thyroid nodule

[heartaches101]

Should my thyroid levels be  checked because of the nodule?  Which test should be done, if any?

[Barb135]

It's good that you're being started on the Synthroid.  That will help alleviate some symptoms, as will vitamin D, when your levels get higher.

Your TPOab is just slightly elevated and normally, we'd say that's Hashimoto's, but small amounts of TPOab can be present in other autoimmune diseases, as well.  The doctor should have ordered Thyroglobulin Antibodies (TGab), as well.  TGab is another marker for Hashimoto's.  Some of us have one or the other, some have both; you should ask the rheumatologist or the endo for the TGab test.

I'm not good with the ANA readings; positive with positive rheumatoid factor would most likely be RA.  CRP measures inflammation in the body, which is consistent with, both RA and Hashimoto's.

The report was just mentioning certain conditions that could be present with those readings - not that you actually have all those things. I'm sure the rheumy will do more testing to get a definitive diagnosis.

[heartaches101]

I finally seen the Endocrinologist and got the test results back.  I have Hashimoto's thyroditis.  He is sending me to a Rheumatoid arthritis doctor because of the levels of some of the test.
FT4 was1.22 range is .93-1.70
TSH was 3.19 range was  .250 - 4.20
Started me synthroid last week.
Vitamin D was down to 26 and range is >30  now has me take 50,000. units twice a week for next six weeks.
Sedimentation rate  ESR  results 28 and range 0-30
TPO was 41 and range was 0-34

All of thr antinuclear stuff is Greek to me!
Antinuclear antibodies ifa  negative <180  borderline  1:80  positive 1:80
homogeneous pattern 1:16 abnormal
Speckled pattern 1:16 abnormal

then it has a statement that positive ana results may occur in healthy individuals or be associated with a variety of disease. See interpretation below:
pattern    antigen detected    suggested disease associations
homgeneous (smooth)  dna (ds, ss,), ss-a/ss-b    high titers - sle
speckled     sm, rnp, scl-70 , ss-a/ss-b      sle,mctd,scleroderma,sjogrens
nucleolar    scl-70, pm-1/wscl  high titers scleroderma overlap
centromerge     centroinere   pss w/crest syndrome variable...

rheumatoid factor is  abnormal at 16.   with range 0 to 13.9
uric acid              is abnormal at 7.3 with eht range in  2.4-5.7
c-reactive protein quant test
crpl3     .700 is abnormal....,range is 0 to .500

what is the indication of the labs.   That I have rheumatoid arthritis or maybe lupus?  My appointment with the rheumatoid dr is May 27.

thank you for your help and guideness.

[heartaches101]

I got the report from the  4-1-14 NM Thyroid upt and scan  I123  ......result was uptake was calulated at 10.3%.   The right lobe uptake is 5.9 and the left lobe uptake is 4.3.  Thyroid gland demonstrates no photopenic or area sof abnormal radiotracer accumulations.  Impression: (1) Symmetric uptake of the thyroid gland without photopenic regions or metabolic area of increased activity. (2)  Thyroid uptake at 10.3% which is at the lower limits of normal.  (3)  Given the size of the solid nodule on ultrasound and development since the prior examination of 2/7/2007 fine needle aspiration is recommended to ensure a benign process.   NOTE:  I DID NOT NOTICE THE DATE OF THE 2/21/07 until later and called drs office back and told them I never had a test on my thyroid until this year.   Nurse checked with Radiology dept. and called me back to tell me I was correct and I had not had the 2007 scan.   There are two other people living in the small town I live in with the same name.   I even have them check my birthday on everything...which they are suppose to do anyway.  

1-23-14Ultra souond results :  There is a 1.8  cm thyroid nodule involving the mid pol.  I123. recommended.

1-27-14CT soft tissue neck with contrast Unremarkable nasopharynx, oropharynx, tongue base, axial epiglottis, and cords.  Unremarkable parotid glands, and submandibular glands.  No mass or adenopathy identified.   Specifically no mass identified laterally in the right neck at the site of a marker overlying the site of a possible mass.   There is a 1 cm somewhat tubular area of decreased attenuation posteriorty in the right lobe of the thyroid which is unchanged from 10/18/12.....which I did have a chest scan done to check the nodule in my lung that the surgeon had not biopsied when he did the lymph nodes in 07/12.  

There is chronic obstructive pulmonary disease.  .
No acute osseous abnormality.  There are multilevel degenerative disc space disease in the mid to lower cervical spine.

So do I have two different nodules?     I did not know about the tubular area?

I do go for the fine needle biopsy on Tuesday morning.   I am first going to get the remaining reports checked to be sure they are mine, and not a name alike results?

