multinodule goiter results and such

[worried§confused]

Ultrasound results= findings consistant with multinodular goiter- largest found mid left lobe, complex predominantly solid measures 5.9 x 4.6 x 6.3cm. Left lobe measures 8.3 x 4.9 x 6.3 cm.

Right lobe measures 4.5 x 1.2 x 1.1 cm with at least 6 nodules solid and partially cystic, largest 7 mm.

One family member has history of Paplitory Thyroid Cancer.

Thyroid Blood tests normal. TSH, 3rd GEN. 1.11 - FREE T4 1.35 - Microsomal AB <10 - Thyroglobulin AB <20

Female approaching 40. I have always had hypo symptoms- with normal blood work. Symptoms= cold intolerance, fatigue, menstral irreg/infertility/probible PCOS, VERY high Cholestral (over 300) but low blood pressure, I suspect metabolic syndrome and insulin resistance- recent blood fasting glutose 101. BMI of 30 with abdominal fat/apple shaped. Can only lose weight with extreme carbohidrate moderation. Gain weight w/low calorie/high carb.

thyroid scan today- talking to the radiolist I am confused-- he asked about hypo symtoms -- presumably he will be looking for cold spots indicating this. I said have always had hypo symptoms but blood test results always normal. He said it was possible that I was hypo and that blood results don't always tell the truth. WHAT? How? Why was I never given a thyriod scan before with my symptoms?

And the second part of my question is of corse I am worried-- seems like the ultrasound results suggest cancer? How common is a benign growth of this size? I just found the lump, hence all the testing but have noticed respitory probs in the last 8 months or so- esp. laying down and yawns

[utahmomma]

Don't be worried or confused, you've got lots of help here.

I'm not the expert on labs but I'm sure GravesLady will answer that for you.

Your nodules do sound quite large however size doesn't really matter - it's what the nodules contain.  What may be a bit more concerning is the fact they are "predominantly solid" and "solid and partially cystic".  After reading what I could find it was because the nodule was "mixed" or "complex" that I decided to have removed.  I had completely normal labs too.

You said you have a family member with papillary carcinoma.  How close to you?  Reason I'm asking is many endocrinologists have stated that there is no hereditary link in papillary carcinoma but 3 of my 4 sisters and I all had it.  We are in a research study right now to find a genetic marker.  While it may not readily be "hereditary" there are at least two families in this study who may have a genetic marker.

I'm not trying to scare you but it is obviously something on your mind since you brought it up.  What is your "gut level" feeling about your thyroid problems?

Is your endo suggesting a biopsy?

[GravesLady]

The radiologist is probably doing the scan due to your nodules. However, thyroid scan can provide information on the size and shape of the thyroid gland as well as the overall activity of the gland whether the whole thyroid gland is overactive or underactive. The scan can determine whether inflammation of the thyroid gland (thyroiditis) is present and is probably why radiologist asked about your symptoms. It can also detect the presence and degree of overactivity of the gland (hyperthyroidism ).
Thyroid scanning is especially helpful in evaluating thyroid nodules, particularly after a fine needle aspiration biopsy has failed to provide a diagnosis. Thyroid scanning can be done to help determine if thyroid cancer has spread beyond the bed of the thyroid in the neck. For this purpose, usually a whole body thyroid scan is performed. A thyroid scan can provide information on both the structure as well as the function of the thyroid gland and this information can help you and your physician determine if further investigations, procedures, or medications may be worthwhile.

Microsomal AB <10 - Hashimoto’s have positive anti-thyroid antibodies.
Thyroglobulin AB <20 - Almost all patients with Hashimoto’s hypothyroidism have high titers.
However lower titers such as 20 are common in patients with other thyroid disease.
For me to comment on your levels I would need to know what your F/T-3 level was at the same time your TSH and FT-4 were done. However I am not a docrtor and it would be just my opinion.
TSH is exclusive in relating hypothyroidism or hyperthyroidism and the FTs on how they relate to each other as to thyroid issues such as Hashi, Graves', etc.  If you are not on thyroid hormone supplements, your TSH and FT-4 does not relate to hypothyroidism, although the scan might state otherwise.  Thyroid symptoms are so nonspecific that they share many of the same symptoms with other health conditions.

