Definitely biopsy, and check your TGab thyroglobulin antibody. Why wouldn’t you? I wouldn’t wait. If you are in Florida definitely the place to go and get your surgery is wth Doctor Clayman at TAMPA GENERAL HOSPITAL
I had my labs tested for Hashimoto's and TSH was mid 2's with both thyroid antibodies elevated. My TSH was 1.4 to 1.6 with normal thyroid gland function.
Excerpt from Your Thyroid Problems Solved by Dr Sandra Cabot...
"Based on new research, the revised reference range for TSH is 0.3 -2.0 mIU/L.
Research has shown that anyone with a TSH above 2.0 mIU/L is likely to be in the early stages of hypothyroidism!"
***
Excerpt from Radiopedia - Hashimoto's thyroiditis...
"It is difficult to reliably sonographically differentiate Hashimoto thyroiditis from other thyroid pathology. Ultrasound features can be variable depending on the severity and phase of disease 1,5:
diffusely enlarged thyroid gland with a heterogeneous echotexture is a common sonographic presentation 6
the presence of hypoechoic micronodules (1-6 mm) with surrounding echogenic septations is also considered to have a relatively high positive predictive value 3,4. This appearance may be described as pseudonodular or a giraffe pattern
colour Doppler study usually shows normal or decreased flow, but occasionally there might be hypervascularity similar to a thyroid inferno
prominent reactive cervical nodes may be present, especially in level VI, but they have normal morphologic features
patients are at higher risk for papillary thyroid carcinoma, so a discrete nodule should be considered for biopsy
In some situations, large nodules may be present, which may be referred to as nodular Hashimoto thyroiditis 10"
Wow... are you sure those are the only symptoms you have? I'd be feeling like crud if my Free T4 and Free T3 were that low in their ranges...
Most of us tend to feel best when Free T4 is about the midrange point. Yours is only at 37% of its range. We also tend to feel best when Free T3 is in the upper half to upper third of its range; yours is only at 21% of the range. Free T3 is the active hormone that's used by nearly every cell in the body and if we don't have enough, we're going to have hypo symptoms. If you don't know how the Free T4 and Free T3 work, I'll be happy to explain it.
I would definitely recommend that you get the antibody tests to confirm/rule out Hashimoto's because IMO, your thyroid is definitely not producing optimal levels of hormones, regardless of what your doctor says or thinks.
Free T4 and Free T3 can be perfectly normal but you can still be positive for antibodies. Antibodies can present for years before enough damage is done to the thyroid to cause Free T4 and Free T3 to go out of range. On top of that, simply having Free T4 and Free T3 "in range" doesn't mean you don't hypothyroidism... you're right that all of us are different and because of the way the ranges are set, even if you're in the bottom of half of the range, you can be hypo.
Symptoms of Hashimoto's are, typically, mostly the same as those of being hypo though there are a few different ones.
In many instances, I agree with your doctor about "Dr Google", but there's nothing wrong with doing internet searches if you're using reputable sources to get your information. Many doctors have so much ego they simply don't want patients questioning (or adding to/subtracting from) what they say... Don't let that put you off. The thing with internet research is to make sure you don't go looking for the worst things or let your imagination run wild so you buy trouble that will most likely never come. It's my habit to stop looking/reading if I start scaring myself, especially if it's way off from what my doctors have said, though I will run by my doctor what I read in order to get an explanation of why that doesn't fit my case.
If you'd like to post your Free T4 and Free T3, with reference ranges, I'll be happy to take a look at them and give you my opinion. Also, provide any additional symptoms you might have besides being cold and/or dizzy.
If nodules aren't really suspicious, etc. many times, they aren't described well. Mine was simply described as a "solid" nodule and the size, so I don't know if it's calcified or not.
TSH has very little to do with nodules, so don't let the fact that it's "normal" bother you in relation to the nodule... TSH is a pituitary hormone and all it does is signal the thyroid to produce thyroid hormones. As long as, both, the thyroid and the pituitary gland are working properly, TSH will be in the normal range.
What happens is that sometimes the body, for whatever reason, sees the thyroid as foreign and produces antibodies to destroy it. The antibodies can be at work for many years, diminishing thyroid tissue and output, before the pituitary gland realizes what's going on. Besides TSH, you also need to have Free T4 and Free T3 tested. Those are actual thyroid hormones and will tell you what thyroid output really is. TSH is only an indicator, and should never be used as the sole determinant of thyroid status, though many doctors use it as such because that's what they learn in med school.
I'm sure your doctor probably lectured you on doing too much internet research, huh?? lol
You can go back and let him know you've been doing more research and that you'd like to have Free T4 and Free T3 tested to determine actual thyroid status, along with thyroid antibodies, Thyroid Peroxidase (TPOab) and Thyroglobulin Antibodies (TgAb) to confirm or rule out whether you have Hashimoto's.
In theory, TSH only goes out of range, when thyroid hormones become too low. That theory doesn't work for all of us, because there are things other than thyroid hormones that can affect TSH so it can vary by as much as 70-75% over the course of a day. Without having Free T4 and Free T3 tested, you don't know if your thyroid is working well or not.
Is the large neck the only symptom you have that might indicate a thyroid condition?
You should ask to be tested for Hashimoto's Thyroiditis. That's an autoimmune condition in which antibodies attack the thyroid and eventually destroy it so it can no longer produce the hormones you need.
Cystic nodules are fluid filled and can come and go. The nodule having grown from 6 mm to 7 mm is not a big deal and I doubt you'd even find a doctor willing to do an FNA on that because there's no reason to.
Although solid, hyper-vascular nodules are more likely to be cancer, FNA (biopsy) of nodules less than 1-2 cm is typically not done because it's hard to get enough sample to make a determination as to whether or not cancer is present or not. This is what your endo meant by over-treatment because you will end up "watching and waiting" because the results will most likely be indeterminate.
If you wait 3 months then have another ultrasound to see if the nodule has grown large enough for biopsy you'll have a better chance of getting a good sample the first time and knowing exactly what you're dealing with.
Thyroid cancer doesn't often spread to other parts of the body and is, typically, cured by removing the thyroid.
All of that said, even though you've gotten a second opinion, you should feel free to get additional opinions if you still don't feel comfortable.
To put it all in a different perspective, I have a solid nodule that's 1.1 x 1.0 x 0.8 cm and my doctor refused to even refer me for biopsy... I've had this nodule for almost a year; when/if it reaches 2 cm, which is the American Thyroid Association's criteria for FNA (except in certain situations), my doctor will refer me... because yours is calcified, your doctor should not wait until it reaches 2 cm, but may wait until it reaches 1 cm in order to ensure chances of enough sample during the first FNA so they get a determinate result.
In the meantime, since the ultrasound indicates that you have thyroiditis, have you also been diagnosed with, either hyper or hypothyroidism? Do you take any type of thyroid medication? If so, what medication(s), dosage(s), for how long, etc.
What prompted the ultrasound?
Ooh and just to add to the info above, the entire thyroid gland is heterogeneous in structure and has several micronodules.