Aa
Multinodular goiter .low TSH .shall I go gor surgery ?
Good day everyone am so glad to find such a great supporting group and hoping to find some answers from your great experiences , I have a multinodular goiter that was diagnosed four years ago one of the nodules is big about 3 Cm . .and I did regular check ups every three months and three FNAs , my TSH kept going down though that this week it reached as follows :
TSH 0.033
FT3 5.4
FT4 14.3
What confuses me is that the T3 and T4 are always in the normal range but the TSH is decreasing . My doctor asked me to do nuclear uptake thyroid test and am wondering how safe is it ? He also says most likely we will go for surgery , then why would I need this nuclear test ? and am looking to try for a baby and wondering shall I try after surgery or delay it ??
Thank you
TSH 0.033
FT3 5.4
FT4 14.3
What confuses me is that the T3 and T4 are always in the normal range but the TSH is decreasing . My doctor asked me to do nuclear uptake thyroid test and am wondering how safe is it ? He also says most likely we will go for surgery , then why would I need this nuclear test ? and am looking to try for a baby and wondering shall I try after surgery or delay it ??
Thank you
COMMUNITY LEADER
Hi Shiry... Are you having symptoms of either hyper or hypothyroidism?
Is the nodule causing swallowing or breathing problems?
A nuclear uptake test actually measures thyroid function, but it doesn't do imaging. I'm not sure why your doctor wants to do this test, unless the FNA's were inconclusive, since the nuclear scan can also help determine if one has thyroid cancer, but if your nodule was benign, that shouldn't be a consideration.
Even though your Free T4 and Free T3 are within the ranges, your Free T4 is very low in its range at only 23%. This indicates that the pituitary gland may have stopped working properly, so it's not stimulating your thyroid gland enough to produce adequate hormones.
Free T4 is a "storage" hormone that must be converted to the active Free T3, so the relatively high Free T3 is most likely being converted from the Free T4 that's left. Once there's no Free T4 left, the Free T3 will be used up as well.
Has your doctor suggested trying replacement thyroid hormones?
Is the nodule causing swallowing or breathing problems?
A nuclear uptake test actually measures thyroid function, but it doesn't do imaging. I'm not sure why your doctor wants to do this test, unless the FNA's were inconclusive, since the nuclear scan can also help determine if one has thyroid cancer, but if your nodule was benign, that shouldn't be a consideration.
Even though your Free T4 and Free T3 are within the ranges, your Free T4 is very low in its range at only 23%. This indicates that the pituitary gland may have stopped working properly, so it's not stimulating your thyroid gland enough to produce adequate hormones.
Free T4 is a "storage" hormone that must be converted to the active Free T3, so the relatively high Free T3 is most likely being converted from the Free T4 that's left. Once there's no Free T4 left, the Free T3 will be used up as well.
Has your doctor suggested trying replacement thyroid hormones?
1 Comments
The doctor requested the thyroid uptake test to see if the nodule is hot or cold and whether I need a surgery or not . . I did 3 FNAs the first two were not sufficient sample but the third came out with the benign goiter result . . As for the symptoms I have hairloss , palpitations and heat intolerance plus muscle twitching am not so sure if it has to do with thyroid . . The nodule is not causing me pain or swallowing problems . . And my weight is not affected .
Your feedback about the FT4 is very interesting bcoz no he didn't suggest any replacement , how can the TSH and FT4 both be in the last w range I thought they have inverse relationship.
So do you think I shall do the uptake test ? I was reading about the nuclear dose and seems minimal
Thanks alot Barb
Your feedback about the FT4 is very interesting bcoz no he didn't suggest any replacement , how can the TSH and FT4 both be in the last w range I thought they have inverse relationship.
So do you think I shall do the uptake test ? I was reading about the nuclear dose and seems minimal
Thanks alot Barb
am very confused and I really don't know what to do. I am reading about thyroid removal and how long it takes to adjust. . How people can feel ill and unable to walk if their hormones are not normal . .it sounds scary specially that my friend who did the surgery says it might affect the bones and you must take calcium and vitamin D supplements and the doctor told me about the four parathyroid glands than can get mistakenly removed during surgery and will affect ur calcium level after. But what are my options ? Seems either radioactive iodine or surgery and I prefer surgery . . I haven't set a date yet but I have an appointment with the surgeon tomorrow hopefully to ask him about everything . What shall I ask . I have to think ?
COMMUNITY LEADER
Shiry... I'm not saying you have a problem with your pituitary or hypothalamus... That would be the case only "if" you have Central hypothyroidism and it kind of looks like you don't, but I'll explain, briefly, anyway, since I mentioned it...
The endocrine system consists of several glands: the hypothalamus and pituitary, thyroid, adrenals, reproductive system, pineal gland, parathyroids, and the pancreas. The hypothalamus and pituitary control all the others and sometimes, they malfunction, which would be the case if you had Central hypothyroidism and your pituitary didn't produce adequate TSH. There would be the possibility that it also didn't produce enough hormones to stimulate other glands as well, since a pituitary malfunction can affect one or more glands. Testing of other pituitary hormones would have to be done in order to determine if other glands were involved.
