Thyroid Nodules

[LionHeart_62]

I was diagnosed with Hashimotos 2 yrs ago this month.  I am on no medication for it.  I had the first ulrasound and Doctor said we will watch. That was 2 yrs ago.  Then Doctor didn't want to see me until May, but decided to do ultrasound again.  What was found was one complex, heterogeneous nodule on the
right measuring 1.4x2.3x1.3. And a heterogeneous but predominantly isoechoic nodule in lower left lobe measuring 1.7x1.2x1.1.  no vasularity or calcification.. Anyone know what that means?  

[gimel]

As I feared, your doctor is one of those that uses "Reference Range Endocrinology", by which they will tell you that a thyroid test result that falls anywhere within the reference range is adequate and couldn't be the cause for any hypo symptoms you might be suffering.  So totally wrong.

Just because thyroid test results are within the so-called "normal' range does not mean they are adequate for YOU.  The ranges were erroneously established many years ago and are far too broad for that to be the case.  Many of our members, myself included, say that symptom relief requires Free T3 in the upper third of its range and Free T4 around the middle of its range.  I'd be surprised if you have even been tested for Free T3 and free T4 (not the same as Total T3 and Total T4).  Do you know which tests were done?

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  You can get some good insight into clinical treatment from this letter written by a good thyroid doctor for patients that he sometimes consults with after initial tests and evaluation.  The letter is then sent to the participating doctor of the patient to help guide treatment.  In the letter, please note the statement, "the ultimate
criterion for dose adjustment must always be the clinical response of the patient."

http://hormonerestoration.com/files/ThyroidPMD.pdf

So if not tested for Free T3 and Free T4, along with TSH they always test, then you should go back and request both tests.  If the doctor resists and makes excuses that it is not necessary, just insist on it and don't take no for an answer.    Also, if not tested recently for Vitamin D, B12, and ferritin you should also request those.  Hypothyroid patients are frequently too low in the range for those as well.

If you will get those tests done and post results and their reference ranges shown on the lab report, members will be glad to help interpret and advise further.  Also I suggest that when you go back for the above recommended tests, you should ask the doctor if he is willing to treat clinically, by testing and adjusting Free T3 and free T4 as necessary to relieve symptoms, as described in the letter.  If not, then you are going to have find a good thyroid doctor that will do so.

[LionHeart_62]

Hi gimel...The last few times after the initial hospitalization...when my blood tests were taken the thyroid was normal.  I do have symptoms of hypo-thyroid.  Half of my hair has fallen out. It is very dry and brittle. I don't tolerate above normal hot or cold.  My iron and everything else is fine.  I am really low on vit D though.So for the last 2 yrs it has been an occassional ultra sound and bloodwork.  That is why I was surprized when my ultra sound came back, apparentely with something suspicious on it.  I don't have any blood work that I could post...just the results of the last ulrasound.  The only thing I ever had to deal with is asthma...so this is very frightening to me.  

[gimel]

I just wondered if your doctor has adequately tested you to determine if you need to be started on thyroid meds.  Beyond the tests for thyroid antibodies (TPO ab and TG ab), have you been tested for the biologically active thyroid hormones, Free T3 and Free T4 (not the same as Total T3 and T4).  If so, please post your test results and their reference ranges shown on the lab report.

Also, are you having any symptoms that might relate to being hypothyroid?

Since hypo patients are frequently too low in the range for other important areas as well, have you been tested for Vitamin D, B12, ferritin, and a full iron test panel?

[LionHeart_62]

Thank you so much for your response and your time . I am just a lil confused about the whole thing.  Like I said it has been 2 yrs since the diagnosis. I was very sick when it all came down.  I also have A-fib at the same time. But it is controlled on meds.  I will be making an appointment for FNA after holidays are over.

[898_1]

No vasularity or calcification means that the  nodules are composed from either dead tissue or colloid; this means that the nodules most likely benign. Such nodules are usually monitored; if blood flow calification or rapid growth noted, the biopsy has to be the next step