I'm new to these boards & have been reading over threads in the Thyroid Disorder Section. Folks are very knowledgeable here! Also very compassionate & generous in sharing their knowledge!
I'm not sure if I have a thyroid disease but have been experiencing symptoms of general poor health, some of which seem to indicate problems with my thyroid.
One of my symptoms was/is an unexplained hoarse voice. My DO has sent me to several specialists depending on symptoms & to rule out problems. A few days ago I was seen by an ENT who immediately noticed palpable nodules on my thyroid. He ordered an ultrasound & these are the results:
"Palpable thyroid nodules:
Real-time gray scale imaging of the thyroid gland was obtained in multiple planes.
The right lobe measures 4.8 x 1.8 x 2.2 cm. The left lobe measures 4.3 x 1.8 x 2.0 cm.
Evaluation of the right lobe demonstrates the presence of multiple hypoechoic nodules. The largest nodule is complex with both solid and cystic components in the lower pole and measures 2.2 x 1.0 x 1.6 cm. Three hypoechoic nodules are noted in the upper pole measuring 8 x 6 x 6 mm, and 4 x 2 x 4 mm. Two other hypoechoic are noted in mid portion of the right lobe measuring 7 x 5 x 5 mm and 4 x 3 x 4 mm.
Evaluation of the left lobe demonstrates the presence of two hypoechoic nodules. These are in the mid portion measuring 6 x 3 x 5 mm and in the lower pole measuring 5 x 3 x 3 mm.
There is a 3 x 2 x 3 mm hypoechoic nodule in the thyroid isthmus to the left of midline.
IMPRESSION: MULTINODULAR GLAND AS ABOVE. THE RIGHT LOBE IS MILDLY ENLARGED. "
I have a FNA biopsy scheduled for 05/31/12 at the facility which performed the ultrasound.
I spoke with the ENT re: results & asked him to refer me to an Endocrinologist.
My big question is how can my thyroid function properly if I have all of these nodules?
The truth is, you need very little thyroid tissue to function normally---a little bit of thyroid tissue goes a long way---you actually have a lot of thyroid tissue---it's overgrowth.
You can post your thyroid numbers, tsh, free t3, free t4 and antibodies, and people here can help you see if it really is indeed functioning well or not. I have a feeling it is not "normal" because your thyroid is a multinodular goiter (lumpy bumpy thyroid) and that can come from thyroid disease like hashimotos which you aren't even aware that you have.
I'm sure your results will be fine, but if that is constricting your voice, that's a bad thing, and growing a bit crazy in your neck, and you may have to talk to the ENT about surgery in your future no matter what the fna results.
The Following User Says Thank You to Reece For This Useful Post: OnSafari (05-22-2012)
Thanks for your response! I will post lab results as I get them - I had blood drawn on Monday (for AM Cortisol) & asked lab to do TSH, free T3 & free T4.
As far as I know, thyroid problems do not run in my family but it seems likely that thyroid problems may often be under or mis-diagnosed.
I live in Nassau County on Long Island, NY. I'm looking for someone to evaluate/treat thyroid, do you recommend anyone? Thanks & respect.
It's taken me a bit longer than I thought it would to get some lab results! I still don't have the most recent TSH, free T3 & free T4 however these are from a whole battery of tests ordered by my neurologist on 05/15/22:
TSH 1.03 reference range is 0.40 - 4.50 miU/L
T4, TOTAL 6.5 reference range is 4.5 - 12.0 mcg/dl
T3, FREE 2.5 reference range is 2.3 -4.2 pg/ml
As a footnote to the TSH reference range, the lab (Quest) lists:
For Pregnant Patients:
First Trimester: 0.26 - 2.66 miU/L
Second Trimester: 0.55 - 2.73 miU/L
Third Trimester: 0.43 - 2.91 miU/L
The lower reference range for pregnant patients strikes me as interesting.
I'm going for the FNA biopsy tomorrow & am still waiting for the more recent TSH, free T3 & free T4 lab results.
I scheduled an appointment to see an Endocrinologist however still do not know her philosophy when it comes to treatment, especially if sub clinical hypothyroidism.
What do you think? Thanks & respect for impressions.
[QUOTE=OnSafari;4989622]
TSH 1.03 reference range is 0.40 - 4.50 miU/L
T4, TOTAL 6.5 reference range is 4.5 - 12.0 mcg/dl
T3, FREE 2.5 reference range is 2.3 -4.2 pg/ml
[QUOTE]
First off, hello to you from a former Nassau County resident!!
I've been in NJ for the past 20 years and developed thyroid disease 5 years ago. I wish I had a referral for you but, I don't - sorry.
You could check the Top Thyroid Doctors site to see if any are in your area. A quick check found listings in Garden City, Glen Cove, Massapequa, New Hyde Park...a bunch in Suffolk County and, of course, NYC.
OK...onto your labs
You are quite hypothyroid even without a FreeT4 test result to share.
Firstly, please know that thyroid status is always determined by looking at the actual thyroid hormone levels - FreeT4 and FreeT3 and not pituitary hormone TSH.
Total T4 measures T4 that is bound to proteins but, with your low level, it's doubtful that you have enough unbound (aka "free") T4 for your body to use.
Your FreeT3 level is scraping the bottom end of the range. Based upon your lab's ranges, a healthy person would have a level around 3.4-3.8.
Unfortunately, for many of us, our TSH level is the last to indicate hypothyroidism - it can take years for it to rise above-range while the patient is suffering with the symptoms and related health conditions that are associated with inadequate thyroid hormone levels.
