodule grew from 3mm to 1.6. The tech mentioned I will have to get a FNB on it.

[HelloBeeK]

Hi- Thank you for your advice. I do have a nodule, it's just small 3mm but they are literally calling me back today to get an ultrasound done. That was 3 years ago.

I am taking supplements for either. I think it's time to get a new doc...

[Barb135]

I think it's extremely unlikely that you have thyroid cancer... Less than 5% of people with nodules have cancer and you don't even have nodules!!  That's how rare thyroid cancer is and if you're seeing cancer all over the web, you're looking in the wrong places; you can't let what you read on the internet scare you like that.  

I'm sure there is something "off" and you need to find out what it is - the next step is to have the thyroid antibodies tested.  

If your ferritin is only 11, that's part of your problem, right there... ferritin is an iron storage hormone and since yours is so low, you should have an iron panel done to check actual iron levels, since iron is necessary for the metabolism of thyroid hormones.  Iron deficiency also causes anemia which causes a lot of symptoms, as well.

Plus your vitamin D is way too low, as well.  Are you supplementing with either iron or vitamin D?  Vitamin D is also necessary for metabolism of thyroid hormones.  Vitamin D deficiency can cause a lot of hypo-like symptoms, as well.

[HelloBeeK]

She claims all the tests are within normal limits, even the last two I ordered for Hashis. It just seems like all over the web, all you see is "cancer" and how people had it for years with no symptoms and good bloodwork. I don't want that to happen to me. I just think it's weird my thyroid feels "firm". I was really hoping something (not cancer) was off from how I feel.

My ferritin is now 11, from 8 back in Sept.

[HelloBeeK]

I emailed her that, I hope she listens. I will move on and find someone else. I at least want to rule out having that. Thank you for your advice.

[Barb135]

You don't really need an endo; you just need a doctor who will work with you and order the right tests.  Many endos specialize in diabetes and aren't really good thyroid doctors anyway.

You need to have FT3 done with the FT4 and TSH.  There should be a ratio of FT4:FT3.  FT4 usually needs to be about mid range and FT3 usually needs to be in the upper half to upper third of its range.  That's where most of us find we feel best.  

The antibody tests are important, right now.

[HelloBeeK]

Thank you again for the info. She never ordered a FT3 either. It's funny because she knows since I turned 30 I have had anxiety attacks, heart palps, depression, and all the other symptoms I described. This was 7 years ago. It's always been like "lost weight"-- which I need to drop about 40+ pounds.

Nobody ever mentioned Hashimotos, it was me looking it up. I am going to email her to check the FT3 now. I asked her for a referral to a endo and it was like "Why?".

[Barb135]

Your FT4 and TSH "look" good, but that's not necessarily the end of the issue.  Just because those levels are "in range, doesn't mean they are where you need them to be AND they didn't order a Free T3, which is the hormone that's actually used by the individual cells in the body, whereas Free T4 is a storage hormone that much be converted to Free T3 prior to use and TSH is not a thyroid hormone at all; it's a pituitary hormone.

I think you're worrying needlessly about the "firmness" in your thyroid gland; it's most likely simply swelling/inflammation which is very common with Hashimoto's.  When we have Hashimoto's, we often have goiter, which is a swollen, inflamed thyroid and the swelling/inflammation isn't always uniform throughout the gland.  

I do think it's well worth your while to ask for thyroid antibodies to confirm/rule out Hashimoto's. The tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).  You need them both because they're both used as diagnostics and some of us have one or the other, some have both. If you only get one, you could be misdiagnosed.

Your symptoms indicate hypothyroidism and with Hashimoto's, it's not the least bit unusual for symptoms to appear long before actual thyroid blood work (TSH, FT4, and FT3, if ordered) to be out of range.

[HelloBeeK]

Thank you for replying to me, Barb. I haven't tried a gluten free diet because I saw about 3 gastro docs that said being borderline was a "no" for being celiac and not to put myself through that.

Standard range for Free T4 was: 0.8 - 1.8 ng/dL

TSH: Reference Range > or = 20 Years 0.40-4.50

It's the "firmness" that worries me I guess. This wasn't an issue 5 years ago.

[HelloBeeK]

Free T4 1.2
TSH, 3RD GENERATION 1.44
VITAMIN D 25 19
25-Hydroxy D3 19
Vit D, 25-Hydroxy D2 <4

[Barb135]

It's normal to have nodules on your thyroid.  Many of us the forum have them.  The only thin worrisome would be if the ultrasound found unusual characteristics or something.

What were the exact levels of your TSH and T4 and was that Free T4 or Total T4?  They aren't the same tests, with Total T4 not being very useful.  Also please provide the reference range for that.  Ranges vary lab to lab and have to come from your own report.

Also, what was the actual level of your vitamin D?  Iron and vitamin D are necessary for the metabolism of thyroid hormones.  Did your doctor recommend supplementing with iron and Vitamin D?  If not, you should talk to her/him, as you'll need to get your levels up... Exact levels needed are somewhat controversial, but both should be above 50.

Have you tried eliminating gluten to see if that makes a difference in the way you feel?  

[HelloBeeK]

Oh and my ferritin level is 8 and when I test for celiac, it comes up "borderline" every time, and my Vitamin D is low.

[HelloBeeK]

Also, I said my TSH and T4 were fine but that was from last time. I am waiting on my results from Friday. Sorry for any typos, etc.