Hi I'm back with more questions.

[tebald]

Hi,
I posted on Jan 7th showing my results for an ultra-sound on my thryroid.  It determined that my right lobe was rather enlarged and I had a 2.6 cm mass on my right side.

Then I had a iodine/radioactive one done and it showed that my right lobe was only minimally enlarged and did not detect any cold or hot nodules.

Because of the first report it was suggested I have a FNA (?) needle biospy to make sure.

I have since gotten back my lab reports for the TSH?  Here are the results.

Total T4  result 5.0  flag L  Range 5.1-13.5
Free T4            1.0                      1.0-1.8

TSH          result 2.55        Range  0.27-4.20

I have had a history of Low Thryroid problems and was on medication for awhile (not currently taking anything)

So this morning I had the FNA and they said it looked good as it was solid and not cystic.  They said that is a good sign because most solid masses are Benign.  Well I looked it up and have read the opposite.

Just would like everyone's opinion.  Although my doc said my TSH levels were pretty close to normal, I do still have many low thryoid symptons.

Thanks for anyone's opinions :)

Elaine

[blsdnsvd]

You're right..but, this thyroid "rollercoaster" does contribute alot!

And i must commend you on being so knowledgable about all of this..I pray that i become a patient advocate and expert like yourself one day...:)

[blsdnsvd]

It normally takes up to 1 week to get the fna results back. It's been 1 business day...so if you dont get a call by wednesday (thank god) because that means it's nothing serious.  

You can contact your doctor to go over and question your ultrasound results being that you already have those.

Don't worry...it's very normal to be nervous..Lord knows, i was. It will all turn out okay.

[tebald]

Can I ask how long it usually takes to get an answer from the pathologist?  I mean I don't expect results immediatly, but I am looking over the first ultrasound, looking up terms and I am feeling a bit uncomfortable.  I know I know I shouldn't be doing that but can't help it.  I looked up terms like "quite inhomogenious and indistinct margins" from my report and those two don't look good regarding an outcome for cancer.

This is going to be one long week for me.

[goolarra]

Most of us have come to the conclusion that we can blame almost enything on the "scapethyroid"!  I do it all the time...better than admitting to getting old!

[blsdnsvd]

Sorry...typo!

Should of said that the goiter can be seen if it is enlarged....and yes i have had my thyroid touched many of times.....guess i could blame it on the brain fog! LOL

[goolarra]

No, you are confusing goiter and nodule.  A goiter is not described as "3 cm". Goiter (enlargement) is described as "twice normal size", "two and a half times normal size", etc. That's a nodule at 3 cm..  Not true of the nodules...nodiules can be palpated by your doctor, especially if large.  Usually, he'll touch your thyroid while you swallow water.  He can feel nodules in this way.  US and scans can confirm and further define nodules.

[blsdnsvd]

My right lobe was also enlarged due to a goiter with a 3.7cm nodule (mass).....

The goiter can easily be seen when it is larger than 3cm. Some people have nodules (mass) within the goiter and some just have a goiter. The nodules can only be detected by scan.

Prayfully your fna will come back benign and then you can speak to your endo about options to shrink the goiter and get followups on the nodule.

[goolarra]

Be sure to get FT3 as well as FT4 and TSH.  Yes, get the results of your FNA beore proceeding.  Also, ask for TPOab and TGab to see if you have Hashi's.

A "goiter" is just an enlarged thyroid.  It's a very generic term and should probably be lost once and for all as it causes a lot of confusion.  Nodules are "abnormalities" within the thyroid.  Thyroids are prone to nodules.  I recently read that a doctor thought he could pull five healthy people out of a grocery line and three of them would have nodules.  There are many diferent kinds of nodules, and, once again this is an unfortunate term that also causes a lot of confusion...all nodules are not created equal.  Most of us with Hashi's have nodules, and they're just monitored to make sure there are no sudden changes.  At the other end of the spectrum are "toxic" nodules, which function almost like a mini-thyroid within the thyroid, producing thyroid hormones independent of the influence of TSH and the rest of the thyroid.

