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Avatar universal

Thyroid Nodule 3cm & couple others. TSH 0.35. Correlation?

I went to a new PCP (I moved) to get some routine checkup done and he had me do a blood test for: lipids, thyroid (tsh only), vitamin d, CBC w/ diff and CMP. It was my first time seeing a doctor in 3 years and I went to him for anhidrosis, heat prickly feeling, followed by a rash.

Anyways, my TSH came back at 0.35 and he asked me to come in. My first visit, he didnt really do any "physical exam". Just asked me question and then scheduled a test. The second time, he finally did some tests, felt my neck and immediate scheduled me to see an endocrinologist.

At the endocrinologist, he felt my neck, then said i needed to have an ultrasound right now. We did, and the nodules showed as 1.5/1.6/1.2 and on one side, one showed 3cm. He said that he needs to schedule a biopsy and so I have one scheduled for this upcoming friday.

Anyways, my question is, could those nodules, be the cause of the tsh being at .35? He said its unlikely to cause it to be at those levels. He also had me do a blood draw the same day for the TSH and the other thyroid type tests and some others I didnt recognize. Luckily, I was already fasting and wasnt on any meds. So would those nodules cause that tsh level? Ive read that it usually causes levels above 3.0 and such but not below 0.5. Can anyone a test to this?

The reason I ask is because Ive put on weight (although I was skinny to begin with but the weight I put on, was a lot; 27 pounds to be exact (from 160-187) and the reason for the weight gain, is because of the previous issue  I went to the new PCP for (mentioned earlier). And if my TSH levels, and other tests come back and shower to be low again, Im afraid the meds they may give me...... will only make my weight gain, that much worse.

Its bad enough I cant even clean the dishes without having the reaction I have but I cant exercise at all, and no exercise, pus meds that cause serious weight gain. seems like a recipe for disaster. And Ive yet to figure out the cause for my anhidrosis an the treatments Ive tried for the symptoms Im having, have done nothing.

Anyways, hopefully someone can shed some light and I apologize for making this a bit long and ranting.
7 Responses
649848 tn?1534633700
COMMUNITY LEADER
If one of the nodules is producing hormones independently of the thyroid, they could possibly drive the TSH down that low.  However, due to your weight gain and other symptoms, which sound hypo, not hyper, I'd have to wonder about Central hypothyroidism, which is a pituitary problem, not a thyroid problem.  Nodules are quite common, though, but yours is quite large.

With central hypothyroidism, the pituitary can't produce enough TSH to stimulate the thyroid to produce the thyroid hormones.  

Once you get back the thyroid tests, you can post the results here and we can better tell you what the issue is... Hopefully, the endo ordered Free T3 and Free T4, which are the actual thyroid hormones that your body uses.  If they, particularly, Free T3 is too low, your metabolism will be low and you'll have trouble losing weight.    

When you get those test results, please post them, so we can tell you more about what's happening. With luck, the endo also ordered antibody testing to determine if you have an autoimmune thyroid condition, so we'll be able to tell that from your blood work, as well.
Avatar universal
Hello Barb,

My Total T3 and free T4 came back, as well as the retest of the TSH. Also, for some reason, my Vitamin D went from Normal, to Insufficient in 18 days, dropped from 30-22

Vitamin D, 25 Hydroxy = 22 ng/mL

TSH = 0.64 uIU/mL

T4 aka Free Thyroxine = 0.80 ng/dL (Normal range 0.60 - 1.50 ng/dL)

T3, Total = 177 ng/dL (Normal range 87 - 190 ng/dL

I was really hoping for my TSH to jump to above 1.0 but it still remains low, albeit better than before

Not sure how to interpret the Low normal for Free T4 or the High normal for the Total T3. Im thinking optimum ranges would be near the middle for both?

