Not sure about results

[Susan615]

  I have been struggling with TSH levels all over the place.  Then in Nov. I was told I had one nodule.  We did the "wait and see" and now I am told I have more nodules but he seemed really confused about the ultrasound.
  I am showing my lab results below.  I was told last visit that I have had hashi for 30 years.  Ultra sound says my right lobe looks like it has been operated on, but it hasn't.  Left lobe is enlarged with the nodules (cysts).  You can actually see a slight bump on the left side.   I feel bad.  Really tired, also had mono (I am 48 how did I get that??)  Never had any kind of scan or biopsy, just the ultra sound.  This all started when I was 18 and had a goiter.  I was treated with iodine but I don't remember all the details.  All was fine until recently.  Is this just part of having thyrpoid problems or is there something else going on?

Dec. 2008-TSH 66.00 no ranges were given to me and no other tests.  My meds INCREASED by .025

Oct. 2009-TSH 1.22 (again no ranges) T3 89 (no ranges), T4 2.1 (no ranges).  Told I am finally normal!

Dec. 2009-TSH .19 ( again no ranges given to me) no other tests done.  My meds LOWERED by .025

Jan. 2010 TSH .126 (range .450-4.50).  My meds lowered by .025 again. My  Calcium Serum 10.3 (high in range is 10.2)

Last week-TSH .0050 (range .450-4.500), T4 Free 2.44 (range .82-1.77), ionized calcium 5.7 (range 4.5-5.6) meds LOWERED again by .025.

Cystic nodule goiter-Hashimoto's
Feel terrible.  Told "in 6 weeks you will feel all better".  He said that last time!  Am I just overmedicated?  Do the nodules need more investigation?
Thanks!!

[meomystory]

A related discussion, MIX & MATCH DX's  :-/ was started.

[Susan615]

Thank you for your reply.  It has been 6 weeks since my lasts tests.  I had labs again and TSH is now .0180.  My FT4 is not back yet and they did not do a calcium test this time.  I have an appointment next week.  What should I ask?  What should be the next course of action?  How long before the nodules should be checked again.  I still do not feel well at all.  Should I ask about the PTH being checked?  I would like that, as you suggest, and I think it would make me feel better to have the nodules biopsied since that is what the ENT reccomended back in Nov.  My job is stressful and now that is all I can do, is work.  Doing anything extra is really difficult.  Thanks for any advice on what to ask at my next appointment.

[Mark Lupo, M.D.]

The last TSH of 0.005 suggest you are getting too much medication OR your thyroid is beginning to make excess thyroid hormone on its own ("hashitoxicosis").  In these cases we lower the thyroid meds (to the point of discontinuing) to see what the thyroid impact is.

The calcium is a bit high - check parathyroid hormone (PTH).

Would consider FNA biopsy of the thyroid nodule(s).