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Thyroid Nodules
My doctor found my thyroid to be enlarged in 10/14 at a routine exam. She sent me for an US on my thyroid. Results were:
FINDINGS: The right lobe measures 4.8 x 1.9 x 1.6 in the left lobe 5.1 x 1.6 x 1.5 cm in size. The isthmic areas 0.34 cm in thickness. There is a 1.2 x 1.1 x 0.8 and 1.6 x 1.5 x 1.3 and 0.7 x 0.7 x 0.5 cm nodule right lobe thyroid gland and 0.9 x 0.9 x 0.5 cm nodule lower third region of the left lobe thyroid gland. Contour is free from irregularity. Minimal lobulation to the contour of the thyroid lobes. No other abnormality. IMPRESSION: Sonographic findings and appearance suggests multi nodular goiter as described.
I was then sent for a thyroid uptake scan with the following results:
FINDINGS: Planar images obtained of the thyroid gland. Thyroid gland size appears mildly prominent. Thyroid tracer activity appears diffusely heterogeneous throughout bilateral gland. There is no evidence of abnormal focal increased or decreased tracer activity to suggest the presence of hyperfunctioning or hypofunctioning nodules. The 6 hr radioiodine uptake measures 20%, mildly elevated. The 24 hr radioiodine uptake measures 34%, mildly elevated. IMPRESSION: 1. Mildly prominent, heterogeneous appearing thyroid gland without evidence of dominant hyperfunctioning or hypofunctioning nodules. 2. The 6 hour and 24 hr radioiodine uptake measurements are mildly elevated, please correlate clinically for possible hyperthyroidism.
My TSH was 1.11 in 6/2012 and was 0.8 in 10/2014. T3 and T4 not tested.
The results to me seem to indicate nothing to worry about, maybe just watch it, but I want to make sure I'm not getting blown off by my doctor. Can someone please advise on if any further tests should be done or if this warrants further monitoring?
FINDINGS: The right lobe measures 4.8 x 1.9 x 1.6 in the left lobe 5.1 x 1.6 x 1.5 cm in size. The isthmic areas 0.34 cm in thickness. There is a 1.2 x 1.1 x 0.8 and 1.6 x 1.5 x 1.3 and 0.7 x 0.7 x 0.5 cm nodule right lobe thyroid gland and 0.9 x 0.9 x 0.5 cm nodule lower third region of the left lobe thyroid gland. Contour is free from irregularity. Minimal lobulation to the contour of the thyroid lobes. No other abnormality. IMPRESSION: Sonographic findings and appearance suggests multi nodular goiter as described.
I was then sent for a thyroid uptake scan with the following results:
FINDINGS: Planar images obtained of the thyroid gland. Thyroid gland size appears mildly prominent. Thyroid tracer activity appears diffusely heterogeneous throughout bilateral gland. There is no evidence of abnormal focal increased or decreased tracer activity to suggest the presence of hyperfunctioning or hypofunctioning nodules. The 6 hr radioiodine uptake measures 20%, mildly elevated. The 24 hr radioiodine uptake measures 34%, mildly elevated. IMPRESSION: 1. Mildly prominent, heterogeneous appearing thyroid gland without evidence of dominant hyperfunctioning or hypofunctioning nodules. 2. The 6 hour and 24 hr radioiodine uptake measurements are mildly elevated, please correlate clinically for possible hyperthyroidism.
My TSH was 1.11 in 6/2012 and was 0.8 in 10/2014. T3 and T4 not tested.
The results to me seem to indicate nothing to worry about, maybe just watch it, but I want to make sure I'm not getting blown off by my doctor. Can someone please advise on if any further tests should be done or if this warrants further monitoring?
COMMUNITY LEADER
What are the reference ranges for the Free T3 (Triiodothyronine) and Free T4? Ranges vary lab to lab and have to come from your own report.
Vitamin D is necessary for the metabolism of thyroid hormones.
There's another antibody test, mentioned above, that should have been ordered. It's the Thyroglobulin Antibodies (TgAb), which would also be the basis for diagnosing Hashimoto's. While your TPOab is negative, without the TgAb, a diagnosis could be missed, since some of us have one or the other of the antibodies and some have both.
Hashimoto's is progressive, in that the antibodies (if TgAb are present) are constantly destroying thyroid tissue, so your FT3 and FT4 would gradually come to indicate hypothyroidism, even more so than they might right now, though your FT4 appears low (depending on its reference range).
Vitamin D is necessary for the metabolism of thyroid hormones.