Try selenium for the tightness, fullness feeling...many people with Hashi's feel this helps.

The enlargement you refer to is a "goiter", the additional mass is a "nodule".  Yes, two separate issues.

[tebald]

Thank you so much for all of your posts on this subject.  It really has helped me to learn about this more.

So I should probably wait until the results are in to have the labs re-done right?  Also even if it isn't cancer (crossing fingers lol) I might still have the mass removed for comfort correct?  I hate the tight fullness feeling I get in my neck ect.

Also, can someone tell me the difference between a nodule and a goiter?  I get confused and think it's the same.  For example the first ultrasound said that my right lobe is rather enlarged with an additional Mass on it.  So are those two issue's separate?

[goolarra]

Unfortunately, there's no easy answer to what levels of FT3/4 are right for each of us.  It's very individual.  The rule of thumb (one of those rules designed to be broken!) is that FT4 should be about midrange, and FT3 in the upper half to third of the range.  However, we all have to find where we are most comfortable.  We all have our own personal range within the population ranges that are on our lab reports.  Your personal range is going to be much narrower than the population range. Once you find where you are comfortable, meds can be adjusted to keep FT3/4 levels in your range and keep you symptom-free.

Suggestion:  cross out "total", write in "free", check the box!  Whatever gets the job done!

[blsdnsvd]

Thanks for the info. My tests include all but FT3 and on the lab slip, it's not mentioned (just T3Uptake/she requested and T3 Total/which she did not request).

What level do you believe the FT4 and FT3 should be at to be normal???? I will check my result for the FT4 and speak to my doc about testing the FT3....

Thanks

[goolarra]

Unfortunately, this is what most doctors learned in med school..."TSH is the gold standard for evaluating thyroid conditions".  Back when they went to med school, that might have been true.  It no longer is because assay methods for evaluating FT3 and FT4 have improved so and gotten cheaper over the years.  However, med schools are still teaching TSH, although some seem to be catching on to FT3/4.

My PCP, who "diagnosed" (another story!) me, knew virtually zero about thyroid, but she amazingly DID know enough to order FT3, FT4 and TSH.  She's pretty young, so maybe there is hope for those coming out of med school.  Let's suffice it to say she was totally inept, which drove me to recearch my condition and ultimately find this forum.  I learned a lot from many wonderful members.

I don't know what your lab slips look like.  Mine are a full page long and have check boxes for all kinds of bloodwork...thyroid among many others.  FT3, FT4 and TSH are all on there.  If your doctor is generating his own slips rather than using a preprinted form from the lab and his form doesn't even have FT3/4 on it, it's a bad sign that this doctor doesn't have a very good understanding of thyroid problems.

You have to make sure that they are testing FREE T3 and FREE T4.  T3 and T4, without the free or "F", are tests of total T3 and T4.  The totals tell the total level of T3 and T4 in the body, but much of that is chemically bound by protein and therefore unavailable to cells.  The frees tell what is actually there for you body to use.

You can pre-interview doctors before making an appointment.  You'd probably have to talk through a nurse, but one really good question is what tests they regularly order...gives you an idea of the doctor's philosophy of treatment.  Also, what treatment options they're open to (T4-only, synthetic T3/T4 combos, dessicated).

I have a pituitary issue (but didn't know that for over a year after diagnosis).  My TSH hovers around 20 all the time (even now that I'm euthyroid).  My doctors kept looking at my numbers and wanting to increase my dosage big time.  I knew something wasn't right, but try to tell that to one of these guys who thinks TSH is sacred.  For so many of us, TSH just does not reflect thyroid status the way it has been touted to.

Just read the many posts on this forum (several daily) from people who are being treated based on TSH and who are miserable because their FT3 and FT4 are being ignored.  Some doctors run FT3 and FT4, and then proceed to ignore them.

My endo always orders FT3, FT4 and TSH.  He's very symptom-oriented.  If one endo knows enough to do this, don't you think the others ought to get with it?

