cold nodule

[eilande]

21year old female - initially we thought it was arthritis - hands swelling and painful, shoulders ache and her neck is sore to the touch on occasion. she has also gained weight in the last 6 months - dr. did blood work and her t3 was 9.9 (she has an overactive thyroid) - thermal scan was done and it is a "cold nodule"  Now we are just waiting for the appts for the ENT and an endocrinologist.  I'm not sure the size of the nodule. Her aunt had thyroid cancer years ago-mother takes meds for thyroid.
My question is - What is the next step? FNA and who would do it? ENT or endrocrinologist?
I have researched thyroid problems and the hands swelling and shaking can be a symptom of thyroid issues...correct? I'm her mother...I'm just at the mercy of the doctors as far as getting things done.  Has anyone had this experience before? thank you in advance

[898_1]

Yes! It looks likely like Grave's but elevated TSI will confirm that.

[eilande]

Her 6 hour was 58.3 %
her 24 hour was 66.8 %
T4 was 13.7 total
T3 free was 9.9
TSH .12
and she has hyperthyroidism
she hasn't had blood work done to test her TPO/TG and TSI antibodies but you bet I will ask for them if we need them (that is a test for Graves correct?) thanks

[898_1]

Overactive thyroid,  specifically Grave's disease causes shaky hands (tremor), but I cannot say anything definitive about swollen hands (fluid retention? delated inferior vena cava?)  
What was the 24 hour % uptake and have she had a blood test for TPO/TG and TSI antibodies??

[eilande]

Thank you.

It was an I-123 scan and it did show a "cold Nodule" - her tests confirmed also that she has an overactive thyroid.  Am I correct in assuming that this COULD be the reason she has shaky, swollen hands with pain?  These symptoms with a "cold nodule" isn't an extra concern? thanks for the feedback.

[898_1]

I am not familiar with thermal scan ( I know about I-123 scan); however hyperthyroidism is usually accompanied by hot nodule or increased activity of the entire thyroid.
Next step will be ultrasound with Power Doppler and possible shear wave ultrasound. Only after that the decision can be made if FNA is necessary!!