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Old 07-17-2006, 01:15 PM   #1
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Nodule question

I had a US of my ultrasound and need help in understanding the following.

Right Lobe 4.6 X 1.8 X 1.7 cm
Left Lobe 3.6 X 1.7 X 1.4 cm

"3 to 4 mm hypoechoic nodule on right thyroid lobe, likely representing an adenoma'' The thyroid sonogram is otherwise unremarkable

Question With normal thyroid tests and negative Antibodies for Hashis, would this nodule be likely or possible to cause symptoms of poor thyroid function? I have fatigue, poor sleep, weight gain, Carapl tunnel, and dry skin. Does it make a differnence what size the nodule is in causing overall symptoms?

Also, does this suggest that my right lobe is enlarged in comparison to the left?

Thanks,

Jon

 
Old 07-17-2006, 01:30 PM   #2
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Re: Nodule question

Also my numbers for antibodies were as follows

Thyroglobulin 11 expected values <=33

Thyroperixidase <20
Refe range <=40


jon

 
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Old 07-17-2006, 05:47 PM   #3
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Re: Nodule question

The nodules are very tiny and are likely the result of low thyroid function rather than the cause of it. From what I remember reading, your right lobe might be slightly enlarged. I did a brief search looking for the thread that contains the normal size for a thyroid gland, but I can't find it at the moment. Try doing an advanced search of your own.

HypoT cannot be diagnosed based on an ultrasound. Have you had TSH and free T tests? What were those results?

 
Old 07-17-2006, 06:09 PM   #4
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Re: Nodule question

My tests last summer when i first started having symptoms were as follows

T4 .8 .56-1.5 Range
TSH 2.7 .3-5.8 Range

tests this June

T4 7.7 4.5-12.9(Range)
TSH 1.7 .3-5.8 Range

 
Old 07-18-2006, 07:57 AM   #5
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Re: Nodule question

Anyone with any advice on this issue?

 
Old 07-21-2006, 06:01 PM   #6
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Re: Nodule question

I found the thread I mentioned that discusses normal thyroid size. You need to copy and paste it into your browser window - we can't hotlink here. Remove the [url] parts before c & p'ing...
http://www.healthboards.com/boards/showthread.php?t=277772

There is a difference between free T4 and total T4. It appears that your earlier test may have been an FT4 and the latter one a TT4. Free T4 is the better test, the most conclusive. That said, your test from last summer might indicate you were hypoT at that time, since you would probably have felt best with FT4 in the mid-to-upper third of the range. That reading is low.

The total T4 test can be deceiving, and so is not as revealing as the FT4. That reading may or may not be normal for you, even though it is within the "normal" range. Based only on those two tests in June, you'd probably have a devil of a time getting an MD to prescribe supplemental hormone.

You asked in a later thread how hypoT is connected to carpal tunnel. HypoT frequently causes a proteinaceous compound to build up around joints and tendons, and that leads to the inflammation of the nerve that passes through the carpal tunnel, among others.

I hope that was useful. If you have more specific concerns, one of us will try to help.

 
Old 07-21-2006, 06:39 PM   #7
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Re: Nodule question

Thanks for the info.

the doc did put me on a supplemnt-5o mg I think og Levoxyl. I was surprised. he said that the right lobe was borderline and that it was 40 % biiger than the other. Also, that the nodule could be a result of poor thyroid function. he also said there are 10 other antibodies they don't even test for, even though the two I tested for were negative.

He has hashimotos and seems to really be an expert on thyroid issues. I was surprised he gave me the supplement

I am a bit concerned about going on the supplement. Any thing I should be worried about?

Jon

 
Old 07-21-2006, 07:20 PM   #8
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Re: Nodule question

Also, canan enlarged thyroid and underactive thyroid be caused by somethin else other than Hashimotos?

 
Old 07-22-2006, 12:26 PM   #9
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Re: Nodule question

You're very, very fortunate that your doctor has Hashi's. He knows better than most doctors just what it can do to a body, and he probably therefore knows more about how to treat it. You should not worry about having to take extra hormone. You need it the same way a type I diabetic needs insulin. It isn't a chemical soup of ingredients like most prescription drugs; it's the same hormone your gland would make if it could. I would feel confident that your MD knows what he's doing, and I would follow his advice unless it starts not to work or make sense any more.

Underactive thyroid can be caused by a number of other things, but Hashi's is the most common cause in developed countries.
Some other things are ~ diet high in goitrogenic foods; treatment of overactive thyroid; partial or total thyroidectomy due to cancer; some drug treatments such as lithium or amiodorone; pituitary tumors or injury (somewhat rare); iodine intake, either too little or too much; radiation treatment of the head, neck, or chest during the 1920's thru the 1960's; environmental exposure to certain chemicals, nuclear plant emissions, perchlorate, etc; smoking; whiplash or other severe neck injury.

A noted thyroid author and expert says that between 10% and 20% of those with Hashi's test negative for TPO and Tg antibodies. The antibody tests are clear evidence in most cases. In cases like yours, the one definitive test would be a fine needle biopsy. Cell changes clearly indicate the damage that Hashi's causes, even if antibody tests are negative.
Few MDs ever do an FNA solely to test for Hashi's. Whatever caused yours is kind of a moot point now. You're getting treatment, and that's what counts most.

 
Old 07-23-2006, 12:40 PM   #10
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Midwest

Midwest,

thanks for the encouragement and the info.

How long for the supplement to start to kick in in your opinion?

My doc says that some people have dramatic improvment in 2 weeks, then level back off until the dosage is upped. what has been your experience?

Jon

 
Old 07-23-2006, 01:57 PM   #11
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Re: Midwest

If I didn't have my own doc, I'd sure want to be treated by yours! You are one remarkably lucky fellow to have him for an MD.

In my experience, he's right on about when you will feel a difference from the med, and what can happen before the dosage is upped again. The only thing I can add is that sometimes - instead of "leveling" - people actually backslide and feel a little worse than they did before they started treatment. This happens because the hypothalamus senses there is more circulating hormone, so it reduces the amount of "signal" hormone it sends to the pituitary, and then the pituitary reduces the hormone it sends to the thyroid. The slowing of the whole feedback loop means you might end up with a net loss of hormone. It all evens out once you reach your optimal dose, though. The key is to have a great MD who knows the difference between "optimal" levels and "in-lab-range" levels. I have a feeling yours knows that difference and will not stop increasing your dose at some arbitrary level that isn't enough for you.

How fast you recover depends in part on how deficient you've been and for how long. You first have to get the blood levels of thyroid hormones back to the place where your body needs them to be. Then the body will "right" itself and will begin to heal from the damage that the hypoT caused. How long that takes depends on how much damage has been done.

I would wish you good luck, but I think you already have found it.
Please let us know how you do from here on out.

Last edited by midwest1; 07-23-2006 at 01:59 PM.

 
Old 07-23-2006, 07:59 PM   #12
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Re: Nodule question

I guess I hope I am on the right track.
I am still not sure, but I am glad that i have a doctor who is compassionate and up on the thyroid issues, who treats the patient rather than numbers.

I have tiredness, some sort of sleep disorder.
GI probs for the last year-dignosed ibs and gerd
Carpal tunnel in hands especially at night., face fells tight and heavy from ear to ear
Keratosis on upper arms-dry skin?
throat feels full, high collared shirts really bother me feel like I am choking
Also, anxiety that has gotten worse

I hope this is the fix....It would explain most of my problems

i will let you know of how I do on the meds.

Jon

 
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