The elevated 24 hr uptake is what favors hyperthyroidism - that means the thyroid is absorbing extra amounts of iodine, therefore, would be expected to be using that iodine to produce extra amounts of thyroid hormones.
The obvious way to confirm this is to test Free T4 and Free T3 levels. If those are over-range, then you are hyperthyroid. If they are not over-range, you are not hyperthyroid.
You should be tested for thyroid antibodies, as well. The #1 cause of hyperthyroidism is Graves Disease, however, many people have periods of hyperthyroidism in the early stages of Hashimoto's as well. The antibody tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb) to test for Hashimoto's. Thyroid Stimulating Immunoglobulin (TSI) is the definitive test for Graves Disease. These tests are all common and easy to get from most labs as long as your doctor is willing to order them.
If you've had any of these blood tests, please post the results and we can help you interpret them. Be sure to include reference ranges, which vary from lab to lab and have to come from your own reports for the best comparisons.
The uptake scan was performed following the ultrasound on the recommendation of the radiologist, due to the presence of the nodules, particularly, the dominant one on the right side. The nodules are heterogeneous, which means the tiss-appue is not all the same. They are also "solid-appearing", with some increased blood flow. Has anyone suggested doing an FNA on the largest 2 of them just to be safe?
Cold nodules are more likely to be cancer than hot nodules, so that's probably what she's basing her decision on. I looked at the ultrasound again...American Thyroid Association (ATA) recommends FNA on nodules over 2 cm unless they have certain characteristics; being solid is one of those characteristics, but as I noted previously, your ultrasound says "solid-appearing", not that they nodules are actually solid. I've never actually seen a report that says that... They should be able to tell if they're solid - that's the only thing I would question about that report. Cysts aren't anything to worry about.
I totally agree that you aren't hyperthyroid and I'm quite surprised that your uptake was so high and your Free T4 is so low. Yes, I know it's in range, but I can't help asking if you have any symptoms that could suggest hypothyroidism...Hypo symptoms include fatigue, weight gain/inability to lose, constipation, muscle/joint aches/pain, facial swelling, loss of body hair, especially the outer eyebrows, puffiness around/under the eyes, swelling/edema in the legs/feet and hands... there are many more, but those are some of the more common ones.
Most of us feel best with Free T4 about the mid-range point and your Free T4 is only at 27% of the range. That's pretty low and indicates that your thyroid isn't producing enough hormones. Of course, with Free T4 that low, we'd expect TSH to be higher. Since it isn't, this could be an indication of Secondary, otherwise known as Central hypothyroidism. Secondary/Central hypothyroidism is when the thyroid works fine, but there's something wrong with the pituitary or the hypothalamus so there isn't enough TSH being produced to adequately stimulate the thyroid. Many doctors miss Secondary hypothyroidism because they place too much emphasis on TSH and as long as labs are "in range" they think all is well.
You can try to talk to your doctor about this or try to get a second opinion.
You need antibody tests to determine if you have Hashimoto's. Those tests are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb)... Both are markers for Hashimoto's; some of us have one or the other and some of have them both. Some people are diagnosed with Hashimoto's based on the characteristics of their thyroid gland, even if they have negative antibodies. Your ultrasound report doesn't mention that, but that doesn't necessarily mean anything...
You also need to get vitamin B-12 and Ferritin tested. Most of us need to keep B-12 in the upper part of its range in order to feel best, even though doctors seem to think that anything that's in range is good enough - they tend to think that way about everything...
If your Ferritin is low, you need to get an iron panel. Don't let them just tell you that you don't need that because your hemoglobin and hematocrit is good, because that's not always satisfactory.
I know how frightening it can be to change doctors, but sometimes we have no choice. I'd been with my previous doctor for 8 yrs and I really liked him, until my thyroid died; then he showed his true colors. I like the doctor I have now and I've been with him for 9 yrs, but I've had difficulties with him as well and would leave him in a heartbeat if I have trouble getting decent treatment for my thyroid.
I wouldn't let him treat my thyroid when I first started seeing him... first because I had an endo I was happy with and second because he would only look at TSH and wouldn't test Free T3. My endo went out of practice and the next one I got was horrible... In the meantime, I'd convinced my pcp that he "had" to test Free T4 "and" Free T3 for me because TSH isn't reliable since mine is suppressed and I'm not hyper. Once I got that through to him, things began to turn around and I've since ditched the second endo and my pcp is doing well - so far... As long as he doesn't start trying to decrease my medication, we'll get along fine...
