Benign Nodule/Hashi or Possible Parathyroid Issue??

[mystpete]

Just benign nodule/Hashi or possible parathyroid issue?

4/13/12 - Ultrasound
Large nodule seen centrally within the left thyroid 1.9 x 1.2 x 1.5

4/13/12 - Labs
TSH 3rd Gen - 2.900
T4 Free - 1.0
T3 Total - 1.03
Calcium - 9.8 mg/dl
Creatine - 0.60 mg/dl
HCT - 35.0%
MCH - 31.4 pg
RDW 15.5%
Mono 11.5%
Alt - 58 IU/L
AST - 80 IU/L
all other labs were normal range

10/24/12 - FNA
Benign follicular cells, macrophanges, blood & colloid favor goitrous nodule

10/30/12 - Labs
TSH - 3.54 uIU/mL
T3 Circulating - 1.2 ng/ML
T4 Free - 0.59 ng/dL
Calcium - 10.7 ng/dL
Osmo Calc - 271 mOsm/L
Creatine - 0.5 mg/dL
HCT - 39.5%
MCH - 32.7 pg
RDW -13.9%
Mono Abs - 866 /uL
RBC - 4.12 x10^3/uL
Alt - 34 U/L
AST - 34 U/L

Symptoms -
fatigue, muscle/bone pain, ear/jaw pain, salivary gland swelling, poor focus, weight loss, irritable/depression.

Not sure where to go from here & would appreciate any & all help!!
Have a fantastic Friday!

[Barb135]

Your symptoms do go along with hypothyroidism.  Your lab is using an outdated reference range for TSH....... the range recommended  by AACE, 10 years ago, is 0.3-3.0; using that range, your TSH would be higher than normal.  Your Free T4 is way too low in the range, further indicating hypothyroidism.  Have no idea whether that "circulating T3" is free or total.  The range is different from what we normally see for Free T3, so I'm guessing it's probably total.

"The only reason I mentioned a possible parathyroid issue was due to the high calcium lab result.  Unsure if that could be a result of thyroid issue."  As I noted above, the only relationship between parathyroids and thyroid is their location in the body.  The parathyroids control the amount of calcium, which is not affected by thyroid issues.  You should follow up on that high calcium.

You should also get tested for Vitamin B12 deficiency.  The high RDW and MCH indicate that you may be deficient, or at least, low range, which will certainly cause fatigue and other symptoms.

Along with that, you should get iron and ferritin tested, since your RBC is low, indicating a possible iron deficient anemia.

Do make sure that all thyroid tests include both Free T3 and Free T4, which are the actual thyroid hormones.  You should also get the thyroid antibodies tested, as I mentioned previously.

[mystpete]

Thanks Barb & my condolences to you & your family.  I have never been diagnosed w/thyroid issues (no meds) & the original blood work/ultrasound done in April w/only the result of my prodding/concern to Drs.

4/13/12 Ultrasound -  Large nodule seen centrally within the left thyroid 1.9 x 1.2 x 1.5

4/13/12 - Labs
TSH 3rd Gen - 2.900 ulU/mL
T4 Free - 1.0 ng/dL
T3 Total - 1.03 ng/mL
Calcium - 9.8 mg/dl
Creatine - 0.60 mg/dl
HCT - 35.0% Low (37.0 - 47.0)
MCH - 31.4 pg High (26.0 - 31.0)
RDW 15.5% High (11.5 - 14.5)
Mono 11.5% High (0.0 - 10.0)
Alt - 58 IU/L High (7-50)
AST - 80 IU/L High (10 - 42)
all other labs were normal range

10/24/12 - FNA
Benign follicular cells, macrophanges, blood & colloid favor goitrous nodule
W 255 cm Length 127.5 cm

10/30/12 - Labs
TSH - 3.54 uIU/mL (0.34 - 5.60 )
T3 Circulating - 1.2 ng/ML (0.9 - 1.8)
T4 Free - 0.59 ng/dL (0.58 - 1.64)
Calcium - 10.7 ng/dL High (8.5 - 10.5)
Osmo Calc - 271 mOsm/L Low (275 - 295)
Creatine - 0.5 mg/dL Low ( 0.6 - 1.3)
HCT - 39.5% ( 37.9 - 47.0)
MCH - 32.7 pg High (27.0 - 31.0)
RDW -13.9% (11.5 - 16.0)
Mono Abs - 866 /uL High (50 - 600)
RBC - 4.12 x10^3/uL Low (4.20 - 5.40)
Alt - 34 U/L (10 - 40)
AST - 39 U/L (10 - 42)

Symptoms -
fatigue, muscle/bone pain, ear/jaw pain, salivary gland swelling, poor focus, weight loss, irritable/depression/withdrawn, cervical lymph node swelling, dry/thin skin.

The only reason I mentioned a possible parathyroid issue was due to the high calcium lab result.  Unsure if that could be a result of thyroid issue.

Having trouble getting my Dr. to show any concern & order proper testing.
No insurance & on a sliding scale, thus, the "intern" w/the hospital!

Picked up lab reports, FNA Ultra image & report on disc & biopsy slides from lab (strange thing is, they are numbered 1, 3, 4, 5 & 7. Unsure of what happened to slides numbering 2 & 6??

I am feeling alittle hyper today which is a nice change from the hypo symptoms.  

Thanks again for all of your help & have a wonderful Sunday!

[Barb135]

No, your post wasn't too clinical; we all volunteer our time here and there's not always someone on the forum to respond right away.  I, personally, have been dealing with a death in my family, so have been on the forum very little the past couple weeks.

We need to have the reference ranges for all the lab tests, since ranges vary lab to lab and have to be posted with results.

Nodules are quite common with Hashimoto's, but you need to have the antibody tests done to properly diagnose that.  The tests you need are TPOab and TGab. You need them both, because some people have only the TPOab, while others have only TGab and still others have both.

For future reference, Total T3 is considered obsolete and of little value.  Much more important is Free T3, which is the hormone that the body actually uses.

A thyroid nodule has nothing to do with the parathyroids.  The only relationship between parathyroids and the thyroid is their location in the body.  

Have you previously been diagnosed with a thyroid condition?  Are you on a thyroid replacement medication?  If so, which one, at what dosage, for how long?

[mystpete]

Unsure of why I didn't receive any feed back...guess my post was to clinical?
Woke up this morning with swollen cervical lymph node, on same side as "benign" nodule & now I am not only scared, but mad as heck!  Wish my intern would have ordered the PTH & TgAb last week!!  

Any & all help would be appreciated, positive or negative!
Have a blessed Sunday y'all!