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Old 08-29-2011, 07:31 AM   #1
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Multinodular Goiter...so confused???

Hi!

I am 23 years old and have a multinodular goiter. My Endo didn't explain anything to me except I need to do a FNA which came back normal...she made it seem like it was not a big deal and its a very common thing to have. I had several blood test done and they always come back normal but I never actually physically seen my results. I explained my symptoms to her and she's like "ehh I personally wouldn't worry about it, it can happen to anybody". These are the results from my uptake:

Thyroid gland is to some diffusely inhomogeneous, with patchy photopenic areas. An ultrasound reported 1.7 cm nodule or mass in inferior right lobe. This may correspond to a subtle photopenic area in this region, though there are other photopenic areas, some of which appear more prominent.

Seven hour uptake calculated at 18.6%, 24 hour uptake calculated 35.4% These values are upper normal if not slightly elevated (i'm not sure what's considered normal range)

IMPRESSION:
1. Inhomogeneous thyroid gland with patchy photopenic areas in both lobes, may correspond to nodules described on ultrasound
2. Borderline slightly elevated 7 and 24 hour uptake calculations

*The symptoms I'm experiencing is fullness in throat, sometimes I feel like there's a lump in my throat. I don't know if this has anything to do with thyroid but I have frequent swollen lymph nodes right under my chin and a small pea size moveable lump on jawline that causes pain and comes and goes. I'm very sensitive to warmer or hot temperatures

Any advice would be greatly appreciated, thanks!

 
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Old 08-29-2011, 10:06 PM   #2
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Re: Multinodular Goiter...so confused???

Hi Irene,

I am by no means an expert but I also have a multinodular goiter so I wanted to lend you some support and a little advice.

It's easy for an endo to act like "it's no big deal". I sincerely believe that they say this to make you feel better and to be honest, it is true that a multinodular goiter is a fairly easy condition to live with.

I do not possess the necessary knowledge to tell you everything about your test results but based on the reaction of your endo, it seems that they don't want you to worry. It's great that your FNA came back normal and that should give you some peace of mind. However it sounds like you have more questions and you have a right to understand what it going on with your condition.

I would highly recommend seeing an ENT next. Take all your test results and questions and tell them about and show them any swellings you have and describe any pain. They may want to take a good look at how your enlarged thyroid is affecting you structurally and guide you in the right direction. In any case, I would highly recommend keeping a good watch on your thyroid just to make sure nothing changes. My ENT is keeping a very close watch on the size of mine and is being very supportive in regards to what I feel structurally. It is also nice to have a second opinion regarding certain matters. I feel pain from time to time and I worry about it a lot. My ENT picks up a lot of slack in the worry department where my endo sometimes falls short.

Best of luck to you!

 
Old 08-30-2011, 07:07 AM   #3
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Wink Re: Multinodular Goiter...so confused???

irene000;

First please look at the post by teajah1098, Please help with ultrasound results!!!! I wrote a thorough reply there and am texting this one... So I am trying to save on excess phone tapping.

I am 23 years old and have a multinodular goiter. My Endo didn't explain anything to me except I need to do a FNA which came back normal...she made it seem like it was not a big deal and its a very common thing to have. I had several blood test done and they always come back normal but I never actually physically seen my results. I explained my symptoms to her and she's like "ehh I personally wouldn't worry about it, it can happen to anybody". These are the results from my uptake:

Have you hand any antibody panel done (TPOAB, TGAB, TSI, TRAB). Normal FNA results those are not. They are not cancerous that may be what your MD was referring to... This smacks of Hashimoto's early stages. Have you had a TSH, FT3, and FT4 blood panel run? What were results to any of the seven blood tests listed above including ranges if you have had then done. If you haven't had them done you need to get a lab order for them. Now to explain a bit about your excerpt below.

Thyroid gland is to some diffusely inhomogeneousfancy way to say mixed textured or heterogeneous with patchy photopenic areas. An ultrasound reported 1.7 cm nodule or mass in inferior right lobe. This is a lump that is large enough to test for cancer, your results came back cleanThis may correspond to a subtle photopenic area in this region, though there are other photopenic areas, some of which appear more prominent.

