thyroid nodules

[huffy110]

I have had joint pain particually the wrists, shoulder and hips on and off for a couple of years. I also get bouts of overwhelming fatigue. I also get depression, racing heart rate, and hot flashes. My skin is very dry and my hair is dry. I also have had swelling of the left neck area. Ct scan revealed throid nodules.  I have an elevated sed. rate and slightly elevated ana. My tsh levels have been checked a few time and come back normal. Can thyroid nodules cause hypothyroidism symptons even though tsh levels are normal or could this be something else?

[MANmom]

Yes  !I was having symptoms similar to yours, pain in my elbows, tired, night sweats, hot and cold, blood pressure elevated,  but I also had some swallowing issues and hoarseness.  I had three nodules on the right, one on the left.  Two weeks ago I had the right side out to 1) test for cancer and 2) try to relieve my hoarsenss (I am a singer).  They found cancer, so the other side is coming out...my thyroid hormones were all NORMAL except for the TPOab...thyroiperoxidase antibody.  That was positive and that can be an indication of cancer...it was in my case.  How big are the nodules?  Are they cystic, solid, or mixed? Mine were all solid, vascular, and round, and they were big, the largest was 2.1 cm and the one still in my left side is 1.4 cm...if they are over 1 cm, get a biopsy.  It is not always a sure bet, either...mine revealed only BENIGN follicular clusters, I still had cancer.  Keep after it, there is an answer, but you may have to go through a lot to get a final answer.

[goolarra]

Let me answer your question this way:  yes, you can still be hypothyroid even if your TSH comes back as "normal" (nodules or no nodules).

There are two reasons for this:

1) The old TSH reference range was 0.5-5.0.  Within the recent past, endocrinologists have adopted a new range, 0.3-3.0.  Many labs and many doctors still have not accepted this new range.  So, you have to get your actual TSH numbers to see if you really are normal.

2) TSH as a diagnostic tool, by itself, has also come under more recent scrutiny.  Without also testing the thyroid hormones free T3 (FT3) and free T4 (FT4), TSH testing alone leaves a lot of people untreated.

Nodules can complicate the situation.  Sometimes, they "leak" rather than secrete thyroid hormones into the bloodstream.  This happens in an uncontrolled manner and can lead to peaks and valleys in the hormone levels in the blood.

If I were you, I'd have my TSH repeated and get FT3 and FT4 at the same time.  Make sure you get your results (preferably printed) from the doctor.  The results will  also have the reference ranges that your lab uses for FT3 and FT4.  This is important because it varies from lab to lab.  Whenever you provide someone with your results, you have to include the reference range so they can interpret appropriately.

Since you know you have nodules, you might also get your thyroid antibodies tested.  These are TPOab and TGab.  They will tell you if you have the autoimmune disease, Hashimoto's thyroiditis (the most common cause of hypo in the US).  Nodules are common with Hashi's.

Beat your doctor up if you have to, but insist on further testing!  Good Luck!