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mellymermaid40 · 10-31-2006, 07:05 AM

Hi everyone.

I will start with just a brief background. I am 41 years old. At the age of 37 I went to doctors with complaints of symptoms that were unusual for me (now I know they are classic thyroid symptoms). Long story short, the doctor thought she felt a goiter and sent me for blood work and unltra-sound. I never heard back with the results and [B]assumed[B]that everything turned out okay.

I go to same office but see a new doctor each time.

Since that time I have been back for other minor ailments and the big one last year sever anxiety attacks, heart palpations, shortness of breath, insomnia. The doctor prescribed me wellbrutrin and sleep medicine and never mentioned my previous symptoms from 2002.

Now a year later My neck is swollen and protruding, having difficulty swallowing, tightness in neck and feeling as if I am not getting enough blood or oxygen to the brain (I know that sounds strange).

So back to Doctor........ask her to check my thyroid. She questions my why. I give her the run down from 2002. She tell me that because she has never seen me befor she wouldn't know if my neck looked unusual or not.

She looks at it and says she will order blood work. Sends me to lab and out the door! I call back the next day for results and she tells me my levels are high and that she schedualed me for another ultra-sound.

I didn't hear anything for few days after test so called her. She said that I had a goiter and that she has called me in a prescription Levothyroxin 50 mcg.end of story.

No diagnosis?

That is when I got mad and decided to take charge of my treatment. First I requested a refferal to endo. I have asked for all of my result to all test. Now I need help interpreting them. I cannot get into endo. until after Christmas.

HERE THEY ARE:2002

Individual chem Test:

T4 (Thyroxine) 8.31 4.45-12.00
T-Utake 1.20 0.66-1.27
TSH 4.832 0.350-4.940

THYROID ULTRASOUND:

CLINICAL DATA: PALPABLE NODULE

FINDINGS: survey of both thyroid lobes show extremely heterogeneous echo patterns throughout without a sistinct nodule or distinct cyst. This appearance is most frequently associated with Hashimoto's thyroiditis. An areas of somewhat decreased density is present in the mid left lobe. It is recommended that a follow up study be done in six months to exclude and expanding mass ( rather doubtful given the appearance of the rest of the gland).

IMPRESSIONS: Somewhat enlared and irregulare and heterogenous echo patterns throughout consistent with thyroiditis. Recommend a follow up in six months. END OF REPORT.

Now 2006:

TSH: 5.88O H 0.290-5.500
(ONLY BLOOD TEST DONE)

EXAM: THYROID ULTRA SOUND
CLINICAL INFORMATION: GOITER
TECHNIQUE: MULTIPLE SONOGRAPHIC IMAGES OF THE THYROID GLAND WERE OBTAINED.
COMPARISON: ULTRASOUND THRYROID 2002

FINDINGS: Thyroid isthmus measures 0.95 cm. Right lobe measures 6.6 x 2.7 x 2.7 cm. left lobe measures 6.9 x 2.2 x 2.7 cm. The gland is enlarged and shows a heterogenoeous echotexture. A 4 mm cystic nodule has developed in the right lobe which was not present before. The previously seen nodules cannot be discerned.

IMPRESSIONS: Enlarged heterogeneous thyroid glad with no discernment of nodules seen previously. A new cyst is noted. ***end report***

Phew!!! I know that is alot of info.

Can some of you help me understand what all this means? I need to interpret them. Also...what does heterogeneous mean?

Please help!

melanie

midwest1 · 10-31-2006, 08:17 AM

What a way to practice medicine... "pass the patient". Your odds of having your hypothyroidism successfully treated seem a bit slim unless you have the option of switching doctors. If you can't switch, you will need to educate yourself even more than the average thyroid patient. I suggest you get a copy of Thyroid for Dummies so that you can learn the terminology and have your questions answered if your MD won't help.

It appears you have Hashimoto's thyroiditis, the autoimmune condition that destroys thyroid tissue over time. The term "heterogenous" means that the texture of the tissue or cells isn't uniform throughout, in the way that it looks with Hashi's.

You have a very small nodule. Nodules are usually only of concern when they measure 1 centimeter or more, or if they produce thyroid hormone on their own, which causes hyperthyroidism. This doesn't look to be of concern to you. Your nodule may shrink once you get a steady dose of thyroid hormone from your pill; if it doesn't shrink, it may at least stop growing. Time will tell. It's somewhat possible that if treatment had been started in 2002, when your TSH clearly showed that you were hypothyroid, your nodule wouldn't have formed in the first place.

