What questions do I need to ask my son's physician?

[dizc1961]

My 19 year old son, has recently complained of having problems swallowing, which prompted his doctor to do an ultrasound on his thyroid.  The ultrasound results were as follows:
Thyroid ultrasound:
a nodular goiter with the right lobe measuring 66x18x21mm and the left lobe measuring 66x16x18mm.  Isthmus is upper normal at 5mm.  The largest nodule is on the superior-lateral aspect of the right thyroid lobe measuring <29x9mm in parasagittal cut.  The nodules on the left measure 5x3mm and 7x5mm.  There is some coarseness to the rest of the thyroid stroma.
Opinion:
Multinodular goiter.

In his March blood work all thyroid levels were within normal range.

His doctor is sending him for more blood work.

Are there any questions I need to be asking?

[dizc1961]

Thank you both so much for your suggestions.  All his thyroid bloodwork came back within normal range.  His A1C was 5.2.  The only things elevated were his AST(SGOT) 48 and ALT(SGPT) 78 (fatty liver??) and his Albumin was at 4.9.  He is going for a radioactive iodine uptake test July 23rd.  I will be speaking with his doctor before then and will ask about these other test.  He is a LARGE fellow @ 6'6" and about 280...very large boned.  
Had an enlarged parathyroid gland and mild diffuse goiter at age 14 with A1C of 8.6.  
At age 16 thyroid ultrasound showed no goiter and normal parathyroid gland and A1C was back down to normal ranges.

[Blue727]

I am not a doctor, but I am a young man going through some similiar problems.  I applaud you for being your son's advocate on this, as sometimes the patient's mis-interpret or take things being said differently.

If you have a doctor that is willing to run the gammit of tests, I would suggest the following, which was taken from the allthingsmale.com website.  It's an extensive list, but it will rule out pituitary issues, thyroid issues, adrenal gland issues, if there is a disease of the thyroid (Grave's or Hashimoto's) and if the neurotransmitters in the brain are blocking or receiving the correct information (from what I was told).

Suggested Tests:

* Total Testosterone
* Bioavailable Testosterone (AKA "Free and Loosely Bound")
* Free Testosterone (if Bioavailable T is unavailable)
* DHT
* Estradiol (specify the Extraction Method, or "sensitive" assay for males)
* LH
* FSH
* Prolactin
* Cortisol do this test by blood morning fasting test.  If it's below 15, then do a saliva test
   through CanaryClub.com.
* TSH But this lab is only for diagnosis of hypopituitary.
* Free T4 and Free T3 (note the word “free”)
* Thyroid Antibodies (anti-TPO and TgAb. YOU NEED BOTH.) Test for Grave's and  
  Hashimotos
* Ferritin (and do stress FERRITIN, not just RBC)
* Adrenals Cortisol levels (but we strongly recommend saliva tests)
* B-12
* Estrogen
* Progesterone
* DHEA
* Reverse T3
* CBC
* Comprehensive Metabolic Panel
* Lipid Profile
* ACTH Stim test
* Growth Hormone (24 hour urine test)
* Neurotransmitter (24 hour urine test)

If your there and the doctor is willing, an MRI with and without contrast of the pituitary gland may also be helpful.  In my case, I have low TSH, low Free T3, low Free T4 and low Testosterone, so it's more than likely a pituitary/hypothalmus problem.  These are the tests I will be having run very shortly.

Hope this helps and good luck with everything.

[redheadaussie]

Ask if the doctor is doing an anti-thyroid anti-bodies test. Ask if Free T3 and Free T4 were done, as just getting the basic TSH level is not enough to do a thorough diagnosis.
Multi-nodular goitre is suprisingly very common, many people never even know that they have a lumpy bumpy thyroid. Only when it causes problems with swallowing or breathing is any action taken. So ask if these tests were done.
   Often even just a low dose of replacement thyroid medication is enough to shrink the goitre down and the symptoms are often greatly reduced.
Good luck!