I think you might have something with your theory of metabolic syndrome and insulin resistance and I would suggest to medically follow through with them.  Also keep checking thyroid level(s) periodically for you can eventually become thyroid. However, symptoms without Labs confirming, does not conclude thyroid illness.

Good luck with all your test and all the doctrors, sounds like you are going to be pretty busy.

[worried§confused]

F/T-3 level? Don't think that was done in the comprehensive metabolic panel. Looks like as far as the thyroid levels go, just the 4 that I mentioned was taken. They were done at the same time. All the other numbers looked fine or borderline-- sodium was borderline high at 144 which from what I read could be from simple dehydration. Neutrophils was borderline high at 68.1% and Lymphocytes was borderline low at 23.1%.

I assumed Hashimoto’s would be ruled out as my TSH was normal- but now am reading that sometimes it reads normal? Graveslady, you went over my head with the "Microsomal AB <10 - Hashimoto’s have positive anti-thyroid antibodies." So... my score says I don't have positive anti-thyroid antibodies? They are just numbers to me ;-)

Also Graveslady, the comment... "symptoms without Labs confirming, does not conclude thyroid illness." Can you elaborate? I am assuming since I have this monster 6.3 cm nodule in my thyroid that it is thyroid illness... are you suggesting that perhaps due to my *normal* TSH and labs that the nodule was caused by other means such as my apparent metabolic syndrome symptoms?

As far as my "gut feelings"-- before my labs came back normal I thought- finally!! an answer to my hypo symptoms with the thyroid lump, I was SURE my TSH would be high. Now I am just worried and confused and don't know what to think. Also, the family member was not closely related- an uncle.

[GravesLady]

Microsomal AB only needs to be present/positive in the blood for Hashi,  you have a 10 which show that  Hashimoto’s Microsomal AB are present/positive in your blood.  This means that if Labs are normal now, some where in time they will show Hypo/Hashi and you'll need to be treated with meds. However if you have thyroid surgically removed due to nodules, it won't matter because you will need to be on meds and monitored by Labs anyway.  A thyroid scan can show hypo or hyper and thyroiditis, etc.

People can have thyroid nodules with out having thyroid disease, that is with normal healthy thyroids. Most people who have them don't even know it - I believe it is about 50 % of the  world's population. There are many causes for nodules, three being Hashi, Graves' and iodine deficiency.
Normally Labs are in the normal range. Most nodules do not have symptoms. However depending  on the size of the nodule, symptoms may include difficulty swallowing, shortness of breath, and voice changes (hoarseness).  An enlarged thyroid can also press on your windpipe or your esophagus, which may make you cough, have a hoarse voice, feel shortness of breath, feel like you don't want to wear turtlenecks or neckties, feel fullness in your neck, experience choking or shortness of breath at night, or feel like food is getting stuck in your throat. Pain is uncommon.

Some thyroid symptoms are shared by other health conditions - too many to list ( Lupus, Multiple Sclerosis, Raynaud's Phenomenon, Celiac Disease, Addison's Disease, Cushing's Disease,  menopause, etc.).  Even hypothyroid and hyperthyroid share some.  So that is why Labs need to back up and confirm the symptoms for initial diagnose.  I am sure you wouldn't want to be treated for thyroid by symptoms alone, when your condition might be something else. Once confirmed with thyroid, doctor will or should take into consideration symptoms with treatment, along with Labs.

I hope I answered your questions.

  

[worried§confused]

Sorry Graveslady... don't mean to be beating a dead horse but want to make sure I completely understand this issue.

Regarding Hashi: So, from what you are saying and what I am reading on more reseach... as long as I am positive on Microsomal AB then it could be Hashi even though my TSH is normal.

This is where my confusion comes in... my lab reports on the AB's read *normal* as long as it is less than 35 (<35) for Microsomal AB. I was told mine is normal at <10. And less than 40 (<40) on Thyroglobulin AB. Mine is <20. Which is also normal. So, am I understanding that most results in healthy people come back as NO antibodies or a score of zero?? Then why would <40 be normal or okay? and so if you have some as I do then it can be considered Hashi?