There's another antibody test, mentioned above, that should have been ordered. It's the Thyroglobulin Antibodies (TgAb), which would also be the basis for diagnosing Hashimoto's. While your TPOab is negative, without the TgAb, a diagnosis could be missed, since some of us have one or the other of the antibodies and some have both.
Hashimoto's is progressive, in that the antibodies (if TgAb are present) are constantly destroying thyroid tissue, so your FT3 and FT4 would gradually come to indicate hypothyroidism, even more so than they might right now, though your FT4 appears low (depending on its reference range).
Okay, a different doctor (because I haven't seen the same one twice :)) tested my T3/T4/antibodies, etc. and they all came back normal.
TSH w/reflex to FT4 - 0.94
Triiodothyronine free serum - 3.2
Throid Peroxidase Antibodies - 7
T3, Total - 145
T4, Free - 0.98
She also had my vitamin D level tested and that came back low at 15.7. She is putting me on high dose of Vit D for 12 weeks then supplements indefinitely.
Since it seems I only have multiple nodules and all scans/labs seem to be normal, is the Vit D deficiency related (hinting at something more) or just a coincidence? Should I be concerned with my thyroid or just wait and see what time will tell?
TSH w/reflex to FT4 - 0.94
Triiodothyronine free serum - 3.2
Throid Peroxidase Antibodies - 7
T3, Total - 145
T4, Free - 0.98
She also had my vitamin D level tested and that came back low at 15.7. She is putting me on high dose of Vit D for 12 weeks then supplements indefinitely.
Since it seems I only have multiple nodules and all scans/labs seem to be normal, is the Vit D deficiency related (hinting at something more) or just a coincidence? Should I be concerned with my thyroid or just wait and see what time will tell?
COMMUNITY LEADER
Be sure to let us know the results... we'll look forward to hearing.
Thank you! I really appreciate your responses. I went back to the doctor today and they are going to do the antibodies testing. Hope the new year finds you in good health!
if nodules do not have blood flow on Power Doppler they are benign. TSI antibody test can be a next step due to increased 6 hour diffuse uptake.
COMMUNITY LEADER
While there may not be anything to really worry about right now, I do think further testing is warranted, because nodules aren't real common on a completely "normal" thyroid.
Free T3 and Free T4 (not just T3 and T4 - there is a difference) should be tested every time a TSH is tested, though I know most doctors don't agree with that.
In addition, since RAI uptake was mildly elevated you should have antibody tests done to determine if you have either Hashimoto's Thyroiditis or Graves Disease, both of which are autoimmune thyroid diseases. One can have either of these diseases for long periods of time with no symptoms, or symptoms can gradually start appearing.
Hashimoto's is, most often, associated with hypothyroidism, but is often characterized by periods of hyperthyroidism in early stages. Graves Disease is always associated with hyperthyroidism.
The antibody tests you need for Hashimoto's are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb). You need them both, because some of us have one or the other, some have both. The definitive test you need for Graves Disease is Thyroid Stimulating Immunoglobulin (TSI).
Common symptoms of hypothyroidism are unexplained weight gain, constipation, fatigue, hair loss, facial puffiness, muscle/joint aches/pains, depression, low heart rate, cold intolerance, etc. Common symptoms of hyperthyroidism include unexplained weight loss, diarrhea, fatigue, depression, anxiety, rapid heart rate, heart palpitations, hand tremors, irritability, mood swings, etc. This is by no means a complete list of symptoms of either...
Free T3 and Free T4 (not just T3 and T4 - there is a difference) should be tested every time a TSH is tested, though I know most doctors don't agree with that.
In addition, since RAI uptake was mildly elevated you should have antibody tests done to determine if you have either Hashimoto's Thyroiditis or Graves Disease, both of which are autoimmune thyroid diseases. One can have either of these diseases for long periods of time with no symptoms, or symptoms can gradually start appearing.
Hashimoto's is, most often, associated with hypothyroidism, but is often characterized by periods of hyperthyroidism in early stages. Graves Disease is always associated with hyperthyroidism.
The antibody tests you need for Hashimoto's are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb). You need them both, because some of us have one or the other, some have both. The definitive test you need for Graves Disease is Thyroid Stimulating Immunoglobulin (TSI).
Common symptoms of hypothyroidism are unexplained weight gain, constipation, fatigue, hair loss, facial puffiness, muscle/joint aches/pains, depression, low heart rate, cold intolerance, etc. Common symptoms of hyperthyroidism include unexplained weight loss, diarrhea, fatigue, depression, anxiety, rapid heart rate, heart palpitations, hand tremors, irritability, mood swings, etc. This is by no means a complete list of symptoms of either...
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