Oh my... your doctor couldn't be more wrong. Hashimoto's is the # 1 cause of hypothyroidism in the developed world and although some consider it "rare", it's really not that rare. Although it's more prevalent in women, it's not gender-specific, so men can get it just as well. They are also equally subject to the resulting hypothyroidism. Just like women, men can have Hashimoto's for years before labs actually go out of range.
Your doctor is obviously, no well versed in thyroid care, since he doesn't understand that Free T4 and Free T3 must be at a level that's right for each individual and that TSH is only an indicator and should never be used as the sole diagnostic for a thyroid condition. Doctors in his category typically, keep their patients ill due to inadequate testing/treatment.
If I were in your situation and had a choice, I'd find a different doctor before it was time to retest again because this one will obviously not test beyond the TSH unless/until it goes out of range and then the most you're likely to get is Free T4. By then, symptoms may have gotten considerably worse and you may feel quite ill.
Yes, I agree if the lump is a lipoma there would be nothing to be done with it. At this point, it would be best to move on with the reminder to have another ultrasound in 6 months to check on the lump just to be sure it hasn't grown or changed in any way.
I would recommend that prior to the ultrasound in 6 months, you also have blood work done and insist that your doctor order Free T4 and Free T3, with the inevitable TSH. I'd also ask for thyroid antibodies to rule out Hashimoto's, for sure. Hashimoto's can be present for years/decades before it does enough damage to the thyroid to prevent it from producing adequate thyroid hormones. Nodules are also very common with Hashimoto's, so in my opinion, it should be confirmed or ruled out. If your doctor refused to order the tests, I'd consider a second opinion.
Good afternoon Barb135,
I was seen by the endocrinologist this morning and he pretty much told me that his best quess was "Lipoma" a fatty lump is what he described it. He said there's no treatment to it and he recommended a follow up ultrasound in 6 months to see if it's growing or not. I told him that it feels uncomfortable at times but unfortunately I cannot have it removed unless its becoming life threatening. It would be considered an elective surgery at this point :(. He also said that surgery at this point would be more harmful than helpful. All my bloodwork checks outs based on my results I have stated above this post. When he felt the lump on the right side of the neck, he said that it doesnt feel like a swollen thyroid because of where its swollen. The bump was too high in my neck area to be the thyroid (according to the doctor). I was told that in the future I can develop more lipomas (or not). At this point I quess I could say I feel somewhat of a relief but still uncertain. If its indeed lipoma then I should work towards in moving on and put this behind me until my next ultrasound. What are your thoughts on this Barb135.
Thank you for all of your help.
As noted, cystic nodules have very low suspicion for cancer, plus the sizes are very small and it would be extremely difficult to get good samples at biopsy. Biopsy is, typically, not done on anything smaller than 2 cm if the characteristics are right, though under "some" circumstances, biopsy will be done at 1 cm, but guidelines state 2 cm. Your nodules don't meet the criteria for biopsy at this time and the person doing the biopsy has every right to overrule your primary doctor.
I suggest you try to get the antibody tests done to determine if you have Hashimoto's as discussed above.
That's about what I anticipated and confirms what I told you about the TSH w/reflex - if TSH were abnormal T4 levels would be checked, but since it was normal, nothing further was done.
They are also correct in that TSH is released in response to low T4 and will be suppressed by too much T4 but that's not the whole picture, by any means. There are many times in which TSH is not an accurate marker for T4/T3 levels.
TSH can also be low (normal) under other circumstances even if one has hypothyroidism. It's up to you whether or not you want to pursue this further as you haven't really said if you have symptoms of hypothyroidism. I'll be more than happy to explain further if you want to continue to discuss it with this doctor; however, he seems rather determined that TSH is the best/only test he is going to order at this time. The fact that he ordered "TSH w/reflex T4" in the first place tells me he's not a good thyroid doctor and you might have better luck with the endo on May 3.
You certainly don't sound like a dummy... This is a very delicate issue because it's hard to question our doctors without abusing their ego. Some doctors won't mind and will stop and explain things, but others (probably most) will become offended right away. There's no way you can know which category your doctor is going to fall into or the reaction you'll get...
