Recently diagnosed - no endo appointment for 3 mos

[wilsonsne]

I was recently diagnosed with Hirosh and can't see an endo for 3 mo. Should I be concerned with ultrasound and try to get it sooner? Here are my results from pcp:
The right thyroid lobe measures 4.8x2.6x2.7 cm. In the superior right thyroid lobe there is a 1.0x.9x.9 cm nodule with thick calcifications. In the midportion of the lobe there is a 1.5x1.3x1.3 cm fairly homogeneous nodule. Adjacent to this nodule there is a 1.0x.9x1.3 cm heterogeneous nodule. In the inferior aspect of the lobe there is a .7x.6x.8 cm hypoechoic nodule and slightly more inferiorly there is a .6x.7x.6 cm nodule with thick peripheral calcifications.
The isthmus measures 4mm. The left thyroid lobe measures 5.2x1.7x1.8 cm. Within the superior aspect of the left thyroid lobe there is a .8x.8.x1.4 cm nodule with thick peripheral calcification. In the inferior aspect of the thyroid lobe there is a .9x.6x.8 cm slightly heterogeneous nodule.
Impression: Multiple thyroid nodules in both thyroid lobes consistent with multinodular goiter.

Before meds:
T4: 5.5
Free T4: .7
TSH: .64
Thyroid Peroxidase Ab: 25.9
Thyroglobulin Antibody: 114.7
Recommended: 4 week followup bloodwork and Levothyroxin 50 mcg daily

After meds (Levothyroxin 50 mcg) for 4 weeks:
T4: 9.5
Free T4: 1.2
TSH: <.10
Thyroid Peroxidase Ab: 34.3
Thyroglobulin Antibody: 152.4
Recommended: 6 week followup bloodwork and Synthroid 100mcg daily
Also have low but normal range cortisol and other hormones.Concern is ultrasound and higher antibodies after Levothyroxin for 4 weeks and no endo appointment for 3 mo.Should I be concerned?

[Smilerdeb]

When radiologists do scans, then inject radioactive material into the vein, the end result is the radioactive material will be taken up by the thyroid. When looking at the scan, different areas in the thyroid take up different amounts of radioactive material. The difference between the darker and lighter areas is reported as representing different conditions.

In this case, sound waves are generated and focused on the thyroid using ultrasound. The differences in the reflections of the sound waves refer to differences in the structure of the thyroid, and can indicate various conditions as well.

Hope this helps!

[Smilerdeb]

My TSH doesnt go lower than 2.3 as it seems to have stabilised at that level which I am comfortable with.
When the TSH goes higher than 2.3, I get a bad throbbing ache down my leg leg and hip and have had an ultrasound done on it at its worst which showed fluid.
But yet that is the sign I get from Hypo, also slow heartrate, anxiety, no energy etc.
Its the T3 that makes me get the HYPER symptoms when it is at the top of the range or over.

[wilsonsne]

Can you tell me if the words homogeneous or hypoechoic were in your report for your nodules? I don't have an appointment with an endo for 3 months and want to make sure I am not missing something that should be taken care of quickly.

[wilsonsne]

So when your TSH gets low you feel symptoms of hyperthyroid? I don't have any of those symptoms. I only have the symptoms of hypo - hair falling out, tiredness, constipation & no weight loss despite exercise and diet. But I have had these symptoms for more than 10 years so I am thinking I have had hashi for quite a while but the nodule growth started the dr thinking and then she finally ran the antibody test.

[Smilerdeb]

I have never had a T3 med and survived good on a T4 med alone.
Sometimes the FT3 will go a little too high and I have to cut back for a day or so as the 'racing heart' comes into it.
The TSH is too low in my eyes....I cant be lower than 2.3 but everyone is different.
It took me a good 6 months to get my levels good.
Take baby steps and dont think that if you increase your meds fast that you will feel better...been there, done that lol.
The slower you take to increase the meds and get the levels right...the better the outcome.
Baby steps :)

[LazyMoose]

It takes the body some time on thyroid hormone replacement. Many recently diagnosed are under the false impression that they will feel like new in a couple months when starting for the first time on T4.  Your free T4 went from .7 to 1.2, so it did something.

***  You never mentioned symptyms, did any of your symptoms go away from Synthroid use?***   - And with you now low TSH, do you feel hyper at all, many would (at less than .1) , this is why you need to know your free T3.

I should have explained most people do not have cytomel added (if ever) untill a T4 only med (synthroid is one brand only) has been tried for at least a few months, and free T3 testing is many times used in this decision by the doctor.

Do not expect the Thyroglobulin Antibodys to go down, you have them, and they will stay around, dont worry. The med is thyroid replacement hormone not an antibody 'exterminator'.

Should you need T3 down the road, there is some info on aboutthyroid . com. Huge site if you have not read it yet. I believe the New England Journal of Medicine did some T3 studies - it might be on aboutthyroid.

[wilsonsne]

I will ask again about Free T3, I am not sure what she is going to look at for results. If antibodies can't be used and TSH is in normal range. I asked and she did hormone and pituitary tests this time. All of them came out low but in normal range. I wanted to rule out other potential issues. She thinks it is just Hashi but I don't know how much I trust her judgment. I will ask her about Cytomel. Do you know of any info or studies I could use as reference for my argument?

[LazyMoose]

"only wants to do blood draw after agreeing to dose according to symptoms"

- dosing according to symptoms is a good start!

One can only imagine that docs are under pressure to cheapen test costs. But, if you take take replacement thyroid hormone, you need to see what the levels are, thus FREE T3 (different from just T3) and free T4.  A perfectly good thyroid will convert T4 to T3, why do docs assume a diseased thyroid also will? Some dont convert good.

One last note. If synthroid doesnt work with free T3 in upper range, ask the doc to lower T4 med and add Cytomel, a T3 med also synthetic. T3 can be tricky if your doc dosen't know much, people here can help. And dont nessessarily jump to dessicated just because it was natural at one time, unless nothing else works -last resort.

[wilsonsne]

I mentioned the T3 tests to my doctor but she didn't think they were needed. She did say she would give desiccated meds if synthroid doesn't work. That is one of the reasons I plan on getting the second opinion, I was upset that she didn't want to visit with me in 6 weeks and only wants to do blood draw after agreeing to dose according to symptoms. Thanks for the info especially about antibodies. I was thinking they would go down and disappear when on the correct meds.

[LazyMoose]

I'm no nodule expert, but I will say doctors seem to only have extra interest in nodules greater than 1 cm in any direction like some of yours. But, some have reported that even smaller nodules were enough to get FNA biopsy. Go to our health pages to read up on the types of nodules. Many of us have nodules, In many cases it sounds worse than it is. And waiting- well, that doesnt make you feel any better does it?

What I will add is you really need free T3 testing to manage Hoshimots disease. Some have to push the doctor to do this, some stubbornly think its not needed. If we were to go by tsh labs- you look a little hyper, how do you feel now?

At your 'timeline' in the disease (you a newbie, right?), you need closer doc appts.

Antibodies no not necessarily go down with meds, they fluctuate.