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Left Thyroid enlarged in size (5.7 cm x 5.5 cm x 3.0 cm)
I am 53 years old. Just two months back I noticed a swelling on the left side of his neck.
The Doctor treating me asked me to conduct tests of Sonography of Thyroid & Neck, F.N.A.C,,Thyroid Function test, (T3, T4 and TSH tests).The reading of T3 is 121.3 ng/dl, T4 is 5.26 mcg/dl and TSH is 0.564 microlU/ml (All readings are within the normal range). The F.N.A.C. report indicate No malignant cells seen, there is a cellular hyperplasa seen without any increased or abnormal mitosis. Mild inflammation seen which needs clinical correlation & correlation with thyroid status.The sonography report indicates Left Thyroid enlarged in size, normal in shape and shows smooth margin. It measures 5.7 cm x 5.5 cm x 3.0 cm.There is a well defined large round area of altered echogenicity is seen in left thyroid gland. It measures 4.9 cm L x 4.5 cm B x 3.4 cm D (1-2 cystic areas are seen within it). What should I do? Please advise
The Doctor treating me asked me to conduct tests of Sonography of Thyroid & Neck, F.N.A.C,,Thyroid Function test, (T3, T4 and TSH tests).The reading of T3 is 121.3 ng/dl, T4 is 5.26 mcg/dl and TSH is 0.564 microlU/ml (All readings are within the normal range). The F.N.A.C. report indicate No malignant cells seen, there is a cellular hyperplasa seen without any increased or abnormal mitosis. Mild inflammation seen which needs clinical correlation & correlation with thyroid status.The sonography report indicates Left Thyroid enlarged in size, normal in shape and shows smooth margin. It measures 5.7 cm x 5.5 cm x 3.0 cm.There is a well defined large round area of altered echogenicity is seen in left thyroid gland. It measures 4.9 cm L x 4.5 cm B x 3.4 cm D (1-2 cystic areas are seen within it). What should I do? Please advise
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What are the reference ranges for the T3 and T4? Ranges vary lab to lab and have to come from your own report. Are they Free T3 and Free T4, or are they Total T3 and Total T4? If they are tests for the totals, they are of limited value, as those tests are considered obsolete. Free T3 and Free T4 are the active hormones.
The swelling/enlargement indicates an immune issue, either Graves Disease or Hashimoto's Thyroiditis. Graves Disease is associated with hyperthyroidism, while Hashimoto's is most often associated with hypothyroidism, but in early stages, can be characterized by periods of hyperthyroidism and/or swinging from hyper to hypo, to normal.
You need to get antibody tests done to confirm/rule out either/both. Thyroid Stimulating Immunoglobulin (TSI) is the definitive test for Graves. Thyroid Perxoidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAB) are the markers for Hashimoto's. You need them both, because some people have one or the other, some have both.
The swelling/enlargement indicates an immune issue, either Graves Disease or Hashimoto's Thyroiditis. Graves Disease is associated with hyperthyroidism, while Hashimoto's is most often associated with hypothyroidism, but in early stages, can be characterized by periods of hyperthyroidism and/or swinging from hyper to hypo, to normal.
You need to get antibody tests done to confirm/rule out either/both. Thyroid Stimulating Immunoglobulin (TSI) is the definitive test for Graves. Thyroid Perxoidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAB) are the markers for Hashimoto's. You need them both, because some people have one or the other, some have both.
The Report reads as follows:-
THYROID FUNCTION TESTS (Profile I)
Test Result Units Normal range
Total T3, serum 121.3 ng/dl 60.0 - 181.0
Total T4, serum 5.26 mcg/dl 4.50 - 10.90
TSH (Ultrasensitive), serum 0.564 microlU/ml 0.35 - 5.50
Right now, besides swelling, have muscular pain and little tiredness (but not sure whether the muscular pain and tiredness is connected to this, as muscular pain is felt for the past two years). Besides this no other problem
THYROID FUNCTION TESTS (Profile I)
Test Result Units Normal range
Total T3, serum 121.3 ng/dl 60.0 - 181.0
Total T4, serum 5.26 mcg/dl 4.50 - 10.90
TSH (Ultrasensitive), serum 0.564 microlU/ml 0.35 - 5.50
Right now, besides swelling, have muscular pain and little tiredness (but not sure whether the muscular pain and tiredness is connected to this, as muscular pain is felt for the past two years). Besides this no other problem
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Quick explanation: Some of the total T4 in your blood is bound by a protein, which makes that portion unusable. The portion that's not attached to a protein is the "Free" T4. The body doesn't use FT4, directly; it has to be converted to T3.
T3 works the same way... some of the total T3 in your blood, is bound by a protein, which makes that portion unusable. The portion not attached to protein is the "Free" T3 and is the portion that's used, directly, by the individual cells.
Approximately 95-99% of the Total T3 and Total T4 are bound by protein.
All of that said, your T3 is approximately mid range and your T4 is quite low in its range. It's pretty safe to think that Free T3 and Free T4 might be relatively low in their ranges, as well.
It's very possible that you have hypothyroidism.
You should get your doctor to test the Free T3 and Free T4, along with TSH again. TSH is a pituitary hormone and is an "indicator" of thyroid dysfunction, at best. You should also get your doctor to do the antibody tests that I mentioned above, to confirm/rule out an autoimmune condition. Since your T3 and T4 are relatively low in their ranges, you'd only need the tests for Hashimoto's (TPOab and TgAB).
With Hashimoto's, it's not unusual for some symptoms to start showing up before labs get really bad. Best to get the rest of the testing to confirm and start medication before symptoms get out of hand.