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Old 10-09-2009, 09:55 AM   #1
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Thyroid Nodules

I ordered my own blood work 3 weeks ago. TSH was 4.3, LDL 129, T4 was 7.6, T3Uptake 29, Free Thyroxine INDEX 2.2.

Had started noticing trouble swallowing or like a lump in throat. Went for regular GYN exam and he agreed to do thyroid ultrasound.

Thyroid glands of normal size. Focal solid mass right 2.2 x 1.8cm. Second mass left lobe measuring 2.0 x 1.6cm. After getting this result was sent for nuclear scan using Tc-99m. Initial report shows no increase or decrease of uptake in the thyroid. The doctor is out over the weekend and the nurse said she doesn't know what he will suggest next.

Is this conclusive enough for me to not request any other tests? I have had depressing, mood swings, extreme fatigue that comes and goes, constipation, etc. Not sure what to do next or if I have done enough?

Last edited by moodymt; 10-10-2009 at 07:35 AM. Reason: left out information

 
Old 10-09-2009, 10:51 AM   #2
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Re: Thyroid Nodules

Sorry, I didn't post the ranges earlier for the lab that I used.
TSH 4.290 Range 0.45-4.50
T4 7.6 Range 4.5-12.0
T3 Uptake 29 Range 24-39
Free Thyroxine INDEX 2.2 Range 1.2-4.9

Thanks!

Last edited by moodymt; 10-10-2009 at 07:35 AM. Reason: left out information

 
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Old 10-09-2009, 11:28 AM   #3
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Re: Thyroid Nodules

What kind of doctor are you seeing? An endo? An ENT? I'm sorry I can't help you with the blood work, but with nodules of that size, you will want to get a needle biopsy to get a sample of the cells in each, and get a picture of whether those should be watched for changes or removed. Those are definitely large enough to feel in your neck.

Others can help you with the blood work, but it might be good to get a free t3 to see if the thyroid is affecting how you are feeling.

Let us know what happens.

Last edited by Reece; 10-09-2009 at 11:28 AM.

 
Old 10-09-2009, 11:57 AM   #4
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Re: Thyroid Nodules

Actually I was due for my Gynecology check up and since I was going any way decided to start there. I have an appt in 3 wks with an Endocrinologist that I had made for myself anyway. I will post more info as I get it. Thanks for your reply!

 
Old 10-09-2009, 06:12 PM   #5
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Re: Thyroid Nodules

Your labs are definitely hypo. Your TSH is high and your Free Thyroxine (Free T4) is only at 27% of range (and yes, a Free T3 would be good too but your T4 is very low and it's a given your T3 will be too). I would also get some antibody tests, a TPO-Ab and a TG-Ab as well as test your ferritin, vitamin D and B12.
You need treatment ASAP. Do some research on your treatment options and find a doc who will treat you. And follow Reese's advice about getting those biopsies .

 
Old 10-09-2009, 10:31 PM   #6
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Re: Thyroid Nodules

I don't think you had a true free thyroxine test. The other tests listed suggest that what you had was a free thyroxine index test, which is worthless.

Get another TSH, along with genuine free T4 and free T3 tests and the antibody tests that javelina mentioned.

 
Old 10-10-2009, 05:47 AM   #7
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Smile Re: Thyroid Nodules

Thanks to everyone for their help so far.

 
Old 10-10-2009, 07:32 AM   #8
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Re: Thyroid Nodules

You are correct. I went back and looked and it is Free Thyroxine Index 2.2 Range 1.2-4.9 . What is the difference between the index and what you were talking about? I think the doctor ordered a recheck of the TSH and I think he said "Free T".

Also, on the labwork that I ordered, if it helps anyone, my
Calcium, Serum 9.4 Range 8.5-10.6
Alkaline Phosphatase, S was 53 Range 25-150

 
Old 10-10-2009, 07:52 AM   #9
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Re: Thyroid Nodules

Free thyroxine is free T4 (FT4). It's the portion of the serum T4 that is unbound to protein, "free" and available for conversion to the active hormone T3.

The true free thyroxine (FT4) test directly measures the amount of FT4 in your blood. The FT4 index (a.k.a. T7) uses the total thyroxine measurement (the sum of both bound and free T4) and the T3 uptake result in a math calculation which arrives at an inaccurate estimate of the FT4 level. Clearly, an estimate is not nearly as useful as a direct measurement. That's why the genuine FT4 test is the better one.

The T3 uptake test has nothing at all to do with the T3 circulating in your system. It's a measurement of the protein which carries thyroid hormone. The usefulness of this test is extremely limited; it's mostly done only for the FT4 index test, which as I explained, is useless.

Your TSH is only half a point lower than mine was when I was diagnosed and started treatment, so if another TSH comes back similarly elevated - even if still within "normal" range - you're definitely hypothyroid. It's quite possible that you have the autoimmune disorder Hashimoto's thyroiditis, which is the leading cause of hypothyroidism in industrialized countries. It also can also cause nodules. If you're found to have thyroid antibodies, it's very likely they have caused your nodules.

 
Old 10-10-2009, 07:49 PM   #10
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Re: Thyroid Nodules

You said that my T4 was very low. Of course it is within "normal" according to the lab range, but was is really an optimal level for T4?

 
Old 10-12-2009, 08:07 PM   #11
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Re: Thyroid Nodules

Quote:
Originally Posted by midwest1 View Post
Free thyroxine is free T4 (FT4). It's the portion of the serum T4 that is unbound to protein, "free" and available for conversion to the active hormone T3.

The true free thyroxine (FT4) test directly measures the amount of FT4 in your blood. The FT4 index (a.k.a. T7) uses the total thyroxine measurement (the sum of both bound and free T4) and the T3 uptake result in a math calculation which arrives at an inaccurate estimate of the FT4 level. Clearly, an estimate is not nearly as useful as a direct measurement. That's why the genuine FT4 test is the better one.

The T3 uptake test has nothing at all to do with the T3 circulating in your system. It's a measurement of the protein which carries thyroid hormone. The usefulness of this test is extremely limited; it's mostly done only for the FT4 index test, which as I explained, is useless.

Your TSH is only half a point lower than mine was when I was diagnosed and started treatment, so if another TSH comes back similarly elevated - even if still within "normal" range - you're definitely hypothyroid. It's quite possible that you have the autoimmune disorder Hashimoto's thyroiditis, which is the leading cause of hypothyroidism in industrialized countries. It also can also cause nodules. If you're found to have thyroid antibodies, it's very likely they have caused your nodules.
I received the results of my T4, Free (Direct) 1.03 Range is 0.93-1.71. My rechecked TSH was 4.3 Range 0.45-4.50 so it up a hundredth. Of course, my genecologist said what I expected, the nuclear scan report stated "No areas of increased activity or photopenia. Overall thyroid appears within normal limits. Unremarkable Pertechnetate thyroid scan. No focal nodules of increased or decreased tracer activity and overall normal size." So he thought it was fine to do nothing unless I wanted a 2nd opinion he would refer me to a surgeon. What do you all think about this? I have an Internist and an Endocrinologist in mind that I found on "Top Thyroid Docs" list.

 
Old 10-13-2009, 05:55 AM   #12
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Re: Thyroid Nodules

I would get to the endo or an ENT, it's very good that the nodules weren't "cold", but it's a good idea to get them followed up based upon their size alone.

 
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