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hot thyroid nodule treatment


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Old 01-11-2017, 06:26 AM   #1
Jaye2017
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hot thyroid nodule treatment

Hello All

This is my first post. I've had thyroid nodules for over 15 years with annual ultrasounds and several FNA. All was well until August 2016 when I began to feel ill. It was discovered through an Uptake scan that I have a hot nodule. 0 TSH and slightly elevated Free T4. I don't have the results of my current blood work from 1/5/17 but the doctor phoned and said the Free T4 rose again slightly. He ordered 10 mg of mechlizine and return to him in 4 months.

My question is to anyone who has dealt with a hot nodule (I have more than one nodule but only one is hot per the uptake scan which was of normal uptake other than to that one nodule) what is the best treatment? R131 or surgery? I have read you cannot remain on mechlizine long term due to possible liver damage. The doctor gave me these options but advises R131 and gave me meds while I decide.

Also - I have read that a virus can affect your thyroid. I had a 2 week flu in December and was just recovering when I had this blood work. Could that affect the rise in T4?

Thank you for any help you can offer

Jaye

 
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Old 01-11-2017, 07:12 AM   #2
Jaye2017
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Re: hot thyroid nodule treatment

Medication is: methimazole not mecilizine.

 
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Old 01-11-2017, 09:11 AM   #3
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Re: hot thyroid nodule treatment

Here is the URL to a recent study that looked at the risks and safety of long-term methimazole vs. radioiodine treatment. Your doctor either isn't being honest about the risks or he's just mistaken. You would probably be easily able to find other studies that confirm this one.
https://www.ncbi.nlm.nih.gov/pubmed/15879354

RAI treatment is very likely to cause hypothyroidism in your future. At that point, you'll be dependent on some MD's misinformed idea of proper treatment that will allow you to have the right type and amount of supplemental thyroid hormone for your needs. I wouldn't risk that unless there were no other options.
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Old 01-11-2017, 09:24 AM   #4
Jaye2017
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Re: hot thyroid nodule treatment

Thank you for the reply and link Midwest1. Have you ever heard of a hot nodule dying out or going back to cold? I had read some nodules shrink as we age. I don't understand why I'd be more hyper now than in Sept. I don't feel hyper at all. I do suffer depression but I just lost my husband of 40 years on May 6, 2015 so who knows if the hyper or grief is causing the depression. That's when all hell broke loose on my body. After he passed I suffered a string of pretty serious health issues, this being the current. 2014 on has been very stressful. I also read stress can trigger autoimmune. I wonder if this nodule could be a result of stress? This endo isn't bad but not like my PCP who is wonderful. I had to wait 3 months to see him too. I'll post my blood work later, maybe see what you think of the readings. Thanks again :-)

 
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Old 01-11-2017, 01:48 PM   #5
Jaye2017
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Re: hot thyroid nodule treatment

Results from 1/5/17
Ranges: TSH 0.49 - 4.70
In Oct I was .004 now I'm .015 so I went up a bit.
T3 Free range: 2.3 - 4.2 I am now 5
T4 Free range: 0.71 - 1.85 In Oct I was 1.60 now I'm 2.75

I'm now on 10 mg Methimazole daily and lots of supplements and see the endo in 4 mths for blood work.

 
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Old 01-11-2017, 02:53 PM   #6
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Re: hot thyroid nodule treatment

Please understand, I'm just a layperson who's read a lot about thyroid disease.
I'm so sorry for your loss. Every widow I've known developed some kind of health problem shortly after their loss. I can't say that's what's happened to you, but I wouldn't be surprised.

You are definitely hyperthyroid and must surely be feeling it. Your free T4/3 are above the standard ranges, and those are the levels that account for symptoms. You need some kind of treatment to prevent serious complications from those excessive thyroid hormone levels.

Four months seems to me too long to wait for a follow-up visit. Two to three months seems more reasonable. If you begin to feel markedly worse, with high heart rate, blood pressure, fever, sweating, diarrhea, shakiness, confusion, and/or anxiety, go to an emergency room. There is a life-threatening situation called "thyroid storm" that occurs from high circulating levels of thyroid hormones. It's somewhat unusual, but you need to be aware of it and what to do if it happens.

I-131 therapy is not that precise, no matter what you've been told. The theory is to hit the gland with just enough radiation to curb hormone production without making the patient hypothyroid. But it isn't that simple, and most people will experience some permanent degree of hypothyroidism.

You might choose to remain on methimazole for the time being and see what happens. I've seen at least one report that says about 1/3 of hot nodules eventually "burn out". In the interim, you could consider the value of having the lobe of the gland containing the hot nodule surgically removed. You'd probably still become hypothyroid, but at least the nodule and its excess hormone production would be gone.

This is just me personally... I'd choose drug treatment first. If that didn't do the job completely, I'd choose surgery second. I'm just not that comfortable with radiation's potential long term effects.

The book Thyroid for Dummies addresses all aspects of thyroid function, dysfunction, and treatments. Reading it may help you decide for yourself the course you want to follow.
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Old 01-12-2017, 06:38 AM   #7
Jaye2017
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Re: hot thyroid nodule treatment

Hi
Thank you for your help. I think we learn more from one another than from some of the doctors. I've read so many controversial articles on thyroid that it's head-spinning so hearing "real" stories and experiences helps immensely.

I don't feel too bad physically, other than tired, but I'm depressed a lot. I no longer have zest for life, but that could be grief. It's so intertwined. After my husband passed - a week later things started hitting. I've always been very healthy and annual physicals were perfect.

A week after Tom passed I had a "normal" gel detachment in my right eye but it was accompanied by a retinal bleed. Not so normal and very scary. Took months for my vision to clear in that eye. I started getting occular migraines 2 to 3 times a month. Then last Feb I got Labrynthitis (virus in inner ear) which put me on my back for 3 months due to severe vertigo and then residual dizziness. Then in June I had the same eye event but in the left eye.

In August my legs felt weak and I was fatigued and very dizzy. That's when I found out my thyroid readings were off. I read a virus can attack your thyroid and cause problems. The labrynthitis was one heck of a virus so it fits. So that's when I found out about the thyroid issues.

September my migraines stopped, just like that. Crazy but amazing. Now I'm depressed to have to contend with this thyroid. I'm on 10mg Methimazole and l carnitine and magnesium along with supplements I've always taken. My biggest problem is I feel I have no life anymore. Not sure if it's thyroid or losing my Tom. It's still all like a bad dream.

I hope the med works because I've had 3 surgeries and don't do well with general anesthesia. There is a clinic at Mt. Sinai in NYC that does thyroidectomy using local. If I must I'll look into it. I have an appt with my PCP next Monday. I think he knows more than that endo who is primarily textbook if you know what I mean. I had a 2 week flu during Christmas and had this last blood test at the tail end. I'll ask my PCP to do a follow up as I've read a virus can alter readings.

I'm also having problems with my left shoulder which affects my hand. I can barely keep it on the keyboard to type. I feel like I'm falling apart inside and out.

Thank you for listening. It helps to vent and speak to others about nodules. Most boards have mostly Graves info. I'm happy to hear you read 1/3 of nodules can burn out. I wish mine would. Wouldn't mind being hypo and taking armour thyroid.

I hope you're doing well :-)

hugs
Jaye

 
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