thyroid ultrasound after fullness in throat

[jessof6]

Hi. I am new to this board. I was diagnosed about 10 years ago with hypothyroid by my pcp when I was starting to feel very fatigued. I believe at that time my TSH was a 12 or 13. I was on .5mcg for the longest time. Then, at one of my lab updates, it was found my levels were back up, so they bumped me to .75mcg. I went on like that for quite some time. Over the last couple years I have felt sluggish and kept thinking it was my thyroid, but my levels came back as "normal' for my doctor so I had to stay put on my meds. A new doctor started at my practice and she and I agreed I could bump up a little as long as I did a repeat lab and if my levels were ok it would be ok. So I am now at .88mcg. I did momentarily feel a bit more awake, but I have since become a little sluggish. Nothing terrible, but not my normal self either. Now that you have my background I will explain what happened this week. Monday, my period started and I felt like someone zapped every part of my energy out of me. I chalked it up as a bad period, although I have never felt fatigue like that in my life.(I will be 40 in about a couple weeks). Then as the day went on, I noticed a lump in my throat type feeling. At first I only noticed it when I swallowed food, then I still noticed it with liquid and then it got to the point that the sensation was there even when I wasn't swallowing. After a couple days, I went to my PCP and she ordered an US. I had the ultrasound later that day. The next morning they called to tell me I had multiple nodules and had to follow up with and endo. Well, I made my appt for Wednesday. I also asked for a copy of my report. The sensation seemed to get less and less the last two days and as my period ended, so did the fullness. I still feel like something is there, but it is no longer uncomfortable/painful to swallow food and drink. So I feel like my period somehow brought this on.

This was my ultrasound findings:
Thy thyroid lobes bilaterally demonstrate a heterogeneous appearance. Relatively increased vasularity is also noted bilaterally. The right lobe measures 4.4x1.8x1.1 cm the left lobe measures 4.3x1.3x1.1cm. Within the right midpole nodule measures 9x6x5mm. Adjacent to the right lower pole there are 2 probable lymph nodes measuring 5x3 mm and 10x5x4mm. Adjuacent to the left lower pole probably lymph node is seen measuring 11x8x4 mm.

impresssion:
nonspecific heterogeneous appearance noted to the thyroid gland as described with increased flow. Finding can be seen with thyroiditis. Clinical correlation is required.

probable prominent nodes adjacent to the lower poles fo the thyroid lobes as described. These are nonspecific. If however there is concern for parathyroid adenoma nuclear medicine sestamibi scan can be obtained.

Should I be worried about the lymph node measurements and the use of the word prominent?

The only drew my TSH with reflex to ft4, which was 2.64 on a range of .4-4.5

[Barb135]

Inflammation and swelling of the thyroid are very common with Hashimoto's.  Hashimoto's is an autoimmune thyroid disease, in which the body sees the thyroid as something "foreign" and produces antibodies to destroy it.  The destruction is progressive, in that the thyroid is continuously producing less and less thyroid hormones as time goes on.  As the thyroid produces less hormones, medication dosages have to be adjusted to accommodate the loss of hormones.  

Many doctors think that just because the numbers are "in range" that you're fine, but that's not the case.  We're all different and we all need different levels of hormones.  Where I might feel well with my levels in the lower part of the range, others might need theirs in the upper part of the range to feel well.  And I'm not talking about TSH either - I'm talking about Free T3 and Free T4, which are the actual thyroid hormones.

Make sure your doctor is testing FT3 and FT4 every time you have labs done.  If you'll post labs, we can better assess the treatment/testing you've been getting.

With Hashimoto's, it's not uncommon to have periods of thyroiditis (swelling and/or inflammation), even if you're on thyroid med, especially, if your dose isn't high enough, though without seeing your labs, I can't tell for sure if that's your case.

The parathyroids are quite complicated, but to put it simply, most of us have 4 of them and they reside just behind the 4 corners of the thyroid gland.  The only thing they have in common with the thyroid gland is their location in the body.  The parathyroids control calcium levels in the blood by producing or not producing parathyroid hormone (PTH).  High calcium levels and high PTH would indicate a parathyroid adenoma, but there could be other indicators as well.

You can get more information about their function here:  
http://endocrinediseases.org/parathyroid/parathyroid_background.shtml

Here's another authoritative site:  http://www.parathyroid.com/

[jessof6]

Thanks, Barb.  I don't know if I have Hashi's.  I got diagnosed as hypothryoid and was put on synthroid and everything seemed fine for a long time so I just didn't do much else about it.  The last couple years, I have felt tired even though my numbers were ok and I have been chalking it up to four kids with four busy schedules and I am getting older.  

I am seeing an endocrinologist for the first time on Wednesday to follow up on the ultrasound findings.  I am confused about something though.  How would I get an inflamed thyroid if I am on thyroid meds?  Is it something that just happens for no particular reason or does it happen when your hypothyroidism isn't well controlled?  I am unfamiliar with calcium and PTH levels, so I will look into those and educate myself on them before going to  the doctor on Wednesday.

Thanks again for your thoughts.

[Barb135]

I'll hope that someone comes along, who knows more about ultrasound reports than I do.  

Since the findings are consistent with thyroiditis, I'd say you don't have a lot to worry about.  Do you know if you have Hashimoto's?  If so, a bout of thyroiditis, could just have coincided with your period without being connected to it in any way.  Nodules are very common with Hashimoto's; most of us on the forum have thyroid nodules.

I'm wondering, though, if our doctor is doing anything to follow up on the suggestion of a possible parathyroid adenoma.  You should be getting calcium and PTH levels tested to make sure they are within normal limits.

If the only blood tests your doctor is doing is regularly is TSH w/reflex to FT4, I might suggest that you need a different doctor.  You should be having Free T3 and Free T4 tested "every" time you have thyroid blood work done so you know exactly what's going on.  Trying to manage a thyroid disorder going by TSH only is like shooting blindfolded - you have no idea what you're going to end up with.

When you're actively adjusting thyroid hormone meds, you should be testing every 6 weeks and it's not unusual for TSH to be very low or even suppressed, when FT3 and FT4 are adequate.