symptoms, nodules, FNA, atypical follicular cells with neoplasm processes, breast cancer

[patti0265]

I had been having these medical problems for years  and was told I was pre menopausal. Excessive menstral bleeding, excessive weight gain, heart palpatations and anxiety and feelings of being anxious, serious fatigue with body aches and pains, feelings of depression with spurts of crying episodes, severe dry skin with scaley ugly patches of red sores, and dry brittle hair that is falling out. Hoarse scratchy voice.,,

I Told Dr, that my sister had hurthle cells,  I asked if I could have a scan done and a TSH with a T 3 and T 4 AND antibody test run.  He denied me the test and kept telling me I was depressed,  the OB GYN said it was pre menopause.   Finally,  I was given an ultrasound of neck with a TSH     Ultrasound found a 2.4 cm nodule on left  with multiple on right, TSH NORMAL
I asked for a T3 and a T4  and antibodies    he said he did not think my symptoms were from my thyroid  he did not think it was anything to worry about, HE  sent me to an ENT
ENT said he wanted to watch it,  I said  no,   the radiologist suggested an FNA and I just found out I had breast cancer,    I wanted a biopsy.  I asked him to give me the T3 T4  he said no..  THEY both said that because the TSH was normal    there was no need to check those
THE biopsy came back with atypical follicular cells with neoplasm processes

I finally got a doctor to run my T3 T4 and antibodies    the T3  was elevated      and antibodies were highly present...  T4 was normal          My doctor is still telling me that the thyroid does not cause these symptoms    
.
Am I  wrong? Does the thyroid problems cause these symptoms?   THANK YOU FOR HELPING ME..  

[Mark Lupo, M.D.]

You have been to many beautiful places!

The isolated elevated T3 is not likely clinically signficant (with normal TSH and T4).  Would retest as free T3.  The FNA should be sent for expert second opinion or repeated before any decision is made regarding the nodule.

[patti0265]

Thank you for your valuable time..   If you ever need any help in the office,   I want to come home:)   I 've been a sales rep for Stryker for the past 2 yrs..      hate the numbers game!!

[patti0265]

  Thank you very much.  I got an Endocrinologist to see me. He put me on .5 synthroid for 30 days then to .1 after,   and also on a low dose of cholesterol   med..  brother had heart attack at 48  mom had 2,  both have stents.. hereditary.
He said he will retest R T3  ?    some sort of T 3 Then.
I needed to know if I can medically say that those symptoms  I was and still have, That I can say were caused from thyroid..  
My doctor made me take time off of work  he was diagnosising me as depressed..    my short term denied it,   I am appealing it..     and sending in thyroid findings.      I was so weak and tired.        
I am a person who ran 7 miles every morning,   anna maria island.   went to the gym daily. worked full time and went to school full time,  surgical  and on-line classes for my RN.  
Made it to every little league game for my son except during exams..      I am not depressed,,   My doctor is a prescription doctor..      thats it.....

[patti0265]

Dear Sir,
I would like to thank you for your time and also for your reply.  In response to your follow up regarding the isolated T3 ,  most likely due to estrogen therapy. ie;  birth control,      I have not been on birth control for over 15 years. Or any other form of estrogen therapy.  

My ultrasound read
RT. lobe measuring 5.1 x 1.5 x 1.2 c.m.    rt. lobe diffusely inhomogenous the gland contains a single hypoechoic nodule  measuring 5x5x2 m.m.

The LFT.lobe measuring 5.6 x 1.9 x 1.1 c.m.  The entire gland is heterogeneous. There is a dominant nodule in the mid to lower portion measuring 2.1 x 1.7 x 0.8 c.m. Several smaller nodules are present elsewhere.

ISTHMUS-- There is a nodule in the right side of the isthmus measuring 7 x 6 x 2

findings= multinodular thyroid gland that is diffusely enlarged. Multiple small nodules are seen with one dominant nodule in left  mid lower lobe recommended for FNA
BIOPSY RESULTS====
THYROID LEFT- FNA-
ATYPICAL CYTOLOGY--
Rare clusters of epithelial cells  with enlarged nuclei, small nucleoli, and oval nuclear contours in the setting of variably - sized aggregates of follicular cells, abundant colloid, multinucleated histiocytes, mixed inflammatory cells and blood.

SEE COMMENT

Cell Block:  clusters of bland follicular eppithelial cells, colloid, and inflammatory cells present.
COMMENT===  The overall cytomorphologic picture is that of a benign thyroid nodule. HOWEVER,    There are rare clusters of epithelial cells with atypical nuclear features. A Neoplastic process cannot be completely excluded.  
BLOOD WORK---     T 3 --200.5
                                    TSH-1.33
                                    T 4---7.0
                                     THYROGLOBULIN -27.4
                                     CHOLESTEROL=230
blood work results on 9-30-2011     breast cancer surgery for DCIS estrogen and progesterin receptor positive was done on 10-4-2011 with a total hysterectomy at same time, same day.
Does the symptoms I was having come from this thyroid issue      or is this a confirmed thyroid disease?  

Please help me understand.  

Thank you very much.---    I would like to add   that I did my surgical training at Sarasota Memorial Hospital,    went on and became a traveler for 4 years,    worked at Scripps in La Jolla,  Ca...      Kauai, Hi  for a year,  and many other beautiful places.  

[Mark Lupo, M.D.]

The TSH remains the best test for thyroid function, but in this case the high antibodies are also helpful and indicate thyroid inflammation due to autoimmune disease which is likely the cause of the atypical biopsy -- would have the slides sent to an expert second opinion and give them the information on the antibodies to assist with the interpration of the FNA.  The most common cause of an isolated total T3 elevation is estrogen therapy (ie, birth control pill).  Would see an endocrinologist, not ENT, to put this case together.