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My thyroid is confusing the heck out of me!!!

This is my first time on such a forum but I am so concerned and confused and could use some advice. At the end of May I found a lump in my neck.  Ultrasound revealed a thyroid that was normal in size and appearance but an isoechoic nodule in the upper left pole 1.2 X1.0x1.4 (this is what I could feel) PLUS two smaller benign looking nodules on right pole (both less that 1cm). The recommendation was to repeat ultrasound in three to six months versus FNA. I did not Want to mess about so elected to have the FNA. just my luck the results were indefinite......wording along the lines of "predominantly benign with focal cytological and architectural atypia and slightly increased number of microfollicles.....conclusion was Atypia of undetermined significance. So this sent me back to my doctor for more tests etc.  I have since had TSH and T3 and  T4 tested plus thyroid antibodies (TG and TPO). In addition I have been really tired, trouble losing weight and brittle nails and dry thinning hair. However, the blood tests have confused me even more. TSH and T3 and T4 were within normal range but antibodies very high (TG was 149 and TPO was >1300) and pathologist concluding autoimmune thyroid disease on the report.  But FNA and ultrasound do not seem to confirm this yet I feel so crap.  I am just really confused and trying to work through possibility of thyroid cancer versus Hashimotos versus nothing at all.  Each test seems to be telling me a different story.  Any advice or help anyone can offer would be appreciated.  I am due to see an Endo in two days but want to try and have a clearer picture before then.
5 Responses
649848 tn?1534633700
COMMUNITY LEADER
You don't need the FNA to determine autoimmunity; the antibody tests have already done that.  The FNA would determine whether or not you have thyroid cancer.  Your FNA is indeterminate, which means your doctor may give you the option of having your thyroid removed or advise you to take the "wait and see" approach and see if the nodule grows larger.

I'd be pretty safe in saying that you feel like crap because, even though your T4 and T3 were "in range", they're far from optimal and you, actually, have hypothyroidism... If you'll please post the actual results, for us, it would be most helpful and be sure to post the reference ranges, as well, since reference ranges vary lab to lab and have to come from your own report.  Also please tell if those were Free T3 and Free T4 or if they were Total T3 and Total T4.  They aren't the same tests, with the tests for Total T3 and Total T4 being much less useful than the Free T3 and Free T4.  It should specify on your lab report if they are the Frees.  If it doesn't, they're the Totals and you should ask your doctor for the Frees next time...

Both your antibody levels are elevated, which confirms that you have Hashimoto's Thyroiditis.  Hashimoto's is the #1 cause of hypothyroidism in the developed world.  

It's not the least bit unusual for symptoms of hypothyroidism to start, long before TSH, Free T3 and Free T4, actually go out of range.   Your symptoms are typical hypothyroidism.

Alleviation of symptoms should be the first consideration, so hopefully, your doctor will be willing to consider the fact that even "in range" FT levels can result in hypothyroidism.  

Will look forward to seeing your results, with reference ranges.  
Avatar universal
HI Barb135, thank you so much for all your information.  All my levels are as follows:

My T3 and T4 were the free and results were
Free T4 18.3 (range 9.0 - 25.0 pmol/L)
Free T3 5.1 (range 3.5 - 6.5 pmol/L)
TSH 2.14 (range 3.5 -6.5 pmol/L)

According to this they are all slightly over mid range...hence my confusion. Although from what you are saying, this is not uncommon for Hashimotos. Are the nodules likely to be associated with Hashimotos or something independent? Thanks again for your help :)

649848 tn?1534633700
COMMUNITY LEADER
Your thyroid hormone levels are still very good; it's kind of odd that you'd be having symptoms with levels like that, but it's not unheard, with Hashimoto's.

I doubt you'll find a doctor that will treat you, though under the circumstances.

Nodules are very common with Hashimoto's... Many/most of us, here on the forum have nodules.  Less than 5% of all thyroid nodules turn out to be cancer.  An ultrasound will determine if the nodules have suspicious characteristics or not.  If not, they are nothing to worry about.  

Avatar universal
Thanks for your thoughts, It will be interesting to see what my endo says tomorrow. I guess I am primarily concerned with the Atypia of undetermined significance result of my nodule FNA ......would be nice to get an answer on that and then deal with the rest. It may be that the symptoms are related to other hormone issues.  I has a total hysterectomy about 15 months ago so some symptoms might be related to lack of oestrogen maybe.  One hurdle at time I guess until I get all the answers.  Thanks again
Avatar universal
Just another thing to possibly alleviate undue fear.

I recently read an article that stated that even with thyroid cancer, it is typically of a type that leaving it alone and keep a watch is just as effective as removal of the thyroid.  And in many cases better.  The gist of the article was that thyroid cancer left in place, most everyone will die of some other cause rather than the thyroid cancer.  (interestingly they are finding a similar thing with regard to prostate cancer and removal versus leaving it alone)

Granted each case is unique and you have to work with your Dr and make the best decision for you and your health.  But the idea is that most thyroid cancer is so slow growth that even if diagnossed with thyroid cancer is not a panic situation to cause great stress at least in the vast majority of the cases.

As far as symptoms and thyroid levels.  I too am surprised that you have several of the classic symptoms of hypo (low) thyroid.

The fact that you have Hashi's means that sooner or later you will be on thyroid replacement hormone. So you MAY be able to talk your Dr into a small starter dose of T4 medication for a clinical trial.  Basically an experiment to see if you feel better with a small dose of thyroid.

In my personal case.  I was also in the normal range and I don't believe I have Hashi's.  However I was able to convince my Dr to give me a very small starter dose (12.5 mcg)  as a clinical trial.  It made a world of difference to me.  The mild symptoms I had went away.  That first fall was the 1st time ever in my life that my toes did not get cold while deer hunting!  It was awesome!
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