Ultrasound Results puzzle me

[widgetgidget]

Very new here, have been going through 2 months of testing, have all of the typical hypothyroid symptoms, you name it I have it & a nice sized goiter.

TSH level is 10.21 , I'm waiting on them to fax my Free T4 results, but she said they were normal range.
They put me on .25mcg of Synthroid which I had to wait until after the RAIU to start taking, been on it 3 days now.

My GP ordered an ultrasound & radioiodine uptake and she called today and said everything looks normal-
I really need help interpreting what it all means because I am not 100% confident in my gp knowing what she is looking at.

RAIU was 15% at 6 hours which is within normal limits.

Ultrasound results are below:
Findings
The right thyroid lobe is 4.2 x 1.6 x 1.8 cm.
The thyroid isthmus is 4 mm AP dimension.
The left thyroid lobe is 3.7 x 1.3 x 1.6
cm. Adjacent to the left lower
thyroid lobe is a 6 mm by 7 mm x 5
mm nodular area which is less echogenic
than the thyroid lobe and this could
represent a small lymph node or
parathyroid adenoma.

In the region of the inferior right
thyroid lobe is observed a cluster of
small oval slightly hypoechoic
structures each of which are
proximally 4 mm
diameter. Parathyroid adenomas are
possible but unlikely to be multiple.
Small lymph nodes are most likely.

CT with contrast may be considered.

No evidence of a definite thyroid mass.

Thyroid gland overall is inhomogeneous.

Impression
Small nodular foci above the inferior
thyroid lobes bilaterally. Favor small
lymph nodes. Cannot exclude
parathyroid adenomas

[Barb135]

At least they have you on replacement hormones (synthroid).  It takes 4-6 weeks for the hormones to reach full potential in your body, then they should retest, since 25 mcg is usually only a starting dose.

You're right - RAIU is pretty much useless for someone with hypo, which your symptoms certainly are.

Next time you get tests, you should be sure to ask for Free T3, which is the hormone that is actually used by the individual cells. FT4 is a storage hormone and must be converted to FT3 prior to us by the cells.  Some of us don't convert adequately and have to add a source of T3 medication, such as cytomel or desiccated hormones.  The only way you can determine that is by testing both FT3 and FT4.

You should also ask for thyroid antibody tests to determine Hashimoto's.  The tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TGab).  You need them both because some people have one, some the other and some both.  For instance, f you tested only TPOab, it could be negative, but you could still have elevated TGab.... and visa versa.

[widgetgidget]

Thanks for the reply,

The labs normal T4 range is .08-1.8

They put me on .25mcg of Synthroid, this is the 4th day I have been back on it since the RAIU, I was only able to take it for 3 days before I had to stop taking it for 3 weeks for the RAIU.

The only tests he has done are the TSH, Free T4, Ultrasound, and the RAIU- which I have read was a total waste of time and money for someone with hypothyroid,  the tech also said they normally only do RAIU on hyper.

Symptoms are goiter, fatigue, dry skin, hair loss, weight gain, brittle nails, extremely cold all of the time, constipation, sore muscles and joints for no reason, extremely heavy periods, & swelling in hands at times.

Thanks again, it's nice to have someone elses insight.

[Barb135]

First off, what's the range for the FT4?  Ranges vary from lab to lab and have to come from your own report.

Your TSH is way too high at 10.21, indicating that you have hypothyroidism, even though FT4 is still in range. Without the range, I can't know for sure, but I'm guessing it'll be pretty low in the range.  

Have you been tested for thyroid antibodies that would diagnose Hashimoto's Thyroiditis?

I'm far from an expert on interpreting thyroid ultrasounds, but I don't really see anything significant with the thyroid, though there are some small nodules, which are common with Hashimoto's and are usually nothing to be concerned with..

What struck me was the reference to parathyroid adenoma.  You should ask your doctor to test your calcium levels and do more to determine if there is a parathyroid issue.

Most people have 4 parathyroids, which control the calcium in your body. The parathyroids lay just behind the 4 corners of the butterfly shaped thyroid.  The only relationship the parathyroids have to the thyroid is their position in the body.  They perform totally different functions.

From the reading I've done, the only treatment for parathyroid adenoma is to remove that parathyroid.

Are you on a thyroid replacement medication?  If so, which one, what dosage and for how long?  

What symptoms do you have?

[widgetgidget]

Got the fax just now rom the doc my Free T4 is at 1 even.

Thanks in advance for any insight anyone can offer.