slightly enlarged thyroid? (with nodule)

[tiredpoet]

35y/o female with large family history of thyroid disease:
My thyroid feels larger to me - I know I have no way of knowing this for certain, but I can say for absolute certain that my neck feels "thick" and I can see my thyroid now when I swallow, where I never could before.  I feel like something is in my neck, and I keep getting this annoying "fluttering" feeling on the right side of my neck that is like a deep tickle.  I have no idea why.

I have severe fatigue and trouble concentrating, frequent skin problems such as rashes, acne and dry skin, recent unexplained weight gain of about 10 lbs that I can't lose (but still normal weight, BMI now 20.77), big problem with water retention, extremely sensitive to cold, etc. TSH at last test was normal at 1.17.  I had an u/s and my doctor sent me a letter saying my thyroid is perfectly normal and did not advise any follow up.

I requested a copy of the u/s report, and it says it is not enlarged.  The right lobe is 5.1 cm in length and the left is 4.5.  Is this normal thyroid size?  And if there's no previous u/s to compare is it possible it is "enlarged" but just not abnormally large?  Another thing, it says the thyroid isthmus is 3mm in diameter.  Is this normal?  It seems awfully small and I'm wondering if it's a typo.

Also, they never even told me, but I just read on the report that there was a 5 x 7 x 7mm nodule in the lower right pole.  it is described as isoechoic and says some internal vascularity and microcalcifications present but not significant.
I would think my doctor should have mentioned this to me as well, but that's another issue.  Does my thyroid, particularly the right side, sound normal despite my symptoms, or should I consider further evaluation?

[Mark Lupo, M.D.]

the right is at the upper limits of normal - so yes, just borderline enlarged.

[Mark Lupo, M.D.]

The size seems normal, 3mm is normal for isthmus thickness.  Based on this it seems to be a normal sized thyroid.  We usually measure the lobes in 3 dimensions, not just the length....

The small nodule needs ultrasound follow-up in 6 months to ensure it has not increased in size.  The characteristics (microcalcifications and increased blood flow) may be suspicious, but the size is relatively small.

The TSH is normal, so you don't need meds.  It is not uncommon for doctors to assume the whole thyroid is normal if the TSH is normal.  This is not the case -- one can have goiter, nodules, cancer, autoimmune thyroid disease.....all with a normal TSH.

[tiredpoet]

Thank you for the response.  The thyroid measurements are actually:
right: 5.1 x 1.9 x 1.6
left: 4.5 x 1.2 x 1.4

The right side is where it feels as though it's gotten larger, and this is where I often feel that annoying "flutter" in my neck.  This u/s was done 6 months ago and I feel that it's gotten larger even since then.  I am going to request another u/s, but based on those measurements does the right side seem like it could be just slightly enlarged?

Thanks!