[heartaches101]

I have been without a computer, because of a hacking issue.  I have that resolved.   My radioactive thyroid scan is scheduled for Monday 3/31 and 4/1, with follow-up with the doctor on 4-4.  Wait.....wait...wait.

I am like you, I feel like some of my numbers are low.   I wonder what my vitamin d would be if I didn't take 55,000. units every Monday for the last 16 months.   I had the test on a Thursday.

I have made an appointment with a Endocrinologist.  They are already requesting copies of ultra sounds,  and the scans I have had.   I have a appointment for May 1st, unless they have a cancelation before then.  My best friend has been with him for years and he comes highly recommended.  His nurse asked what size the nodule was and I told her 1.8 cm and she said he will usually biopsy nodules that were larger than 1 cm.

It seems like I get a lot of different stories on this journey.  I will be glad when the test is over and I see the endocrinologist?

I need to make a list of questions to ask the Endocrinologist in May ,   I should have them to send a copy of the radioactive test to the Endocrinologist as well as the doctor that ordered it.


I guess I should take these test result with me?  Or let him run new blood test?    

So who would do the needle biopsy if one has to be done, and what would be that deciding factor?  The Endocrinologist?   I know the surgeon doesn't.  The surgeon says the T134 scan  and the Endocrinologist nurse made it sound like he size would require one if it was over 1 cm.   I feel like I am in a dark hallway, reaching out and getting bits of information

I am better at understanding numbers.  

Yes the ARNP led me to believe that he was running the test I asked him to run......and in his mind he probably thinks he did....hah..........but he did more than the two doctors I had spoke to did but still not what I asked for in the first place..   I felt like they(drs) didn't run test because I asked if they were going to run test to test the function..  

So I guess I could go back to the ARNP and force the issue but I figure his response is going to be that the numbers are within the range,  Or I can wait....something I seem to be doing a lot of lately......and se what the Endocrinologist will do?     Any suggestions. .

[Barb135]

I do not think they are all "fine" or good or even satisfactory...

Your vitamin D is way too low in the range... it should be in the 50 - 80 area in order to relieve symptoms; you have a long way to go.

Your Ferritin isn't "horrible" but it's still too low.  Ferritin should be around 70, at least.

Your Vitamin B12 is pretty dismal as well.  I, personally, have to keep my vitamin B12 much higher.  The range my lab uses is 200 - 1100 and I have to keep my levels at the upper end or above.  Some countries consider anything less than 500 to be deficient; even my lab puts a note on that says (paraphrased) even though labs are in the normal range, those below 500 can cause symptoms.

Really?  They did TSH with reflex?... that means you won't be getting a Free T3 or Free T4 result.  TSH with reflex is instructions for the lab to test TSH and if it's in range, nothing more is to be tested; if it's out of range, FT4 would be tested.  FT3, typically, has to be ordered as a separate test. If these were ordered by your ARNP, he did you a disservice, if he told you he was ordering all the necessary thyroid tests.

[heartaches101]

I got some of the test results back:
  Test name                                      my results              range
Vitamin D, 225-hydroxy                    32                           30-96 ng/ml
Ferritin                                            51                            10-270 ng/ml
Vitamin B12                                    372                           213-816 pg/ml
TSH  with reflex                               2.5                            0.35-4.94

The Free T3 and Free T4 has not come back but I will post when I get results.   I was told these test came back fine.   What do you think?   Thanks!

[Barb135]

I'm so glad you got the tests done.  Did you get thyroid antibody tests, as well?  

Please be sure to post your tests results when you get them.  Even though they may be "in range" they may not be where you need them.

[heartaches101]

Test done this morning.   He couldn't believe they didn't run any.  Results will be back by Monday.   I gave him the list......and asked if that was what he would have ran and he said yes.   Thank you so much, like I told him, it may all be perfect, but at least we KNOW that for sure and I will sleep better, because that was my first instinct was to have the function levels checked and I am not a medical professional.  He also told me if I ever didn't feel like he was doing what he what I felt he should do, then tell him, or get a second opinion.  So thanks to the two of you, I feel much better, no matter the results of the blood work or the T134 which I will get scheduled on Friday.  I believe that the people and things you need always comes to you when you need it....you just have to be open to it.  So I am ready for the rest of my life to be the best of my life.  May your life be blessed with abundance.   Thank you for taking your time to help me.  Jan

[Barb135]

Good luck.  Will look forward to hearing how it all goes.

