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Old 02-22-2010, 08:17 PM   #1
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THYROID HELP (nodules & enlargement)

I’m learning the thyroid is so complex and would appreciate anyone's input on my results and what the next steps or considerations might be. My follow up is 1 week with my doctor. It can't come soon enough!

Ultrasound: Both lobes of the thyroid gland are enlarged. Both lobes are also very heterogeneous in echotexture, which can cause artifact resembling nodules, as well as obscure nodules.

Right lobe measures 6.3 x 2.0 x 1.9 cm. It appears to contain three heterogeneously hypoechoic solid nodules. The largest is located in the middle third measuring 1.4 x 0.7 x 1.6 cm. The next largest is located in the upper third measuring 1.4 x 0.8 x 1.1 cm. The 3rd nodule is located in the lower third measuring 0.7 x 0.6 x 0.8 cm.

The left lobe measures 5.3 x 1.7 2 2.2 cm. It appears to contain two heterogeneously hypoechoic solid nodules in its lower third measuring 1.3 x 0.8 x 0.8 cm and 0.8 x 0.6 x 0.9 cm. No other nodule, abnormal vascularity, or other significant is identified on either side.

The isthmus is enlarged and measures 0.7 cm in AP dimension.

Impression: Enlarged heterogeneous thyroid with benign appearing nodules measuring up to 1.6 cm in the right lobe. These findings are highly suggestive of multinodular goiter. Follow up can be performed as clinically indicated. (and, what does that mean, too?)

ALSO...... My thyroid blood work reported T3=31 slightly elevated and T4=7.9, and Antibodies=542 (2 years ago they were over 10,000!!!!). I have been borderline hypothyroid for a few years; also 2 years ago, I had an ultrasound showing enlarged thyroid (right lobe) 6.0 cm. Any clarification would be great! Thank you all so much for your time!

Last edited by jibryan; 02-22-2010 at 08:18 PM. Reason: I didn't bold anything - sorry.

 
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Old 02-23-2010, 10:23 AM   #2
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Re: THYROID HELP (nodules & enlargement)

You need to get all the nodules that are 1cm or greater biopsied.

You should be on hormone replacement for your Hashi's (I assume the high antibodies are TPO?). Do you have any labs that include free T3 and free T4 levels? What is your TSH level?

 
Old 02-23-2010, 07:58 PM   #3
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Re: THYROID HELP (nodules & enlargement)

I'm so excited to have a reply - thank you! I was getting worried.

So, I have been on .025 mg (or mcg? starter/low dose) levothroxyn for 1 1/2 months (not missing a day). I was off and on with the meds over the past few years because I was "borderline hypo".... until based on lab work and symptoms 1 1/2 months ago they said - take it - no question - and they said let's see how your body responds to consistency in taking the meds. I don't know much more than the antibodies @ 542, and t3 was 31 and t4 was 7.9 (I called and asked the nurse to give me some numbers from the lab report - she said it looks like overall your thyroid is functioning normally (based on blood work). I will see the full report in 2 days - so I'll know the answers to the questions you asked me then.

 
Old 02-23-2010, 08:03 PM   #4
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Re: THYROID HELP (nodules & enlargement)

Oh, you commented about being on hormone replacement due to my Hashi's. Question... I haven't been diagnosed or told I have Hashis. Is it evident to you that you think that's what all this adds up to? Thank you. I appreciate your reply/questions/thoughts.

Also, what is TPO?

Finally, are you saying because the nodules are > 1 cm I need biopsies? Do you say this due to the nodules size or type (solid, hypoechoic, heterogenous)? And, do you mean a FNA biopsy? What about that "iodine scan"? And, I thought you just don't worry necessarily due to > 1 cm.... do you know the criteria the doctor's go by? (based on what you know about mine?). Thank you, sincerely, for your time!

Last edited by jibryan; 02-23-2010 at 08:28 PM. Reason: Grammar error (woops)

 
Old 02-24-2010, 07:28 AM   #5
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javelina HB Userjavelina HB Userjavelina HB User
Re: THYROID HELP (nodules & enlargement)

Well with elevated thyroid antibodies (TPO=thyroperoxidase, TG= thyroglobulin) you should have been told you have Hashi's or autoimmune thyroiditis. I am immediately suspicious of any doctor who fails to inform their patient of an important diagnosis like this one They are leaving you in the dark and that's bad practice. They should have spent some time explaining this and what it means.

Reese here is the real expert on thyroid nodules but my understanding is that FNA is indicated for any that are 1 cm or over. As far as scans, etc I'm not as informed on when these are indicated. Nodules and enlarged thyroid are very common with Hashi's and most time the nodules are benign but should be checked nevertheless.

Get your labs from the Dr's office. We've learned not to take "you are fine" for granted when told by nurses over the phone, and again they are not as forthcoming as I would like a doctor to be. Always get a copy for yourself and we can give you pointers on how to interpret them. Also we will need the reference ranges that are after your results because these can vary from lab to lab.

As you say, 25mcg is a very small starting dose. You will need to increase until your symptoms are relieved. Going by symptoms is more important than what labs show overall but most doctors are lab junkies and forget to watch how their patient actually feels.

 
Old 02-24-2010, 10:01 AM   #6
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Re: THYROID HELP (nodules & enlargement)

Thank you so much, javelina, for your input and clarification. I really didn't know what to expect from this forum, and you have just been a resourceful friend over the lines. Have a great day!!!

 
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enlarged isthmus, enlarged thyroid, heterogeneous, hypoechoic solid nodules, multinodular goiter



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