As for free T3, not sure why it wasnt tested

Hope the info I provided helps and thank you for your reply.
649848 tn?1534633700
COMMUNITY LEADER
Your Vitamin D was too low at 30, even though it was in the "normal" range... 50-60 is considered optimal, so at 22, you're really low... I hope your doctor advises you to start supplementing.

Does the report actually say  "Free Thyroxine" or does it say just T4?  That can make a huge difference, because if it says just T4, then it's Total T4, which is obsolete and of little use; if it says Free Thyroxine, then it's really Free T4 and what we're looking for...

Most of us find that we need Free T4 to be about mid range and yours is only at 22% of its range, so it's really quite low.  With that low of Free T4, we'd expect to see TSH considerably higher than it is.  This could bear out my thoughts on central hypothyroidism, because it shows that the pituitary isn't producing adequate TSH to stimulate the thyroid.  

The Total T3 is obsolete and really doesn't mean much of anything, since most (90-95%) of that is bound by protein and can't be used anyway... The doctor should have ordered Free T3, so we could see how much of that is unbound (Free) and available to individual cells for use.

In a perfect world, Free T3 would be in the upper half to upper third of its range, but since you don't have an FT3 test, we don't know where yours is.

It's entirely possible that your endo will say that your TSH and FT4 are "in range" so everything is fine, but don't let him get by with that, because you do have symptoms of hypothyroidism and it's entirely possible to be hypo even when labs are in normal ranges.  Don't wait for the endo to bring up the possibility of central hypothyroidism... you mention it, if s/he doesn't and insist that it be ruled out.  

Also insist that Hashimoto's Thyroiditis be ruled out by having the thyroid antibodies, Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb) tested... It's also possible to have it and symptoms can be present for years before labs go out of range. Just don't let them tell you there's "nothing wrong"...
Avatar universal
Thank you again Barb. I see my endo again on Friday for the biopsy so hopefully I can bring it all up to him them.
Avatar universal
I wanted to update people on my biopsy today

the Endo did another ultrasound and while he was reading the findings to a women who was there (to collect the samples), he found that the nodule that was 3cm, is now 3.2cm. He didnt tell me it grew, just told the lady as she wrote it down.

After the biopsy, he said the results would be in by February 19 (2 weeks time). Is this normal?
649848 tn?1534633700
COMMUNITY LEADER
Yes, I think 2 weeks is about right for the results.  Do you have an appointment to go back in to get them?  

You really should ask your endo to updated Free T3 and Free T4 tests to recheck your thyroid status.  Often taking thyroid hormones can decrease the size of nodules.  

If you have central hypothyroidism, this could benefit you.
1 Comments
I might bring it up on the 19th to see if he could test for the free T3. I dont want to ask for too much as after 3 visits to my PCP and letting him/her know that the antihistamines they gave me arent helping with my anhidrosis and the reactions I get because of it, they decided to put me on anti-anxiety meds. Im actually in the process of leaving them because of that recommendation.

Ive never gone to them asking for anything. They were my 2nd PCP in 4 years, due to moving too far away from my first PCP. And the first one I had, I only visited once before I moved anyways, to check my vitamin D levels and cholesterol.

My first visit with my new PCP, was regarding the issue I discussed in another post that Ive been dealing with (anhidrosis and heat prickly feeling I get because of it). It was a quick conversation, the doctor ordered lab work and rescheduled for a follow up. In the follow up, the doctor prescribed antihistamines after seeing me for a couple of minutes and said to return on Feb 4th for a urine test. I returned on Feb 4th and he wasnt available but another doctor was there and she is a partner for this practice and 25 years experience, so I figured maybe she might help. Keep in mind, this was just another follow up appointment. And the following took place: She walked in, never mentioned me by name and asked what I was in for. Keep in mind, the nurse before hand see each patient, writes up a few things in the note and then forwards the entire file over to the doctor to look over, before seeing the patient. So after asking me what i was in for, I got confused and my answer was "my 2nd follow up". She then asked me again, what I was in for. So at this point, I went on to explain what was going on and she replied as follows: "the issue you are dealing with, is likely flushing and the rash you speak of, is not a rash at all". Keep in mind, she never saw me or my rash, that has already been seen by a couple other doctors who saw the rash as it occurs, only to disappear. They knew it was a rash instantly, and not a "hot flash". She then went on to say that I should try zyrtec over the counter, and if that didnt work, she would prescribe anti-anxiety meds.

