What does this mean?

[Anniegirl56]

I have had a goiter which I was told is diffuse since last June.  I had bloodwork done at the same time and was told that it was all normal and nothing to worry about.  I am always tired but can't sleep through the night, I can't lose weight, very irritable, and I forget so many things that it is embarrassing.  Also, I have very slight pain in my ears just above my throat and it feels like someone has their hand on my throat all of the time.  I went back to the doctor and my thyroid has gone from 4.6 on both sides to 5.9 and my TSH levels are on the low normal side at 3.4 but my T3 and T4 are all still normal.  My doctor put me on Synthroid for three months to see if my thyroid goes down.  Also, as a side note, my sister has had half of her thyroid removed due to nodules.  I have also had alot of x-ray contrasts done the previous year due to staghorn kidney stone surgery(ies).  Would this have an effect on my thyroid and what does all of this mean?  Do I have hyperthyroidism or hypothyroidism or anything at all.  I'm very confused because of the weight gain and the treatment seems contradictory.  Any help would be great as I don't know what to make of it or what caused all of this.

[Mark Lupo, M.D.]

The imaging for the stones will not affect thyroid.  The TSH is borderline -- measuring the length of the thyroid can be tough, so would not read too much into the difference on ultrasound (assuming the 4.6 to 5.9 was the length in centimeters of the thyroid on ultrasound measurement).  You likely have hashimoto's -- would see if thyroid antibodies (TPO-antibody) is high to confirm this.  Treatment with synthroid is reasonable if that is the case.  The initial TSH of 3.4 itself does not mandate treatment, so if there is no definite benefit, would discontinue.

[Anniegirl56]

Dr. Lupo,
Sorry, to bother you again, but I am starting to have pain on my right side of my thyroid.  I have had this goiter for a while and aside from it growing and a little ear pain, I haven't hurt in my neck before.  Is this normal while being on Synthroid?  I am just wondering if something else is going on with it as I didn't think I had been on the meds (one week today) long enough for there to be any changes.  Should I just give it time or should I call the doctor about it?