Could Hashi be why I have borderline high Neutrophils at 68.1% and borderline low Lymphocytes at 23.1% Doctor wasn't even concerned enough on these readings to address them.

If I am understanding this correctly then it looks as though Hashi may be MY problem for my rather large goiter as from what I am reading it can be evident in some patients that are clinically euthyroid, such as myself.

So... to beat that dead horse again ;-)Copying & Pasteing this... I have satified this... "Laboratory findings  
Positive for anti-thyroid microsomal antibody or anti-thyroid peroxidase(TPO) antibody. Positive for anti-thyroglobulin antibody"
Correct?

My other question is in relation to this... "A patient is possible to have Hashimoto's thyroiditis if hypoechroic and/or inhomogeneous pattern is observed in thyroid ultrasonography."

I can't find a definition of hypoechroic or inhomogeneous pattern and it doesn't mention these terms in my ultrasound report. What does this mean? From reading my reults in my original post does it appear I have this?

I sooooo appreciate your time and patience. I live in a rural area and suspect that I am being sent to a ear, nose and throat specialist because there are no Endos. in the area. I have an appt. Monday and want to be armed with good information so I won't get blown off. I am thinking that perhaps it is Hashi even though my regular doc ruled it out. Your thoughts on my Hashi diagnosis?

[GravesLady]

I am quite fatigued today with lack of concentration, so I am going to subtitle with links for a fast resolution - hope they help.

Autoimmune type II hypersensitivity reactions are evoked by antibodies in the host directed against his own cell or tissue antigens (autoantibodies). As an example may serve autoimmune haemolytic anaemia caused by autoantibodies to the patient's own red cells; Hashimoto's thyroiditis with autoantibodies against thyroid peroxidase surface antigen; idiopathic thrombocytopenic purpura manifest by platelet destruction evoked by anti-platelet antibodies; Goodpasture's syndrome in which complement-mediated damage to basement membrane due to specific autoantibodies is observed.
http://nic.sav.sk/logos/books/scientific/node41.html
http://en.wikipedia.org/wiki/Autoantibody
http://www.medicinenet.com/neutropenia/article.htm

Atrophic hypothyroidism is caused by microsomal autoantibodies in the thyroid. The hypersensitivity reactions result in thyroid atrophy and hypothyroidism (Chapter 28).
Hashimoto's thyroiditis is caused by other microsomal autoantibodies. The inflammatory reaction produces goitre (struma) with or without hypothyroidism.
Graves's or Basedow's disease is hyperthyroidism combined with eye signs (exophtalmus). Normally, the thyroid stimulating hormone (TSH) increases the thyroid hormone production after its binding to the thyroid TSH receptors. Bacterial infection in a genetically susceptible person may be the cause of autoimmune production of the TSH-receptor antibodies. These IgG -antibodies behave exactly like TSH itself, and thus stimulate the thyroid hormone production (Chapter 28). Retroorbital swelling and damage of the extraocular muscles cause the thyroid eye disease from specific antibodies.
http://www.mfi.ku.dk/ppaulev/chapter32/Chapter%2032.htm

Presence of specific antibodies against thyroglobulin (TG) and thyroid peroxidase (TPO). Presence of these antibodies is not enough for a diagnosis of Hashimoto’s thyroiditis, since 10 percent of women in the population have these antibodies.
http://autoimmune.pathology.jhmi.edu/diseases.cfm?systemID=3&DiseaseID=22

The immune system protects the body from potentially harmful substances (antigens) such as microorganisms, toxins, cancer cells, and foreign blood or tissues from another person or species. Antigens are destroyed by the immune response, which includes production of antibodies (molecules that attach to the antigen and make it more susceptible to destruction) and sensitized lymphocytes (specialized white blood cells that recognize and destroy particular antigens).
http://www.nlm.nih.gov/medlineplus/ency/article/000816.htm

Guideline for the diagnosis of Hashimoto's thyroiditis (Chronic thyroiditis)
Clinical findings Diffuse swelling of the thyroid gland without any other cause (such as Graves' disease)
Laboratory findings  
Positive for anti-thyroid microsomal antibody or anti-thyroid peroxidase(TPO) antibody  
Positive for anti-thyroglobulin antibody  
Lymphocytic infiltration in the thyroid gland confirmed with cytological examination

