Dr LUPO can I please get your opinion........

[vicky841]

Dear Dr Lupo;
I am a 22 year old male have upper and lower gastric problems and severe insulin resistance but no diabetes yet and am Obese. I have gained a lot of weight since sixteen years of age...due to the insulin resistance I guess..around when I was seventeen to eighteen I started getting a high TSH like highest was 6.85 ..but always normal t3 and t4 levels and normal thyroid peroxidase and thyroglobin antibodies...I was put on various..levels of synthroid took that for about two and a half years and TSH was normalized but never low than 3.10...I had my first ultrasound in nov 2011 which revealed multiple subcentimeter  thyroid nodules up to 0.5 mm in size...after that I was put off the synthroid and my TSH has been testing normal ever since...fast forward had another ultrasound nov 2013 which revealed no nodules no cysts or growths but enlarged left and right thyroid lobes.. This year I have gained and lost the same twenty pounds due to a gastric condition but other than that it has always been impossible for me to loose weight.

THYORID ULTRASOUND NOV, 2011

RIGHT LOBE: 5.5 X 1.4 X 1.7 CM.
LEFT LOBE:  4.6 X 1.4 X 1.9 CM.
THYROID ISTHMUS: 2mm
FINDINGS: There are multiple subcentimeter nodules upto 5mm in size, right more than left.
IMPRESSION: Bilateral subcentimeter nodules...

CURRENT THYROID LEVELS:
TSH: 2.61 mIU/ml
FreeT4: 1.6 ng/dl

THYROID ULTRASOUND NOV 2013
Findings; THE RIGHT LOBE IS ENLARGED AT : 4.5 X 1.3 X 2.1 CM
              THE LEFT LOBE IS ENLARGED AT: 4.2  X 1.1 X 1.5 CM
               THE ISTHMUS MEASURES: 4mm
The Thyroid gland demonstrates no evidence of solid or cystic mass or lesion. No mass effect on the airway.
The surrounding musculature, soft tissues and visualized bilateral carotid vessels appear symmetrical. No hypervascularization is identified.

I have a large round fatty neck with pressure in the throat area and face appears bloated and chubby.

[vicky841]

Dear dr lupo thanks for the response ive had multiple testing for cushings such as urine saliva and blood cortisol even 24 hr urine several times...my question is has my thyroid shrunk or is it still large and requires treatment?

[Mark Lupo, M.D.]

Thyroid status (current labs and US) are normal appearing based on what you describe.  Would consider testing for Cushings (excess cortisol production) but insulin resistance may be the root cause problem.