Seven hour uptake calculated at 18.6%, 24 hour uptake calculated 35.4% These values are upper normal if not slightly elevated (i'm not sure what's considered normal range)

this is saying you are testing via conversion of T4 to T3 as mildly hyperT. But not excessively so.. You really need the results of the blood work j recommended above.

IMPRESSION:
1. Inhomogeneous thyroid gland with patchy photopenic areas in both lobes, may correspond to nodules described on ultrasound
2. Borderline slightly elevated 7 and 24 hour uptake calculations

*The symptoms I'm experiencing is fullness in throat, sometimes I feel like there's a lump in my throat.

YES THIS IS VERY COMMON. Your thyroid is inflammed and enlarge that is what is causing you lymph node and lump in throat feelings.

I don't know if this has anything to do with thyroid but I have frequent swollen lymph nodes right under my chin and a small pea size moveable lump on jawline that causes pain and comes and goes.

I'm very sensitive to warmer or hot temperatures

This is due to that hyperT component mentioned if it is Hashimoto's there will be a period of this you have to live through until your thyroid function dies off enough for supplementation. I wish I could help more but I soul really need to see your bloodwork on those tests I recommended above. Sorry for any typos.

MG
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Old 08-30-2011, 01:28 PM   #4
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Re: Multinodular Goiter...so confused???

Thanks! I had a regular blood test done last week and the nurse told me my results through the phone:

T3 2.81 (2.15-3.90)
T4 0.95 (0.54-1.24)
TSH level 0.73 (0.34-4.50)

...so basically my blood work came back normal range...but I still experience symptoms though.

 
Old 08-30-2011, 01:55 PM   #5
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Re: Multinodular Goiter...so confused???

You need Free T3&4 tests it looks like they are running Total T3&4 tests. These can have up to 40% error depending on medication and more. Just being female and having higher than male estrogen starts you out at 20% error. You need more accurate tests run.

You are not at YOUR NORMAL OR OPTIMAL THYROID LEVELS until your symptoms go away! Too many MDs undertreat their patients. Rarely do you have a MD willing to treat you optimally. They do the bare minimum and shove you out the door. You need to learn how to fight for the care you deserve.

I can not calculate your results right now. But I will I suspect that you are not in optimal range and if you are by the blood work the standard deviation d
Range on the tests can toss you right out of range. Do you know if these tests are total or free thyroid levels. I need to get kids and do the mom thing for a bit. We can help you understand things. I get so mad at MDs and their NORMAL COW FLOP! I tell my MDs screw normal. I hate being average. Make me optimal. We really need to travel in packs more.... I will be back later!
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Old 08-30-2011, 04:07 PM   #6
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Re: Multinodular Goiter...so confused???

So is it possible to still have normal blood test and still have something wrong? My general MD thinks I should have it taken out but she says most endo will think "why have a normal functioning thyroid removed if its not hurting you"? But I still experience the fullness and weird lump in my throat feeling. I get hot really easily and always have swollen painful lymph nodes...can the lymph nodes have anything to do with my thyroid?

 
Old 08-30-2011, 05:07 PM   #7
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Re: Multinodular Goiter...so confused???

Yes. It is possible to have results in the normal range that are not normal for you. The range is from 0-100%. If you were at 0% you are still in the normal range. Would that be acceptable? The answer is know. What you have to do is ask for the best testing and then reason or barter with your MDs for adjustments in medication.

Start keeping a log of your daily symptoms. When possible have someone witness the symptoms. Such as a husband or friend initially your daily body temp ANC blood pressure. Have a physical trainer or work out partner note your exercise routine. Join weight watchers or work with a nutritionist and keep a food log. Show that you are doing everything possible to stay healthy. And given results low in normal range or in mid range you can reason for a small bump in medication.

Unfortunately to manage your thyroid health you often need to manage your MDs. I also agree if they can not stabilize your levels with your thyroid in yank the malfunctioning lump out. I had GRAVES and HASHIMOTOs my HASHIs killed my thyroid. It literally is a useless lump in my throat.