[heartaches101]

I am not sure they sent the report, but the doctors in the hospital network can share labs, test, and such.  He had his nurse pull it up and he pulled it up.  I don't think, from his actions, that he liked the way Dr.F handled it.   Dr. F is arrogant and I'm not sure he would be ordering the right test,  if I hadn't asked when he said the ct scan didn't really show them anything.   I stated, I was under the impression that this test would show hot and cold spots and would determine if I needed a needle biopsy.   Yeah, he looked shock. that's when he told me I was given the wrong test.  I really never seen him unless necessary, I was primarily his nurse APRN, whom I liked very much.   I know the mistake would not have happened if he had handled it.   He left that doctors office suddenly.  He has opened a clinic and I am sure I can go there and he will order the test.  I would almost bet I won't have to tell him the things to check, but I am going to ask what he thinks needs to be checked because I am not going to settle for only checking the tsh, which is what may happen.  So armed with my list, off I go.   I will post how it goes.   Yes I always get copy of my labs to share with my other doctors and as a record, I keep them in a medical journal, so I can keep what happens medically straight.  Thank you so much, for arming me with knowledge....now I can go battle the system.  I hope they all come back great, but the wondering is killing me, and I don't see how the  doctor wouldn't want to know if it is even functioning.  

[Barb135]

Did your doctor sent the ultra sound report to the lung doctor?  Have you gotten copies of all your labs?  If not, you should be aware that your doctor is obligated, by law, to provide them to you, upon request.  Some doctors are so arrogant they think they don't need to provide copies to their patients.

You don't necessarily need an endo, but you do need someone who will test your thyroid hormones (not just TSH), to determine whether or not your symptoms are caused from hypothyroidism.  

If you haven't had B12 and ferritin checked, you should ask for those tests.  Ferritin is an iron storage hormone and iron is necessary for the metabolism of thyroid hormones.  Vitamin B12 causes its own set of symptoms, but shares the fatigue issue with hypothyroidism.  

Be aware that just being "in range" for the thyroid hormones, as well as vitamin B12 and ferritin, is not enough.  Many/most of us have to be well up into the ranges to feel well.

[heartaches101]

I thought he deserved a F to.  I always seen his nurse aprn, who I felt safe with but he left.  I know I would have gotten the right test the first time he h was treating me..  My b12 or Ferritin have never been checked as far as I can tell.  I do request copies of all of my labs to share with other doctor.   When I told him I wanted my lung doctor to be sent a copy of ultra sound results, he didn't like it but I have a lung nodule that was not biopsied when the lymph nodes was so now he has ben watching it.   Lung dr. has ordered a ct scan for chest for June ....after the T134 can be done....it'll be 1 1/2 years since the last one on mychest.  .   He asked if they sent me to Endocrinologist  but they sent me to a surgeon.  Should I go see a Endocrinologist?.

[Barb135]

Your doctor is right that the nodule wouldn't necessarily affect thyroid function, but since nodules are common with Hashimoto's and you have symptoms of hypothyroidism, it would make sense to check thyroid function.  

Nodules don't always (or even usually) mean cancer, either, but your doctor is ruling that out... as should he confirm/rule out hypothyroidism.

He gets an "F" from me, for diagnostics.

If you're low in Vitamin D, have you also been tested for vitamin B12 and Ferritin?  If not, you should be.

[heartaches101]

I had a knot on the side of my neck and was sent to have a ultra sound of the neck.  They found it then.   It is 1.8 cm.  I was sent to have a ct scan but I was sent for a regular one with contrast, which did not tell them anything.   I was suppose to be sent for a T134, which I know is radioactive scans and will show hot/cold spots and help determine if I need a needle biopsy.   But because of the iodine given me in the wrong test, I have to wait 8 weeks to have the right test.   I did ask if I needed my thyroid levels tested and the doctor said the nodule wouldn't necessarily affect the function.  
I have a lung doctor that has been watching a lung nodule that surgeon failed to biopsy when he biopsied the swollen lymph nodes which were not cancerous.  He is re-scanning in June.... 1 1/2 years since last scan.
I have symptoms of Hypothyroidism.   Weight gain, unable to lose weight., hair loss low vitamin D,been on 55000 units a week for about 1 1/2 years.
Oh yeah, we put  marker on the knot for the ct scan but it didn't show any thing.  Yet you can feel it and it caused sharp pains occasionally. Now I have noticed another knot under my arm on the same side.
Thanks for your comment.   I have thought it should have been  checked all along.

[Barb135]

Can you give us a bit more information?  How do you know you have a nodule?  

Yes, thyroid levels should be checked when nodules are present.  The tests you need are Free T3 and Free T4 (not to be confused with Total T3 and Total T4) and TSH.

Since nodules are common with autoimmune thyroid disease, you should also have thyroid antibodies tested.  Unless you have symptoms of hyperthyroidism, the antibody tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin  Antibodies (TGab).