If you do the uptake test and find that you have a hot nodule, that could resolve your issue, because it could show that your nodule is producing T3, thus decreasing your TSH level, so your thyroid isn't producing T4. While it would ultimately result in removal of your thyroid, this would save a lot of time and other testing to rule out a pituitary problem.
Did you not have a Thyroid Peroxidase Antibody (TPOab) test?
Yes, I would like you to keep me posted on what you find out and how things turn out for you. I'll also be happy to try to answer any other questions you might have.
No, I'm not a doctor... I'm a patient, just like you. I've had hypothyroidism for years and was treated very badly, so I began researching thyroid issues. I found this forum and members here helped me learn what I needed to do to get better. Over the years, I've had a lot trouble obtaining adequate treatment for my own thyroid condition (Hashimoto's), so I spend many hours researching various types of thyroid conditions, so I can help people prevent the horrible treatment I've received...
The endocrine system consists of several glands: the hypothalamus and pituitary, thyroid, adrenals, reproductive system, pineal gland, parathyroids, and the pancreas. The hypothalamus and pituitary control all the others and sometimes, they malfunction, which would be the case if you had Central hypothyroidism and your pituitary didn't produce adequate TSH. There would be the possibility that it also didn't produce enough hormones to stimulate other glands as well, since a pituitary malfunction can affect one or more glands. Testing of other pituitary hormones would have to be done in order to determine if other glands were involved.
If you do the uptake test and find that you have a hot nodule, that could resolve your issue, because it could show that your nodule is producing T3, thus decreasing your TSH level, so your thyroid isn't producing T4. While it would ultimately result in removal of your thyroid, this would save a lot of time and other testing to rule out a pituitary problem.
Did you not have a Thyroid Peroxidase Antibody (TPOab) test?
Yes, I would like you to keep me posted on what you find out and how things turn out for you. I'll also be happy to try to answer any other questions you might have.
No, I'm not a doctor... I'm a patient, just like you. I've had hypothyroidism for years and was treated very badly, so I began researching thyroid issues. I found this forum and members here helped me learn what I needed to do to get better. Over the years, I've had a lot trouble obtaining adequate treatment for my own thyroid condition (Hashimoto's), so I spend many hours researching various types of thyroid conditions, so I can help people prevent the horrible treatment I've received...
3 Comments
Hi Barb,
I just finished my thyroid uptake test and as per the report I have both Thyroid lopes enlarged with hyperfunctioning toxic nodule on right-side and two cold nodules on left side which my doctor thinks are just weak warm nodules . . He recommended surgery
I just finished my thyroid uptake test and as per the report I have both Thyroid lopes enlarged with hyperfunctioning toxic nodule on right-side and two cold nodules on left side which my doctor thinks are just weak warm nodules . . He recommended surgery
Have you decided to go ahead with the surgery? Of course, having no thyroid will leave you permanently dependent on replacement thyroid hormones, but many of us are in that situation, and it's not so bad, once you get regulated.
If you've decided to go ahead with surgery, have you set a date yet? Please keep me posted on progress and let me know if there's anything I can do to help or if you have any questions I can answer. If I don't know the answers, I have plenty of resources to find them.
If you've decided to go ahead with surgery, have you set a date yet? Please keep me posted on progress and let me know if there's anything I can do to help or if you have any questions I can answer. If I don't know the answers, I have plenty of resources to find them.
It's very nice of you. . The support itself makes a difference for anyone. . It makes you feel that you are not alone.
I was a bit hyperthyroid for two days (excessive sweating, heart rate 103 bpm at the doctors with high blood pressure) then went back to normal.
On the second day of being a bit hyper I had blood work done. My TSH came back as 0.2 (0.20 - 4.00) with my free T4 at 16 (my sweet spot for optimal free T4 levels for me) and my free T3 at 4.9 pmol/L (2.8 - 6.8).
The lab I go through is weird with their reference range for free T4. It fluctuates between 10 - 20 pmol/L and 15 - 30 pmol/L. Currently at 15 - 30. O_o smh.
On the second day of being a bit hyper I had blood work done. My TSH came back as 0.2 (0.20 - 4.00) with my free T4 at 16 (my sweet spot for optimal free T4 levels for me) and my free T3 at 4.9 pmol/L (2.8 - 6.8).
The lab I go through is weird with their reference range for free T4. It fluctuates between 10 - 20 pmol/L and 15 - 30 pmol/L. Currently at 15 - 30. O_o smh.
COMMUNITY LEADER
Hot or cold is whether the nodule is producing hormones independently of the thyroid or not. If the nodule is hot, it's producing hormone (functioning), if it's cold it isn't. If the nodule is functioning, it will take up more of the iodine.
It's possible that the nodule "is" functioning, which could account for the higher Free T3 level and the high Free T3, could, in turn account for the low TSH because, both, Free T4 and Free T3 affect the TSH level, not just Free T4.
