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Old 03-26-2008, 04:31 PM   #1
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Hashimoto's reactive lymph node-MKG or Access any ideas??

Has anyone heard of or had hashimoto's reactive lymph node? Over the past two weeks, I have had quite the wild ride. During a routine u/s of thyroid ,they found the usual ravages of hashi's(nodular mess like last yr.) but also a 3cm.(about one inch long) mass in my neck . A ct scan with contrast dye and u/s biopsy scheduled. . The ct scan with contrast dye about a week after the u/s found nothing. Then when I went for the u/s guided biopsy the doc said the u/s no longer showed the 3cm mass and also he reviewed the ct scan and the first u/s.and said no biopsy would be done-while I have about 7 nodules on thyroid-none are needing a biopsy.
Well, now the theory is that the 3cm. neck mass was a hashimoto's reactive lymph node and for now it has quieted down. Does anyone have experience/knowledge of this? I was so stunned by all the developments that I hardly knew what to ask when I saw my endo and ent today. But the endo and radiologist think it was the hashimoto's reactive lymph node.It seems the autoantibodies have now decided to send some forces over to the lymph gland to do a little trouble there. I wonder what this will mean long term? Now are they going to destroy the lymph gland in my neck too? My tsh numbers are up too by about 3 points and my synthroid dose is going up from 75mcg to 88mcg. In six weeks she will retest tsh, t3, t4 and autoantibodies.
The ENT wants to recheck PTH and serum calcium to possibly rule out any parathyroid prob-though she doesn't think that is likely. Though my serum calcium is always top of range -out a few times but only a teeny amount.And pth is usually mid range.I have quite bad osteoporosis too and that keeps them wondering about hyperpara.
Anyway, the real focus of my question is the hashimoto's reactive lymph node in my neck-any thoughts?

 
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Old 03-26-2008, 05:34 PM   #2
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Re: Hashimoto's reactive lymph node-MKG or Access any ideas??

Well I know when my thyroid is aching, my lymph nodes in my neck and throat swell. Sometimes they swell so much that my ear HURT severely. I do believe that Hashimoto's can cause lymph nodes to react. I also believe it can attack other organs and joints and other things as well.

SIncerely,
MG
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Old 03-28-2008, 07:41 AM   #3
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Re: Hashimoto's reactive lymph node-MKG or Access any ideas??

I did run into someone else who had a lymph node show up on u/s who also had hashi's. I just can't remember who. Anything that rocks the immune system can cause a reaction in the nearby lymph nodes. It may have been due to the hashi's but it also could have been caused by something else entirely. The main thing is it returned to normal on it's own. That's usually a good sign.

 
Old 03-28-2008, 08:09 AM   #4
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Re: Hashimoto's reactive lymph node-MKG or Access any ideas??

Access-Thank you for you response. I am just wondering does this mean that the tpo antibodies are now attacking the lymph node and that this will just be another location of assault on and off until they destroy that lymph node?
I haven't seen you around for awhile and there were two other questions that have been perplexing me that I wanted to run by you and MKG-
Over the past 12 months with thyroid treatment (synthroid) my right lobe has decreased in size by 48% and left lobe by 17%-do you know about lobe reduction???I thought at first great news, because perhaps everything is quieting down. But, the prior yr. u/s said normal size and this yr. says small size bilaterally. In doing a little searching I read that a hashi's thyroid from years of assault has alot of scar tissue and that scar tissue has contracture. That the contracture process can result in compression of the windpipe and trachea if severe, and that the thyroid should then of course be removed. Do you have any thoughts about that???
Also the u/s reports 7 nodules, 4 on one side and 3 on the other. That seems like alot of nodules-but I don't know. Most people here talk about one, or one on each side. Do you know?
Does it look like a picture that is adding up to a case for removal of my thyroid? My tsh levels are very fluctuating for awhile on 75mcg with a tsh of1.5 then going to almost hyper about 4 months ago (with no apparent reason-no added other drugs to complicate things) , then to 2.8 then now to 4.96. The endo is raising my dose to 88mcg she did not want to have me continue on 75 mcg and add an extra 1/2 two days a week . She said my autoimmune situation is unstable and she want to get it quieted down. My autoantibodies are very high recently over 1200, a year ago about 2500. Right now I don't know the antibody level but it will soon be tested. AND she wants me to take xanax on a regular basis for awhile to see if my Autoimmune system will benefit from some stress reduction. She is not one of those old school docs that is scripting a drug to get you out of their office. I told her it is not what I want to do but she seems so insistent that this research shows if stress levels can be reduced that the AI system can quiet down. I am already going to a stress reduction counselor at the largest metro hospital and she is very respected. I exercise regularly , generally six days a week and therefore she has said since my other approaches are not working we need to try the anti anxiety med.
So-do you think I have a case for thyroid removal with all the nodules , the lymph gland involvement and contracture?
do you think the tpo's now are attacking the lymph node and will just keep doing it till it is destroyed too?
is the xanax course of treatment ill advised?
This whole situation is just getting to be too much for me. Any help would be so appreciated.

for the record as MKG always asks labs , the total picture is now
tsh 4.96 (0.34to5.60)
free t4 1.14 (.58 to 1.64)
free t3 2.9 (2.3-4.2)
treated hashi's for about 18 months

Last edited by osteoblast; 03-28-2008 at 08:37 AM.