That's about all I can tell from the reports.

The dose of levothyroxine you've been given is the smallest possible therapeutic dose. It should be increased at 6-8 week intervals until your symptoms resolve and your T4/T3 levels reach at least mid-range. Odds are that your T4/T3 won't be tested to see where they're headed; most MDs watch TSH only. That works for some people, but not for all.

Also, generic levothyroxine varies in quality, and may not work for you as well as a name brand might. If you don't improve, have a serious discussion with the MD. You won't want to keep doing the same thing if it isn't working. You have options.

Best of luck... hope that helped.

mellymermaid40 · 10-31-2006, 10:49 AM

Midwest1,

Thank you so much for all your help! I have just received my copy of "Thyroid for Dummies." It is helpful, but I feel like I get more out of this forum than anywhere else

The one question I have that concernes me the most is not the nodule itself but the size of my thyroid overall. I know the dimentions don't sound all that big but it is reallynoticable to the naked eye. I am a very small framed person and I look disfigured to me. Aside from the cosmetic perspective the symptoms of the fat goiter is what took me back to doctor and has not been addressed. What I mean is......sometimes I choke on my food, sometimes I wake from sleep as if I cannot breath, and the pressure on the neck (fullness). Can I expect for these symptoms to go away with medication? I sure hope so. They are scary.

P.S. How did you become so knoledgeable?

Thanks Melanie

stephanie867 · 10-31-2006, 12:00 PM

I don't have a lot of info, but can tell you that both me and my neice have thyroid problems. Hers is a very large goiter and I have a nodule. She's taking levothyroxin and her goiter has shrunk considerably since starting the med around 9 months ago. I'm not taking any meds right now...we're playing wait and see with it.

midwest1 · 10-31-2006, 01:08 PM

Melanie,
Most people can expect at least some shrinkage after they find a good dose of thyroid hormone, and some glands will return pretty close to normal.
You see, your gland has enlarged in an effort to pump out enough hormone to keep your body going, and it started trying to keep up way back in '02. (That's why it angers me so much that MDs don't recognize hypoT when it smacks them up side the head... makes me want to do some smacking!)

I wish I knew even more than I do. I guess I'm just the inquisitive sort, and when something happens to me personally, I want to know everything I can about it, so I read and read and read some more. If I can help someone by sharing what I've learned, it's that much bigger a bonus.

Red Maple · 10-31-2006, 01:40 PM

Melanie, are you seeing different doctors at an HMO clinic each time because of insurance coverage??? Making you wait until after Christmas to see an endo. is an absolute crime, IMO, when you could be treated so much sooner, and probably be feeling better.

Have you taken the levothyroxin yet? If so, how long have you been on it? It should help, even if it's just a little bit. It does take a little time though for you to start to feel better after starting medication; your uncomfortable symptoms, including the "fullness" in your neck should start to diminish shortly. I am not a doctor, but your dosage seems to be a very small one, and probably needs to be increased soon. If you don't get at least some relief from your symptoms with the dosage you are currently at after about 2-3 weeks, I would start hounding the clinic until somebody paid more attention to me, and at least upped my dosage. Call them everyday if necessary. There is not limit with your situation on "whinning"- do it everyday if you have to! Maybe you have already done that with no results, huh?

I couldn't agree more that you need to educate yourself as much as possible about thyroid disorders. Midwest also tipped me off to "Thyroids for Dummies" and I first read it from a library copy. Since then I have purchased it for my personal reference. I found my local public library to be a wealth of information concerning thyroid disorders, and gave me many perspectives of treatment options to choose from. You may want to give that a try, and then purchase the books that help you the most. There are also many web sites that have great information. Surf around a bit and you will come up with all sorts of info. just by googling "thyroid disorders".

I also agree that your chances of getting proper treatment for a thyroid disorder are slim if you cannot get some consistency in the doctor you see. There are many options out there for thyroid treatment, and right now you are very limited in taking advantage of all those options. Hopefully the endo you have been referred to will be helpful. In the mean time get as much knowledge as you possibly can.

Best of luck to you, keep us posted on your progress. There are many knowledgable people here, and we all care about each other getting the best possible treatment for our individual problems.

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