That said, you're right that, typically, if TSH is low, thyroid hormones are high and if TSH is high, thyroid hormones are low. In the case of Central (also called Secondary) hypothyroidism, the thyroid actually works fine, but there's a problem with, either, the pituitary gland or the hypothalamus and there's not enough TSH produced to stimulate the thyroid. In this case, both the TSH and Free T4 would be low. Typically, in Central hypothyroidism, Free T3 would also be lower, but it's possible it's like I said before - it hasn't dropped off yet.
It's possible, in your case, that the nodule is producing the Free T3, which is keeping the TSH low, so the thyroid isn't being stimulated so no T4 is being produced, keeping FT4 down.
Your symptoms are consistent with hyperthyroidism, but I'm really wondering if you actually have Graves Disease or if you have the toxic nodule causing you to be hyper.
Did you actually have the TSI antibody test or any other antibody tests? If you did, could you please post the results, with their reference ranges.
Under the circumstances, I'd probably go ahead and have the uptake test to find out if the nodule is functioning, because if it is, the methimazole might not help you much and you'll need your thyroid removed anyway.
It's possible that the nodule "is" functioning, which could account for the higher Free T3 level and the high Free T3, could, in turn account for the low TSH because, both, Free T4 and Free T3 affect the TSH level, not just Free T4.
That said, you're right that, typically, if TSH is low, thyroid hormones are high and if TSH is high, thyroid hormones are low. In the case of Central (also called Secondary) hypothyroidism, the thyroid actually works fine, but there's a problem with, either, the pituitary gland or the hypothalamus and there's not enough TSH produced to stimulate the thyroid. In this case, both the TSH and Free T4 would be low. Typically, in Central hypothyroidism, Free T3 would also be lower, but it's possible it's like I said before - it hasn't dropped off yet.
It's possible, in your case, that the nodule is producing the Free T3, which is keeping the TSH low, so the thyroid isn't being stimulated so no T4 is being produced, keeping FT4 down.
Your symptoms are consistent with hyperthyroidism, but I'm really wondering if you actually have Graves Disease or if you have the toxic nodule causing you to be hyper.
Did you actually have the TSI antibody test or any other antibody tests? If you did, could you please post the results, with their reference ranges.
Under the circumstances, I'd probably go ahead and have the uptake test to find out if the nodule is functioning, because if it is, the methimazole might not help you much and you'll need your thyroid removed anyway.
2 Comments
The anti body result were as follows :
Anti TG <10 ( range <115)
Tsh receptor Antibody <0.3 ( range for negative 1.75 )
What do you mean by "there's a problem with, either, the pituitary gland or the hypothalamus" it sounds scary , how is it determined where is the problem from ??
As for the uptake test I was just wondering if the doctor will most likely advice me to do surgery why would I go through it ? Anyhow would you like me to keep you posted with the results later ? I assume you are a doctor so Thank you Dr.Barb :)
Anti TG <10 ( range <115)
Tsh receptor Antibody <0.3 ( range for negative 1.75 )
What do you mean by "there's a problem with, either, the pituitary gland or the hypothalamus" it sounds scary , how is it determined where is the problem from ??
As for the uptake test I was just wondering if the doctor will most likely advice me to do surgery why would I go through it ? Anyhow would you like me to keep you posted with the results later ? I assume you are a doctor so Thank you Dr.Barb :)
Don't know why the ranges are not clear in the previous comment anyways
For TSH anti body the range is
Negative 1.75
My result was <0.3 guess that's a negative
For TSH anti body the range is
Negative 1.75
My result was <0.3 guess that's a negative
COMMUNITY LEADER
Hi... can you please provide the reference ranges for the Free T4 and Free T3? Ranges vary from lab to lab and have to come from your own report.
Are you taking any type of thyroid medication? If so, what medication, what dosage and how long have you been on it?
What were the results of the FNA's?
One must have good thyroid health before they try for a baby, since adequate thyroid hormones are necessary for proper growth and development of a fetus. The fetus depends on the mother's thyroid hormones until its own thyroid is developed enough to produce hormones. Once we know your own situation, we can better advise about getting pregnant.
Are you taking any type of thyroid medication? If so, what medication, what dosage and how long have you been on it?
What were the results of the FNA's?
One must have good thyroid health before they try for a baby, since adequate thyroid hormones are necessary for proper growth and development of a fetus. The fetus depends on the mother's thyroid hormones until its own thyroid is developed enough to produce hormones. Once we know your own situation, we can better advise about getting pregnant.
1 Comments
Hi Barb135
I am not taking any meds so far and FNA result was a benign mixed goiter . . As for the range of hormones as follows
FT3. 5.4 ( range 3.1 - 6.8)
FT4. 14.3 ( range 12 - 22 )
TSH. 0.033 ( range 0.27- 4.2 )
Regards
I am not taking any meds so far and FNA result was a benign mixed goiter . . As for the range of hormones as follows
FT3. 5.4 ( range 3.1 - 6.8)
FT4. 14.3 ( range 12 - 22 )
TSH. 0.033 ( range 0.27- 4.2 )
Regards
Have an Answer?
You are reading content posted in the Thyroid Disorders Community
We tapped the CDC for information on what you need to know about radiation exposure
Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