 
Old 03-28-2008, 08:16 AM   #5
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Re: Hashimoto's reactive lymph node-MKG or Access any ideas??

Your thyroid as it is destroyed and atrophies shrinks. My left side was below the 4-5 cm normal size range. I asked about the size issue then and there. I was told by the radiologist who was brought in to answer that is common in a dead thyroid lobe or one that is severely underactive. If your lobes are not being used as much and the antibody attacks are decreasing.. inflammation will decrease and all the destroyed tissue will shrink as well.

I do not think it is something to worry about.. just the natural progression of Hashimoto's.

MG
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Old 03-28-2008, 08:34 AM   #6
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Re: Hashimoto's reactive lymph node-MKG or Access any ideas??

MKG-while you are on the board, what do you think of the doc thinking that xanax daily-should be tried for awhile??
And, do you have any thoughts about 7 nodes on the thyroid-none of them of interest to the docs now?
Is my case mounting for removal??
Do you know if I would have less trouble if the thyroid was removed?
Sorry if I am getting too pesky with the questions but I really want to get to the bottom / end of this ordeal!

Last edited by osteoblast; 03-28-2008 at 08:34 AM.

 
Old 03-28-2008, 09:03 AM   #7
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Re: Hashimoto's reactive lymph node-MKG or Access any ideas??

MKG-while you are on the board, what do you think of the doc thinking that xanax daily-should be tried for awhile??
This is a good one for the anxiety board. My opinion is how bad is your anxiety? Are you optimally treated on thyroid meds yet? Refresh me on your last blood work results. If your anxiety is not bad and your thyroid is not optimally treated as yet, I would hold off on taking Xanax. Like most mood altering drugs the FDA states that Xanax has documented adverse clinical events that can be life-threatening and are a direct consequence of physical dependence to Xanax. These include your standard spectrum of withdrawal symptoms; the most important is of which are seizures. The FDA documents that even after relatively short-term use at the doses recommended for the treatment of transient anxiety and anxiety disorder (ie, 0.75 to 4.0 mg per day), there is a risk of developing dependence. Spontaneous reporting system data suggest that the risk of dependence and its severity appear to be greater in patients treated with doses greater than 4 mg/day and for 12 weeks or longer. So how long is temporary and how much does he want you to take?


And, do you have any thoughts about 7 nodes on the thyroid-none of them of interest to the docs now?

I am all for removal of my thyroid.. it is just triggering more antibodies to be produced and giving me optimization issues. I have on nodule almost 1 cm. My ENT is in charge of it. He is checking it every 6 months. He will do an FNA if it is the same size or larger this June. This may change since I am now having swallowing difficulties. I give it 4 weeks to settle down since I just started meds for adrenal insufficiency. If things continue to stick/hang after that.. I am calling him up for an FNA, ultrasound and pushing for its removal.

Is my case mounting for removal??

Possibly. My mother and two of her sisters are loving not having theirs. They have the AI component as well and things just fluxed too much with it. Now they are stable and have no swallowing issues. How big are your nodules? Are you having swallowing issues? Have you had an FNA? Depending on these factors and whether or not you can optimize on your meds will be what determines your need for thyroid removal.

Do you know if I would have less trouble if the thyroid was removed?

I can not say. I can only say, many others on here have had it done and been so much better in a matter of days/weeks. It depends on you and what is up. Me? I would hack mine out in a heart beat.

Sorry if I am getting too pesky with the questions but I really want to get to the bottom / end of this ordeal!

Ask away any teacher knows through questions and answering those questions on knowledge grows. There are no stupid questions only bad attitudes.

Sincerely,
MG
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Old 03-28-2008, 10:17 AM   #8
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Re: Hashimoto's reactive lymph node-MKG or Access any ideas??