Hemoglobin is a protein in red blood cells that carry oxygen all over the body. Hematocrit is the number of red blood cells in your blood. Because iron is necessary for the formation of red blood cells, doctors often use them as a signal that iron levels are adequate, when this isn't always the case.
Monocytes are a type of white blood cells. There several types of white cells and these are, basically, used to fight infection/disease.
As for B-12 and Folate, both are also necessary for healthy red blood cells. As I noted, B-12 is necessary for healthy nerve function, as well as other functions. I have permanent nerve damage in my feet due to long-standing B-12 deficiency caused by Pernicious Anemia, which is an autoimmune condition in which one does not absorb vitamin B-12 via the gut. Because of the inability to absorb B-12 via the gut, I take weekly B-12 injections in order to keep my level near the top of the range.
Folate works in conjunction with vitamin B-12. Folate is another of the B vitamins; I've also been deficient in Folate. Folic Acid is a synthetic version of Folate and must be converted to something the body can actually use; therefore, it's not often recommended for those of us with Hashimoto's or other autoimmune conditions because we, often, can't absorb or convert synthetic substances. It's best to get formulas that are "body ready" so we don't have to convert them. This applies to B-12, as well.
If you look at your blood test reports, you'll see items called "RDW", "MCV", etc... Those are indications of vitamin B-12 status, but of course, they can't the place of actual B-12 or folate testing.
I also wanted to address the acid reflux/GERD issue... As I noted, this is very common with hypothyroidism. I had it horribly bad for some years prior to being diagnosed - even when my thyroid hormone levels were supposedly "normal". For several years, I had been on a prescription drug called Aciphex. You don't hear about it very often anymore, but it was very expensive and it was a constant battle to get my insurance company to keep paying for it; they wanted me to switch to the generic "Omeprazole", which did absolutely nothing for my reflux. I would wake up in the night, literally, choking on acid, unable to catch a breath...
I had not known that was a hypo symptom until I found this forum. People here, also told me that instead of less acid, I actually needed "more" acid... I thought they were crazy. One person, who no longer frequents the forum told me they used to drink dill pickle juice to calm acid reflux. I just knew that if I had more acid in my stomach it really would kill me. lol
One night I woke up choking and once I was able to catch my breath, I went to the fridge and took a couple big swallows of dill pickle juice... oh my, did that burn going down and I thought I'd made the mistake of my life!! Ironically, it was only a few minutes before the acid settled down and although I sat up in bed because I was afraid to lie down, I actually did go back to sleep, which was something I'd hardly ever been able to do in the past. I began to have jars of dill pickles with no juice in my refrigerator and eventually had to start throwing them away... lol I also discovered that vinegar and water works, too, though it doesn't taste as good as dill pickle juice.
I did read up on stomach acid and learned that many of us have too little which, strange as that sounds, does cause reflux/GERD. For a while, I took Hydrochloric Acid (HCl) w/pepsin when at mealtime to help build my stomach acid, since we need a certain amount of acid in order to digest our food. Taking acid reducers prevents this from happening. If you read the inserts of those medications, they were never meant to be taken on a long-term basis. Of course, my doctors look at me like I'm nuts when I mention this...
I had the reflux for so long, my ENT did tests to make sure my stomach and esophagus had not been eroded by the acid.
Now, I only get reflux when my thyroid levels go out of whack or if anxiety levels are really high. I did wake up last night with some reflux and a spoonful of dill pickle juice calmed it down quickly.
I also went through an episode with H. Pylori at the beginning of 2017, which took a while to get diagnosed, as well. H. Pylori is a bacteria that many/most of us have in our stomach but it lives there peacefully with all the other bacteria unless/until something happens and it gets a chance to get a foothold and we get an overgrowth. That required treatment with 2 antibiotics simultaneously, along with acid reducers which allowed the antibiotics to work better and a better diet.
I do have IBS, also and have changed my diet to exclude dairy, sugar and am "almost" gluten-free. I've never eaten soy, but if you do, it's not recommended for thyroid, as it's a goitrogen - you can research that... I try to eat lots of veggies, healthy fats, and protein. I'm also pre-diabetic so I limit fruit to 1-2 servings/day and try to go with the lower sugar ones, except watermelon when it's in season as it's a favorite... :-)
I also want to address the cholesterol/triglycerides, but I'll do that in another post...