Multinodular Thyroid

[TJB54]

Dr. Lupo:  I recently had US of thyroid showing a 4mm hypoechoic nodule with multiple cysts.  My TPOab, TSH, Free T4, T3, etc are in normal range. Cortrosyn stimulation test was normal.  My 24hr Urine test for Iodine was in severly deficient range last Feb'07 thru FFP Lab. Recently I redid it but had it done thru Quest Lab and came back in normal range, but doesn't appear to have been stated as using saturation and loading levels like the previous one did.  I am suffering with numerous symptoms such as: 19 food allergies, environmental & chemical allergies/sensitivities; rashes; I have allergic reaction when I am in the sun for only 5 min. (2 and 3 years ago I was negative for ANA test); have neurotransmitters out of balance: low in seratonin, GABA and epinephrine; high in histamines, agmatine and norepinephrine. I have had cysts in many parts of my body, cyst removed from my ear lobe, my back; I have a fibroid on my uterus and a cyst on each ovary; currently have a ganglion cyst on my left wrist in addition to the thyroid cysts and nodule.  I have been suffering from every symptom of hypothyroid except for weight gain (I am extremely thin and got even thinner when I had to eliminate the 19 allergic foods from my diet.  In addition to the commom symptoms like intolerance to cold, constipation, etc I also have low blood pressure, low blood volume, high cholesterol, and my cells do not properly hydrate. The skin on my face and neck looks worse than the rest of my body. I have rapid aging in that area. Skin has tissue paper effect, is sagging & texture is rough & sandpapery feeling.  I get lots of keratoses, esp. on face and neck.  I have had aprox. 5 basal cell carcinomas removed and several keratoses burned or frozen. Dad has skin problems; Mom had hyperthyroid, goiter and thyroid removed at age 30.  My dr. doesn't know what else to do except redo US in 7 mos. If I were your patient, what else can you think of to do or what would you suspect?  Thanks  TJB  

[scherm]

Thank you for this forum.

I have been diagnosed with a multi-nodular growth in my thyroid, the largest being 2.5 cm. According to my doctor, my thyroid levels are "within the normal range". I had a biopsy, which came back as a "follicular lesion - probably not cancerous".
In recent months, I have developed a hacking cough.  A wheeze develops in my windpipe when I exert myself and I tire very easily. In the morning, there is blood in my sputum.  My lungs are clear according to xray.
I also have a low tolerance for alchohol or high-sugar drinks -- they leave a strange sensation of pressure in my chest and back. My weight is steady. My hair is healthy.
Are any of these things related? My family doctor has a "wait and see" approach, but nothing seems to be getting better -- I've had these symptoms for 2 months, and I don't know where to turn now. Can you give me any recommendations?

[Mark Lupo, M.D.]

The 4mm nodule does not require biopsy and a repeat ultrasound should be done -- 6-12 months is a reasonable time frame for the followup.  These nodules/cysts are very common (about 50% of people have them on US evalution) - only 5-10% are cancer.  With the normal thyroid levels and no significant thyroid nodule, it appears the thyroid is not contributing to current overall symptoms.  You've had the test for adrenal insufficiency.  Would consider an autoimmune (rheumatology) evalution - but work with your internist to figure out the next step.