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14025207 tn?1435674557

Hypoechoic solid nodule. 6.5 x. Another FNA? General anesthesia interfere?

I have Hashimoto’s. I take T4 and T3. A doctor reduced my T4 a month before surgery. I eventually became very hypo, suddenly sprung a goiter. Had another thyroid ultrasound. One nodule is now huge! I think the radiologist is making a completely incorrect recommendations for me to do nothing. Can someone please tell me if I should get another FNA?

An endo reduced my T4 by 12.5 mcg because my TSH was too suppressed. I had been taking 162.5 mcg T4 and 15 mcg T3 for 1.5 years. Taken 15 mcg T3 f5 years, w/T4. My TSH was very suppressed. FT4 and FT3 were at top 1/3 of their lab ranges. No hypo symptoms for yrs. Endo tried to tell me that I was subclinical hyperthyroid. I said no way I could be, having never been the top of range and no hyper symptoms. I told her if my TSH was higher, my FT3 and FT4 would be too low and I'd be too hypo. She tested my Total T3. I was right. It was low, so not subclinical hyper. She said lower T4 by 12.5 mcg because TSH was 0.009, FT4 was 1.38 (.84-1.51), and FT3 was 3.3 (2.3-4.2). I have no symptoms with these levels.

A month later on the morning of surgery and after four weeks of reduced T4, I tested all of my thyroid labs. TSH up to 0.024, FT4 down to 1.18, FT3 down to 2.6. I knew that I needed to increase my T4, so did week after surgery. I think anesthesia was too strong. I had problems for over a week. Three weeks after surgery, the hypo symptoms started. Brain fog, sleepy, gained up to 10 lbs at one point, edema on face and legs, sleep disturbances, eventually feeling in thyroid area of air being cut off. Later noticed neck looked fatter, swollen. Started having problems swallowing. Very surprised reducing T4 only a little caused so many problems. I am wondering if over 3 hours of general anesthesia has negative effects on the thyroid and if it contributed to me becoming more hypo than I’ve been in 5 years?

Throat problems lead to ask for thyroid US. Had benign FNA 5 years ago. Previous ultrasound was 2018. The nodule in question was 0.6 x 0.5 x 0.4 in 2018 and is now 6.5 x 4.8 x 4.7.On my radiology report:

Conclusion:

1. Hypoechoic solid nodule within the left lobe which is compatible with a TR 4 lesion by size criteria no further evaluation is required. (This is the 6.5 x 4.8 x 4.7 nodule. I read that TR4 nodules are “moderately suspicious” and that an FNA is recommended if they are >1.15. Mine is 6.5!!).

2. Hypoechoic solid nodule within the lower pole the right lobe which is a TR 3 lesion and follow-up imaging in 12 months could be performed to evaluate for stability. (This nodule is only 1.5 x 0.8 x 0.8. I read that TR3 nodules are “mildly suspicious” and that an FNA is recommended if they are >2.5 cm. Mine is nowhere nearly that big.).

I told US tech I have 6 previous US's at same facility to compare. I think the radiologist made several mistakes. He said no previous ultrasound to compare. He is said 6.5 TR4 nodule needs no follow up when what I've read is that TR4 is moderately suspicious and needs an FNA if over 1.5 cm. I will call imaging department and tell them I need radiologist to do comparison w/ my previous US and I think he got my TR3 nodule and TR4 nodule mixed up. None of my nodules have ever been bigger than 1.5. Now this one is 6.5 and he says do nothing. I am wondering if I need to get another FNA now?
1 Responses
649848 tn?1534633700
COMMUNITY LEADER
It sounds like you have a lot going on - the worst of which is a doctor that puts too much emphasis on TSH.  

First off - what type of surgery did you have done?  Since you still have your nodules, it must not have been thyroid surgery.  

I agree that you didn't have subclinical hyperthyroidism, prior to decreasing your medication. The rule of thumb is for Free T3 to be about mid range; yours, at 1.38 was at 81% of its range which is higher than it needed to be.  Rule of thumb for Free T3 is upper half to upper third of its range.  Your Free T3, at 3.3 was at 55% of its range which, although in the upper half of its range, leaves plenty of room to increase.  Free T3 should be higher in its range than Free T4 in its range.  

If your doctor wanted to lower the T4 medication, she could easily have done so, by the 12.5 mcg, but then she should have increased your T3 medication by at least 5 mcg to start with and maybe 10 later.

As for the TSH, many of us have suppressed TSH when we're on adequate amounts of thyroid hormones.  Actually, many of us have suppressed TSH even when we don't have adequate amounts of thyroid hormones... lol   My TSH has been suppressed for years and I could certainly stand to have an increase in my dosage.  I'd say you need a different doctor to manage your hypothyroidism.

As for the nodules...you're correct that TR4 is moderately suspicious and typically requires an FNA and the TR3 is mildly suspicious and could be "wait and see" depending on the size and/or physical characteristics of the nodule.  The thing is, they don't give any details about either of these nodules except that they're hypoechoic... it's possible that the characteristics obviously indicate inflammation caused by your Hashimoto's or something like that, which may be why the radiologist isn't recommending an FNA on either nodule.  

Since your medication dosage was dropped and you became more hypo, it's possible the nodules may have become swollen/inflamed (i.e. you developed a goiter) and if you get your thyroid hormone levels back up, the swelling will be reduced.  That said, of course, everyone makes mistakes, including radiologists and since the radiologist did say there was nothing for comparison and you say you've had ultrasounds there in the past, you'll need to call in and have them make the necessary comparison and make sure the radiologist didn't mix up the 2 nodules.   If the only thing written on the report is what you provided above, it would also be to your benefit to ask for a better explanation of the ultrasound findings as those are pretty sketchy.
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649848 tn?1534633700
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