About all you can do is tell them that from what you've read, the TSH w/Reflex T4 is outdated and that TSH is not adequate for measuring thyroid function since it's not actually a thyroid hormone. For the most accurate information, they need to order Free T4 and Free T3 for thyroid function and the antibody tests to determine if you have Hashimoto's. Then ask them to please order these tests for you. You can also list the tests if you like in order to make sure they understand what you want.
You should be prepared for them to deny you the lab order for the tests. Many doctors will refuse to order these tests - the doctor that diagnosed me refused to order Free T3 and the only reason my Free T4 got analyzed is because my TSH level was at 55.5 so there was no doubt I was hypo... He also refused to order the antibody tests because he said it was a "waste" because the treatment wouldn't change.
Since you're having the biopsy, the antibody tests might not be that important right now, so you might want to pick your battles.
TSH w/Reflex is an outdated way to order testing. Instead of ordering the tests as he should have, the TSH w/reflex is simply an order to run TSH and if it's "in range", the lab is not supposed to do anything further; however, if TSH is out of range, the lab should run "only" Free T4. Many doctors think this is sufficient to test for thyroid function, but it's not.
As I explained, TSH is a pituitary hormone, not a thyroid hormone, so it doesn't really tell us whether the thyroid is working or not.
It will be interesting to see what sort of answer you get from your doctor in response to your question about the testing...
You may need to find a different doctor before it's all over...
The FNA (Fine Needle Aspiration) you're having on the 2nd of May may only tell part of the diagnosis.
The tissue samples collected during the FNA will be examined/tested and, hopefully, that will tell you whether or not you have cancer. Sometimes, the FNA is inconclusive, meaning they can't really tell one way or the other. If that's the case, they will decide, then what should be done, based on your circumstances. They may take a "wait and see" approach or they may do decide on something else.
Sometimes, they can tell whether or no a person is having an autoimmune attack, but not always. The antibody tests are best for finding autoimmune conditions.
The only way they can determine actual thyroid function is to do the tests for Free T4, Free T3 because those are the actual thyroid hormones, so they will tell what the thyroid is actually producing. TSH is a pituitary hormone that stimulates the thyroid. Many doctors will only test TSH and if that's in range, they test no further, but that's not good.
It's good that you're getting a biopsy, but let me say that I phrased my comment in a misleading manner, so I'll rephrase it because I'm here to help comfort people not scare them and I'm sorry.
I didn't mean it in such a way that all solid nodules are likely to be cancer. I meant that of all nodules the solid ones are most likely to be cancer, but that doesn't mean that all solid nodules "are" cancer. Also, keep in mind that only 5% of ALL thyroid nodules are cancer. That's a lot of nodules that aren't.
If it's any consolation, I have a 1.0 X 1.1 X 0.8 cm solid nodule and my doctor refused to refer me for a biopsy... he said it wasn't large enough.
Do you have a diagnosed thyroid condition, such as hyper or hypothyroidism?
Colloid nodules are overgrowths of thyroid tissue. They may grow large, but they don't grow beyond the thyroid.
Cysts can be filled with fluid or partly fluid and partly solid material.
Solid nodules are the most likely to be cancer, but it's important to note that thyroid cancer is quite rare (< 5% of all nodules turn out to be cancer). Most nodules aren't biopsied until they're 2 cm unless certain criteria are met; however, the radiologist may feel otherwise. If the radiologist who read your ultrasound felt a biopsy, otherwise known as an FNA (Fine Needle Aspiration) were necessary s/he would most likely have noted it in the report. There's usually a section at the end called the conclusion or recommendations in which the radiologist will notate suggested followup. If there is such a section, you can post the findings. Suggestions are not always noted, however. Many times, it's left up to the ordering doctor to make the follow-up decisions.
In my opinion, a solid nodule over 1 cm should have an FNA to be on the safe side, but I'm not a doctor and not all doctors agree with me.
Lymph node involvement may have other implications and should be discussed with your doctor.