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TSH and Free-T-4 level interpretation with enlarged thyroid and nodules

Hello there, so I went an had an U/S done of my thyroid and the person who performed it was a Dr. He told me that my thyroid itself was enlarged, I had 2, 1cm nodules on the left and one 2cm nodule on the right. He also said that I had a lymph node on the left as well. Long story short, I am stationed with my spouse in Germany, and the test was done at an office in the German economy. So, the report was in German, and a little in English. I am being told I will need to wait 2 weeks for the report to be translated. In the meantime my TSH is 2.94 and my Free T-4 was 7.1. I had told my Dr. that I am having a hard time swallowing, choking in the night and am losing my voice throughout the day. He now wants to refer me to an otolaryngologist. I already have a referral for the rheumatologist (I had a positive ANA), an MRI of the brain, and a cardiologist. I was thinking all of this difficulty with swallowing and what not was more than likely a result of the enlarged thyroid and nodules. I really don't want another referral if I can help it. My Dr. who is wanting to send me to the otolaryngologist hasn't seen my report yet, though I did tell him of the findings that the other Dr. spoke of. I know he needs to see if for himself, I was just wondering if I should sit and wait around for the report before making any other appointments. Thanks everyone!
2 Responses
1530171 tn?1448129593
Hi Marilyn.
I mentioned the possibility of low thyroid function already, when I answered your question in November.
You could have Hashimoto's indeed, according to your most recent findings.
It is Autoimmune Thryroiditis and this would explain some of your results, including the positive ANA (what was the exact titre?) and the U/S.
Could you post lab reference values and units of measure, since the numbers you supplied are not enough to discern anything conclusive, since European Labs use different values.
Your tests also are inadequate for proper evaluation of thyroid function and to rule out hashimotos.
I suggest you look into additional testing: Free T3, Reverse T3, TPO Antibodies and TG Antibodies.
I good endocrinologist would be the specialist to see for this.
And the earlier the better! Pls don't delay it!
Best wishes,
Oh yes, sorry about that, I will post the values. I live in Europe, but get my care at a US Army treatment facility, so I am not sure if the reference ranges are catered to Europe or America. Good question!

Here is the labs and the values...

TEST          Result          Units          Reference Range

Thyroxine      7.1            mcg/dL                4.5-12.0

Thyroptin       2.94          mcIU/mL           (0.36-3.72)
Oh and I now have a referral for an endocrinologist and otolaryngologist. I am not sure if both are necessary to see at this point in time. I am waiting to hear back from my doctor. Thank you for all of your help.
Oh, and my ANA results with ranges are as follows:

SS-A Ab 141 Higher Than Normal AU/mL  (0-120)  
1530171 tn?1448129593
Hi Marilyn.
Thx for posting the lab ranges with units of measure.
iI doesn't matter which country they're done at,
it's usually the units of measure that differ, bearing in mind though that ref. values also may vary from lab to lab.
Well in regards to thyroid, I can't discern anything useful,
however, pls ask the Endo (and insist) for the tests I mentioned.
Anti-Ro/SSA are antibodies found mostly in people with systemic lupus &  Sjogren's syndrome.
For hashimoto's you need the TPO and TG antibodies.
The  otolaryngologist appointment is a bit of an overkill at this point. The Endo can detect an enlarged thyroid and should this be ruled out along with low thyroid function/hashimoto's, then other investigations can ensue.
Cheers and best wishes for a happy holiday season!
Well, the translated report came back and my doctor now wants me to have a thyroid scan. This is what the report says;

"The ultrasound examination showed mildly enlarged thyroid parenchyma. Right caudal 1.1 x 0.8,left centro-caudal as well as left caudal 0.9cm in size hypoechoic focal findings. Left-sided,normal sized, submandibular lymph nodes with the size of 0.7 x 0.4cm. Enlarged thyroid gland with nodes grade 1 with bilateral nodular changes. Recommended thyroid function scintigraphy for further clarification. As secondary findings the localized, normal sized, left-sided submandibular lymph node was seen, which is probably a post-inflammatory reaction to of the lymph node. "

Of course it was a nurse calling me, so any questions I had weren't able to be answered. I was just wondering if you had any insight on what you may make of this? You have been so helpful.

Thank you~!
The findings are far from conclusive, being grade 1 nodes and mild abnormalities.
Further testing as suggested is the normal course of action.

I'm not sure how thermography is viewed in Germany, but my opinion is that is it an excellent diagnostic tool,
predictive of serious disease.
My own opinion is that thermography
is presenting a challenge to the conventional medical system, which explains the sudden negative news and propaganda, regarding thermography!
The procedure involves the measurement of 119 specific points on the body by a highly sensitive temperature probe. The points measured are actually visceral cutaneous reflexes  where the organs actually reflex out to the skin . It is painless, non-invasive and does not involve any compression, radiation, or dyes. After the first set of points is taken, the patient undresses except for underwear ( men should wear loose boxer shorts or loose bathing trunks ). The patient then stands for 10 minutes in the slightly chilled room, and then the full 119 points are measured again.

The reason for the 2 sets of measurements is to see if the body is able to regulate properly to the cold challenge.  The exposure to the cold air puts the Autonomic Nervous System under stress and the second measurement will indicate if the different parts of the body are regulating properly or not as a result. A healthy body will show a specific temperature pattern. There are 3 types of regulation patterns : normal, rigid or blocked, hypo ( excessive cooling ) and hyper ( excessive heating ).

If the different parts of the body do not regulate in the expected normal patterns, then it indicates a disease process starting. This could be from inflammation, degeneration or a blockage such as found in cancerous terrain. This disease process starts as a functional disturbance which means that the area is not functioning properly. This is a very early warning system because it shows areas of disturbed function before there is structural damage.
--Source: ochtherm.ca--

Should this be available in germany, I would recommend you give it some consideration.

Best wishes,
Thank you so much for your detailed response! I am definitely looking into it. I was just wondering why my doctor went this route...seems standard from what I have read that most get a FNA after a positive ultrasound. And do you think these results will yield only negative results? I have read with an enlarged thyroid,it is often Hashimotos?! Thank you!
It can go either way, hyper or hypo, but in your case it's pointing towards Hashimoto's ( A/I thyroiditis).
The scintigraphy may be the proffered imaging to check the functioning and assessment of the thyroid tissue, in Europe, exposing the patient only to low radiation.
In the USA FNA , which is a micro-biopsy of thyroid tissue- seems to be a common diagnostic procedure, albeit more invasive in the event it disturbs potentially malignant tissue.
You're welcome!
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