A patient shall be said to have Hashimoto's thyroiditis if he/she has satisfied clinical criterion and any one laboratory criterion:
A patients shall be suspected to have Hashimoto's thyroiditis, if he/she has primary hypothyroidism without any other cause to induce hypothyroidism.
A patient shall be suspected to have Hashimoto's thyroiditis, if he/she has anti-thyroid microsomal antibody and/or anti-thyroglobulin antibody without thyroid dysfunction nor goiter formation.*
If a patient with thyroid neoplasm has anti-thyroid antibody by chance, he or she should be considered to have Hashimoto's thyroiditis.
A patient is possible to have Hashimoto's thyroiditis if hypoechroic and/or inhomogeneous pattern is observed in thyroid ultrasonography.  
* Some clinicians don't use the term Hashimoto's thyroiditis if patients have no goiter, although association of positive antibodies and lymphocytic infiltration in the thyroid gland was proved by histological examination.
http://www.thyroidmanager.org/Chapter8/8__diagnosis.htm

[mommaboy]

Hello,

I'm new to this site, but I have a question that I hope someone will have some information on.  My son (17) was dx with coccidiomycosis in Feb '06.  He developed a goiter in the right thyroid that was bx and found to have cocci in it.  The goiter is now 3.4 x 4.1 x 1.7cm in size.  A recent ultrasound showed the thyroid to be very nodular.  Does anyone have any info on teenagers having thyroidectomies?  He is scheduled to have lab work done to assess the thyroids function.  Previous labs showed normal function.

Thanks

[utahmomma]

You need to start a new thread with a new subject line so everyone can see your question and respond to it.  My daughter had hers out when she was 16 and I'll give you more info on your new thread.

[GravesLady]

14 year old young lady's Graves' Disease and surgery story
http://www.thyroid.org.au/Stories/Graves14.html

Thyroid surgery in children and teenagers.  PubMed
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=901283&dopt=Abstract

Thyroid surgery in children and teenagers
http://archotol.ama-assn.org/cgi/content/abstract/103/9/544

Pediatric Thyroid Malignancies
http://www.bcm.edu/oto/grand/9894.html

Good luck to the both of you.  If you need more, just ask.

[Proavtive]

I just had a 4.6 cm nodule removed along with my entire thyroid  one week ago.  I also had (2) smaller 1cm nodules on the other side of my thyroid.  I had normal blood tests, and the only symptom was not being able to loose weight, mood swings, and fatigue.  I am 42 yrs. old with three kids and a full time job, so I blamed alot of my stress on that.  I had a biopsy twice, first time came back benign, year later, questionable, this year I opted to take it out thanks to a proactive and new thyroid doctor.  I appears that I do in fact have follicular thyroid cancer at the VERY begining stages, the malignancy is so small, only 2mm.  Has not invaded any blood tissue yet and my prognosis is very good.  I have to take a radioactive iodine pill and can't be around people for three days, then for at least 20 days no work...I was looking for some time off!  It made me realize to follow up, if you have not had it biopsied, do it.  Good luck.  I know how stressful it all is.

[kipland]

I just had my thyroid removed a week ago as well!!  And although my nodule was a bit smaller than yours, my story is identical to yours.  I went into the doc initially for depression, but I knew it went much deeper than that.  Thank God she ran the right tests, because my TSH, T3 and T4 were all within normal range.  I had the antibodies, though - so they thought it was Hashimotos.  This was back in February and all I knew about my thyroid was that it controlled my metabolism.  I always thought it was messed up, because I've struggled so much with my weight.  Thank goodness you also had a doc that was on it!!!

I have a question for you.  I was also told I have to do the RAI treatment, but know very little about it.  They said the nuclear med folks would contact me to get it scheduled, but that it would be 4 to 6 weeks after surgery.  Is that pretty normal to be isolated for 3 days, then 20 days off work??  If so, I really need to let my work know as soon as possible.  Wow, this really IS a rollercoaster ride.

Keep me posted, because it sounds like you and I are going to be doing this around the same time!!

Lori