Ultrasound help understanding?

[Nat_2010]

6 month follow up on nodules a little confused???  I do have hashimotos and am very hypothyroid

Findings: The thyroid gland is very heterogeneous in echo texture which makes evaluation for nodules difficult.
Right lobe:
Size:5.2x1.5x1.8cm
Nodules: The right lobe of the thryroid gland is very lobulated and very heterogeneous in echotexure. There is a hypoechoic mass in the midpole of the right lope measuring 5x4x4mm.A bright echo seen in the inferior pole measures 2mm in size.

Left Lobe: Size 3.7x1.0x1.0cm
Nodules: A small bright echo in the midpole left lobe thyroid gland measures 2mm in size ans may repesent an intranglandular calcification. A hypoechoic nodule inferior to the gland measures 7x5x5 mm and probably represents a small lymph node or parathyroid gland.

ISTHMUS: Mildly thickened measuring 4mm thickness

Impression;
Very heterogeneous thyroid echotexture with tiny abnormalities in the thyroid gland.The nodule seen inferior to the left lobe on the current examination was not seen previously and may represent a lymp node or parathyroid gland!!!!


Had some lab work come back today tsh again is not gone down never been normal in the last 6 months 24.67 and my vit. d is low  please help me understand ultrasound

[Nat_2010]

they have never gotten my tsh below 26 and it bounce all over the place i have gone as high as 150..IM currently on 350 levothyroxine....my calcuim suns 9.8, 9.6, 9.9 ans last time it was ran 9.6 i did have high pth once 87 and now is is 23 so im not sure what is going on? Why would me pth be low but calcuim a little high and vitiman low? What is the next step

[Nat_2010]

I do have hashimtos auto immune would this be causing the problem? And I have had one doc tell that the best thing would be to take my thyroid out because it is dead. Do u believe that to be true?
Thanks for ur time

[Mark Lupo, M.D.]

would screen for malabsorption of nutrients/medication - celiac sprue (gluten sensitivity, also an autoimmune problem) being the most common - ask your doctor about this.

[Mark Lupo, M.D.]

This is most consistent with hashimoto's and pseudonodularity along with normal "reactive" lymph nodes adjacent to the gland.

would look at calcium level though -- if it is in the upper end of normal or high, then this could be a parathyroid problem (given low Vit D) in which case would test PTH (if calcium is for example >9.5).

TSH goal is about 0.5-2.5