When I spoke to her about the medications I was already taking, I told her they were curing the rash but not the other symptoms. I explained it to her like this; when my body gets hot, its attempts to sweat like any normal person. After the attempt to sweat, my entire body starts to feel a prickly heat sensation (feeling of being poked by hot needles that just came out of the oven, from head to toe). Immediately following that reaction, I get a rash/hives all over my body and If I dont intervene and try to cool myself down, my body starts to get very hot, my temp goes up 2-3 degrees instantly and I start to cramp up; as if I had the flu and was dehydrated or just played basketball in the summer with no fluid intake. Simply put, the meds only took away the rash, nothing else.

When I first had this reaction, I didnt want to see a doctor and felt that i could possibly figure it out myself. With a year of trial and error and loads of research, I was able to figure out that what I learned, wasnt enough and it was time to let the professionals figure it out. Which is why I went to this new PCP. Of course during that process, the TSH test came back abnormal but thats not what I was there for. So after explaining it to her, telling her the anthistimes were not working fully, and just taking the rash away, she decided I had flushing, not a rash and that i was suffering from anxiety. The nurse that was in the room with me, was confounded and he facial reactions were as if she knew the doctor was way off. In my 3 visits, Ive seen 2 different doctors, never went there mentioning anything to them about my own research, and hoped that may they could get to the bottom of this issue Ive had. I was always calm, cool and was never anxious; showed no signs of it whatsoever. In fact, when I went to my endo for the first visit last week, his intern noticed the rash as I was having a reaction right in front of him, he ran to get the doctor and he immediately recognized it and knew exactly what I already knew, that it was a cholinergic reaction (cholinergic urticaria). This isnt even in his wheel house and he knew that was the type of reaction i was having. Within minutes of cooling down, the rash and the feeling went away completely.

How int he world one of my PCP would say it was "not a rash" and also due to anxiety, is what led me to believe that this wasnt the right place for me. Also, she never mentioned me by name, never mentioned my bloodwork results (3 came back abnormal) and never even did a physical, which was also something that wasnt done in the first two visits. I should have realized from the starts that this wasnt a place where I would get real answers.

Just unreal. I wish I recorded the entire encounter on video, just to show how horrible it was.
649848 tn?1534633700
COMMUNITY LEADER
You should never be afraid to ask for "too much"... you pay doctors to make you well and when they don't it's time to find another doctor, no matter how many you've gone through... I once grabbed a doctor by the coat tail, as he was walking out of the exam room, because he didn't fully answer my questions...

The doctors can't do anything if you aren't clear and precise about what you're seeing them for... when they come in and ask what you're there for, don't hesitate to tell them, even if you already told the nurse and you think they should have read your file - there's a good chance they didn't or they want you to tell them in your own words.

Your thyroid controls so many of your body functions that having your levels off even a little bit, can cause a lot of havoc in your body.  Even an endo may not think this is important, but it is...

If you have central hypothyroidism, you don't have enough TSH to stimulate your thyroid to produce thyroid hormones and you'll need to take medication to replace what your thyroid isn't producing.  Too little thyroid hormones can cause a lot of various symptoms.  

Another thing to keep in mind is that if your pituitary isn't producing enough TSH, it's possible that it's not producing enough of other hormones either, including female sex hormones, and this could be contributing to your heat rash issues.  These are all things that should be addressed by the endocrinologist, because these are all endocrine hormones.
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649848 tn?1534633700
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