MG
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Old 08-30-2011, 05:21 PM   #8
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Re: Multinodular Goiter...so confused???

Quote:
Originally Posted by irene000 View Post
I get hot really easily and always have swollen painful lymph nodes...can the lymph nodes have anything to do with my thyroid?
I forgot to answer this one. Yes an inflamed thyroid can cause swelling in your surrounding lymph nodes especially if you have one of the autoimmune thyroid diseases as the source of your thyroid angst. Hashimoto's is famous for it!
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Old 08-30-2011, 09:32 PM   #9
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Re: Multinodular Goiter...so confused???

irene000;

Thanks! I had a regular blood test done last week and the nurse told me my results through the phone:

T3 2.81 (2.15-3.90)

How do you calculate your results? THrough the following formula. It works for any thyroid hormone test results and associated ranges. I suspect these are total T3 levels. So no there is a WIDE deviation range to these results.

2.81 - 2.15 = 0.66
0.66/(3.9 - 2.15) = 0.377
0.377 *100 = 37.7 % No this result can be +/- 40% if this is total T3. So you could be -3% or 77% in actuality. The Free T direct test result have a deviation of 2.5 %. Yeah! That is why you need to insist on them. Yes they cost more.. there is a reason for the increased cost. THEY ARE BETTER TESTS.

T4 0.95 (0.54-1.24)

Let's see where you are here:
0.95-0.54 = 0.41
0.41/(1.24-0.54) = 0.5857
0.5857*100 = 58.57% But is this the real thyroid hormone level or is it 18.57% or 98.57%? Humm? We can not be sure.

TSH level 0.73 (0.34-4.50)
It is sad, but your TSH is probably you most accurate result if the T3 and T4 tests are not Free T direct tests.

...so basically my blood work came back normal range...but I still experience symptoms though.

You really have to take in to account your symptoms. Track them in a log. Note intensities and any time there is a shift in symptoms. Also insist on the most current tests so that you know what your thyroid is actually doing.

Symptoms:

Fullness in throat - this is due to imflammation of thyroid due to overworked tissue, antibody attack, nodule growth... I really wish the MD had performed a full thyroid antibody profile on you. TPOAB, TGAB, TSI, and TRAB. Swelling or autoimmune thyroid attack can explain the lymph node swelling as well.

The temperature sensitivity to warm/hot temperatures is a hyperT symptom. Make a list of hypoT and hyperT symptoms. Record which you experience. It will help you when you are refining your treatment regime.

I hope this helps. I think I got it all this time. Good night.

SIncerely,
MG
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Old 08-31-2011, 02:53 PM   #10
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Re: Multinodular Goiter...so confused???

Thanks for the info...i will definitely bring this up to the doctor. My general MD wants me to get another uptake done in less than 2 weeks. Im hoping this time they'll do a better job explaining the results to me and not "brush me off". My doc thinks they need to take it out...but idk if its something to consider because she said most endos will not agree to it if its "normal". So idk what to do.

 
Old 08-31-2011, 03:11 PM   #11
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Re: Multinodular Goiter...so confused???

When you go in next, copy the following list and insist on these tests being added to the mix.

TSH 3rd Generation
Free T4
Free T3

TPOAB
TGAB
TSI
TRAB

If you bring the list and request that they be run so that you have a full picture of your thyroid function and health a reasonable MD will not have a problem with it. You do need to be firm though. My mom is mush with MDs, they are always right and she does not question them.. I however am a bull dog get in your face kind of girl that makes her MDs prove it. Prove I am normal completely analyze my thyroid levels. Prove I am not normal run a complete thyroid profile on me please. I got my first documentation of having Hashimoto's when my MD insisted it wasn't possible by refusing to leave his office until he ordered the test. It is my or your blood right. THey just check the boxes on the lab work form and say SO MOTE IT BE!

Good luck. Stick with us and we will help where we can.

Sincerely,
MG
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