[blsdnsvd]

I totally understand what you are saying and i'm sure that you are an experienced patient, however.....I read in the book that  the "TSH" levels determine how the patients body is feeling as far as the thyroid hormone is concern. and also, on the lab slips given by the doc to the lab doesnt have testing for FT3 just FT4....so, how did you find a doc that tests for FT3 or T3 and base the patients condition on these tests??? Or did you suggest that your doc do these tests???

People who don't know, like myself........will go by what the endo says, only because they are the specialists.....

[898_1]

If solid nodule has no internal blood flow it most likely benign as well as simple cyst. If the report detects the blood flow iside the nodule it needs to be investigated more.
If nodule is not shows up on the RAI scan it means it produces the thyroid hormones [called warm] therefore it can be composed from overgrown thyroid tissue. It still has 5 to 10% chance of being cancerous.

[goolarra]

No, no, no...I can't emphasize enough that TSH is NOT the best way to evaluate thyroid status.  TSH is a pituitary hormone.  It can be affected by any number of factors besides thyroid hormone levels.  Free T3 and free T4 are the tests of the actual thyroid hormones.  They are MUCH mor important than TSH for a number of reasons.  FT3 correlates best with symptoms,  FT4 is somewhat behind FT3.  And TSH barely makes the list.  Total T3 and total T4 are considered obsolete tests (replaced by FT3 and FT4) and pretty much a waste of money.

tebald, you have hypo symptoms because your FT4 is on the floor of the range.  Many of us don't feel well unless our FT4 is close to midrange.  And, yes, they should be testing FT3 also.  You would probably feel much better on meds.

You both need to find doctors who treat on the basis of FT3 and FT4, not TSH.  You will be dealing with this condition for the rest of your lives, so be sure to learn all you can and to read opinions on all sides of all the issues.

[blsdnsvd]

I just started reading a book that i purchased in the summer of 09 before my surgery and i am learning so much from it! They say the TSH is the best way to determine how the body is feeling in regard to the thyroid hormone, and that is what most docs go by.

The scan will detect whether or not the nodules are hot or cold or warm. If it did not detect either, than your test was considered normal. It's normal to be a bit nervous while waiting for results, but do know that whatever the outcome, you will be ok. God Bless.

[tebald]

Thanks for your response.  I am still quite confused, especially when it comes to the TSH and T4 and such.  Weren't they also supposed to do a T3?

Also I don't understand why the Radioactive scan wouldn't show any hot or cold nodules?  That baffles me.  Is it not a very good test?

Thanks all.  I will be on pins and needles waiting for my FNA results and am a bit nervous.

[blsdnsvd]

If your TSH level is at a normal range, you will not be diagnosed as being hypothyroid.
TSH Levels are considered adequate when testing the thyroid function.  I'm still learning about the levels and what they all mean however, in my case...I had a total thyroidectomy due to a multinodule goiter and when i had my first labs done 4 weeks post surgery, my TSH was 39.51 and my Free T4 and Total T4 were both under normal (low) and that indicated that i was "hypo".....and my endo increased my med's based on that. Before i had the TT, my TSH was within normal range and my Free T4 and Total T4 were both on the lower end of normal...however it was still considered normal but I did have a few hypo symtoms and wasn't on any med's at that time.  

It's always a great thing to have more than one opinion, I had three before i finally made my decision.

To get on the subject of the goiter, i was told the opposite with my results. I had a "solid" "cold" nodule and it was at start 3.5cm. Due to the descriptions: "solid" and "cold", i was recommended to have a scan and a fna in which i did.....(started in 07)...the fna was benign, so i had an option to wait and see or have surgery for cosmetic purpose because of the size. In 09, i had the same set of tests again and
the nodule grew to 3.7cm, however the fna came bac benign again...this time, i was told to have surgery due to the abnormal cells that were in the nodule and "cancer" could not be ruled out, however a fna did not detect it and is not considered 100% accurate diagnosis of the particular cells that were there (Follicular and Hurthle cell)...
I had the surgery in Dec and the pathology report was benign....but if i chose to not have the surgery, i would've been taking chances and besides i did not want to go through life having a fna every 6mos.