Multinodular Goiter

[2themoon]

Dear Dr.,
I recently went to my primary care physician with complaints of extreme fatigue and weight gain, higher bp than normal, palpitations, and anxiety. Labs were run and after 4 rounds of labs it seems that each time my T3, T3 free, T4 free are all normal, but my TSH is extremely low, with the last round being at 0.0008 (the time before that it was at 0.0023). I had an uptake and scan done which revealed multinodular goiter, at which point I was referred to an endocrinologist. I am scheduled for a 2nd scan before I meet with him. I've been doing some research, trying to determine if I should be concerned or not, and trying to educate myself before I go in there and prepare myself with what I need to know and ask. Can you please offer any advice or suggestions? I'm very concerned as my symptoms don't seem to match the labs/scan. Thank you!

[Mark Lupo, M.D.]

You appear to have toxic nodular goiter - this causes hyperthyroidism (low TSH) - in your case it is "subclinical" or mild as the T4 and T3 and normal still.  However it can cause high BP, palpitations and anxiety and should be treated.

Options for treatment include radioactive iodine or surgery.

First it is important to compare the I-123 scan to the ultrasound to see if any nodule that is not uniquely "hot" requires FNA biopsy.

[2themoon]

Thank you very much for your insight into this problem! This was very helpful and gives me something to research further as a starting point.