your opinion on results

[Dnmh]

Thank’s in advance for your time. Happy w/my endo - specialty is diabetes. I’m interested in your opinion.
Symptoms include depression @ 6 mo, ache in collarbone region, very itchy skin w/eczema like patches, overheating in the evenings, hot flashes at night, menorrhagia, mild hair loss calves, head & pubic, no appetite due to nausea.

Mar 07 TSH 1.39, Thyroxine, Free 1.03

Sept 08 TSH 1.69 uU/mL, T3 108 ng/dL, T4 7.0 ug/dL, FT4 1.4 ng/dL, FT4 Index 6.5, T4 Uptake 1.07

Thyroid Echo Mar 07
"three hypoechoic nodules measuring 2mm, 3mm & 3mm" on the right lobe "within the left lobe there are two small nodules within the upper and mid-pole measuring 3mm & 2mm" and "Within the inferior pole there is a complex nodule measuring 1.4 x 1 x .08 cm. Remainder of the thyroid parenchyma is diffusely irregular in echogenicity. Contour of thyroid gland is also mildly irregular"
Impression: Findings consistent w/multinodular goiter with a single large nodule measuring 1.4 cm in greatest diameter. Malignancy cannot be excluded and histologic evaluation is recommended.

Cytology Report Apr 07
(A) Thyroid Nodule, Ultrasound Guided Biopsy:
- Negative for malignant cells: inflamed otherwise sparse to acellular specimen
Comment:
Fluid thin layer cell concentrate preparation is examined. This is bloody, moderately inflamed and otherwise sparsely cellular. The inflammation is dominated by small round “mature” lymphocytes with occasional intermixed macrophage and polymorphic nucleated leukocyte. The remaining cellularity consists of anucleated cellular cytoplasmic remnant with only rare fragment of cytologically bland thyroid follicular epithelial cells; these are quantitavely limited and not further diagnostic.
(B) Thyroid Nodule, Ultrasound Guided Biopsy:
- Negative for malignant cells: inflamed otherwise sparse to acellular specimen

Pre-Op Diagnosis: Thyroid Nodule
Post-Op Diagnosis: Not specified

[Dnmh]

Thank you so much for the time and help you offer to this site. My previous endo told me nothing was wrong, my current told me it was consistant with Hashimoto's. He is also doing a repeat ultrasound since the first was over a year ago. I will discuss treatment options with him.

[Mark Lupo, M.D.]

The ultrasound description and FNA as well as personal history of autoimmune disease and family history of thyroid disease all point towards Hashimoto's thyroidits -- an immune sytem attack on the thyroid causing inflammation.  The TSH you post is normal, usually we begin to consider treatment when TSH is >3, but occassionally there is benefit before that.  In some cases the immune system attack causes a hyper (over-activity, ie Graves Disease) but usually it's a progression towards hypothyroidism.

Regarding the FNA - technically it may be insufficient, but sounds like lymphocyte predominance which is what we seen in chronic thyroiditis (ie Hashimoto's).

[Dnmh]

Due to character limit in initial post, couldn't fit this info. Not sure if it's relevant.
42 yr old female. 107 lbs. 5' 7".
Have morphea scleroderma & slightly elevated ANA.
Father has hypothyroidism.
Paternal grandfather had prostate cancer.
Paternal great-grandfather commited suicide due to health reasons - family believes cancer since 5 of his 7 children had cancers.
Thank you again for your time.