MKG-You are great! I love your response about asking questions.
So, the xanax dose is .25mg each 8 hours so that would be .75 mg a day.From what I gathered, the endo seems to be talking something like 6-8 weeks I think.
On the nodules they are calling all of them small and they are all sub centimer, those on the rt. are between 4-8mm and on the left 2-3mm. The right lobe with the bigger nodules is the lobe that started out much larger and now with its 48% reduction is more the size of the left lobe which has the smaller nodules. But, don't you think 7 nodules is alot ???? .No FNA done I am told because no nodule is prominent or appears to warrant FNA.
I do not seem to have trouble swallowing now - BUT the right side of my neck feels tender and very tight. Tight when I move my head to the left then the right side seems tight and the right neck muscle seems to stand out more than on the other side.
I wonder with the removal of your one nodule if it that is required will they take a large percentage of that lobe? Or, do they just take the nodule?
What was it that allowed your mom and her two sisters to get their thyroid out? I am wondering what would necessitate the procedure in the absence of a cancerous nodule?
Another aspect of my treatment that is so hard with the fluctuating tsh is that I have severe osteoporosis so the endo really wants to avoid too much synthroid and making me go hyper so she has been conservative but now I am at 4.96tsh.She says she want to see 1.5 or so and I agree but this situation seems to be changing so rapidly. I posted the labs this morning at the end of an earlier post on this thread as a postscript -probably after you read it and responded.But you will see the numbers now if you look back perhaps two posts.
I wonder if taking into consideration the 7 nodules though all subcent., the fluctuating tsh,the desire not to get into hyper because of the severe osteoporosis, the lymph node involvement, the tightness in the neck,-whether this yet adds up to a case for removal?
So that things can just stabilize .It just seems that optimizing the meds is not happening well. And, I do not think it is my endo's problem because she has a reputation as a brilliant endo and on top of that I really like her. So I do not want to see anyone else.

 
Old 03-28-2008, 10:50 AM   #9
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Re: Hashimoto's reactive lymph node-MKG or Access any ideas??

Questionable of precancerous cells in a biopsy will do it. Or if you have Hashimoto's and Graves such wide hormonal swings and symptoms that treatment can not be done any other way. My Aunt B1 had to go through 2 RAI's first. Both failed and she refused a third and put her foot down and insisted on removal of the thyroid. Groiter/size is another reason for removal. Cancer isn't the only reason to remove it. If they recommend killing it with an RAI you can refuse and request surgery instead. It is your choice.. a dead thyroid is a dead thyroid. If it is left in you it is just a possible source for abnormal growth.

SInce you have so many they are most likely going by the more nodules you have the better. The one that is 8 mm is aweful close to 1 cm. Since you have so many you might be able to push for an ultrasound guided FNA of the beast and see what comes of it.

Sincerely,
MG
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Old 03-28-2008, 11:43 AM   #10
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Re: Hashimoto's reactive lymph node-MKG or Access any ideas??

Thanks MKG-I don't think she will order the FNA on the 8 cm. After all this recent buzz with the 3cm hashimoto's reactive lymph node and all the nodules with one up to 8mm the endo said , new u/s in 6 months.
When I see her in 6 wks after new labs , I am going to ask for the FNA on the 8cm AND
do you think I should ask for new u/s earlier than 6 months?
You are a dear and are helping me far more than an anti anxiety med!

 
Old 03-29-2008, 07:43 PM   #11
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Re: Hashimoto's reactive lymph node-MKG or Access any ideas??

I guess I was kinda quiet. I just needed to take care of me for a little while.

Anyhow, I'm trying to find an issue that mg didn't cover. I'm still not convinced that the lymph node and the hashi's are related but I'm not convinced that they aren't. As to removal, why not? I think every patient should have that option if the darned things going to die anyway. 18 months plus is an awful lot of life wasted trying to get it under control. Sometimes I just cannot believe how long the docs allow us to suffer from these monsters. I think in the hands of a good surgeon, a lot of hashi's patients would be much better off.

Did I miss anything??? It's late and I'm tired, so I'll hit subscribe and let you tickle this tired brain if I did.

 
Old 03-30-2008, 08:40 AM   #12
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Re: Hashimoto's reactive lymph node-MKG or Access any ideas??

You got it, Helen. It is going to die anyway. By cutting it out you remove the source of the problem and the catalyst which stimulates additional antibody production, wtc. Why not be humane and put the floundering gland out of its misery. Cut the cord quick. RAI? Well that will kill it, if you are lucky.. but you are exposed to radiation have to avoid your family for weeks, and risk side effects.. severe ones due to the radiation. While surgery is 1-4 hours, outpatient in most cases, and you are back to almost normal op by the end of the day. My Aunt B1 did radiation twice then the surgery. She strongly recommends the surgery. So does my mom who only had a partial thyroidectomy. Last vote is bye-bye offending tissue, if you have nodes/nodules.. you never know if or when they will go bad.

I am going to try and talk my ENT into yanking mine.

MG
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Old 03-30-2008, 08:55 AM   #13
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Re: Hashimoto's reactive lymph node-MKG or Access any ideas??

I don't blame you a bit. I woulda had this monster yanked in a heartbeat if I hadn't known the darned thing would grow back every time they'd take it out. I know it's horrid but I almost died laughing reading the report of the woman with rth who had her thyroid removed 5 times and her daughter 3 before they discovered they were barking up the wrong tree. Put em on proper treatment to reduce their excess tsh stimulation and they did fine after that. Geez.

 
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