You would benefit from some thyroid hormone replacement.
Now, I'm not so sure an endocrinologist will recognize the obvious - so many of them are focused on "normal" (aka in-range) levels and will tell the patient that their symptoms are being caused by anything but the thyroid.
However, thyroid textbooks are pretty clear about the types of levels healthy people have - it's to our detriment that many doctors don't seem to be aware of this.
Endo Dr. Ken Blanchard writes about people with "normal" (aka in-range) levels who suffer with raging hypothyroidism in his book "What Your Doctor May Not Tell You About Hypothyroidism". He would start you on treatment now (too bad he's in the Boston area).
Many thanks & much respect for your response - it's coming at a time when I've been feeling pretty down about my health issues & unfortunately, not too hopeful when it comes to getting beneficial treatment.
I'm still looking for a practitioner & will take your advice. I will also post more lab results as I get them - I've been requesting copies for myself but have been finding that some offices will not release the report unless the Doctor has gone over the result with the patient. (annoying)
I'm waiting for the results of the FNA biopsy done yesterday. The procedure itself was not painful or problematic in any way. I do hope they got enough cells in the sample they took. The Dr. performing said they used to be able to take a look at the samples under a microscope to ensure they have enough to look at but now they are prevented from doing so because of insurance policy, procedure & regulation. (annoying) I'm hoping they got a good sample. She said they take three samples & feels as if they got enough. She said there was liquid (cyst-like?) & she was also trying to get some cells from a solid section. From what I understand they were only taking samples from the largest nodule (on right lobe). She said I would probably hear from the ENT who ordered the biopsy on Monday.
I really appreciate being able to share my experiences here & read about other peoples' experiences. I've been trying to educate myself as much as possible & people on this site are very generous about sharing. I really respect & appreciate.
I only saw the ENT surgeon once however feel comfortable with his style & philosophy. He specializes in Head & Neck Surgery/ Otolaryngology. I know he has experience in surgeries on the Thyroid. Although I don't know if he follows up on the medication/titration after the surgery? I don't even know if I will need surgery? I know I will need a thyroid savvy specialist in any event.
Thanks again & I'll be back to post when I hear anything!
I can comment on the lower TSH range for pregnant women, as I have been doing quite a bit of research about this recently.
Pregnancy hormone HCG has a very similar molecular structure to TSH, so there is an added stimulatory effect on the thyroid during pregnancy, especially during the weeks of peak HCG (middle of first trimester). As a result, there is a partial blunting of TSH. This reference range for pregnant women takes this suppressed TSH into account, which is also very important for pregnant women whose TSH might otherwise be termed hyperthyroid in the first trimester, due to increased hcg levels.
This is the scenario typical for pregnant women with healthy thyroids, capable of picking up the slack of the increased thyroid demands of pregnancy. Hypothyroid women, especially those with Hashimoto's, tend to have a rise in TSH due to increased blood volume (free thyroid levels become more diluted), increased estrogen (which raises t4 binding globulin), and increased need for T4 to supply to the fetus.
I am sure that this is more than you were looking for but there you go!
The Following User Says Thank You to bee01 For This Useful Post: OnSafari (06-01-2012)
Thanks & respect! It's not more than what I was looking for. I would like to be able to understand as much as possible, I think it's helpful & aids in allowing the mind/body/spirit to heal. I'm not pregnant however I appreciate & found your information useful!
This is from 'The Thyroid Hormone Breakthrough' by Mary J. Shomon:
Quote:
"Thyroid goes through a number of important changes during pregnancy, & proper thyroid function & hormonal balance is essential to a healthy pregnancy & healthy baby.
TBG Increases
In pregnancy, there is an increase in production of T4-binding globulin, known as TBG. TBG is a protein that acts as a transporter for thyroid hormone in the bloodstream. This TBG increase sets off a chain of events that affect the overall hormonal picture in pregnancy:
The estrogen can stimulate the development of TBG development; as estrogen levels rise in pregnancy, TBG levels rise as well, in some cases nearly doubling.
The TBG actually binds to thyroxine (T4) in the bloodstream, which lowers the free T4 levels.
The brain perceives the lowered free T4 levels as being insufficient (hypothyroidism), & so TSH elevates.
The elevated TSH triggers the thyroid to produce more thyroid hormone.
T4 & T3 levels increase.
This process is important, because there is an increased need for thyroid hormone during pregnancy, in particular, early pregnancy when the baby does not have a functional thyroid & relies on the mother's extra production for all its thyroid hormonal needs."
I'm glad the medical community seems to be more accepting of variation in thyroid levels during pregnancy. I still think it would be important to have a thyroid savvy practitioner involved when there is a known thyroid disorder.
I'm glad the medical community seems to be more accepting of variation in thyroid levels during pregnancy. I still think it would be important to have a thyroid savvy practitioner involved when there is a known thyroid disorder.
I hate to burst your bubble but, many in the medical community do not understand thyroid needs during pregnancy based upon what I've read on thyroid forums for the past 5 years.
Yes, patient advocates such as the author of the book you mentioned understand thyroid issues as do many of us who were forced to research extensively so we could rally for the proper care.
Without a doubt, we need thyroid-savvy practitioners - they're the only ones who can even identify thyroid disorders because many other doctors don't.
But, all is not lost.... there are thyroid-savvy doctors out there.
If you work towards understanding thyroid function and what's necessary to feel well while having thyroid disease, you'll know a thyroid-savvy doctor when you meet one.
I must admit, I was quite impressed with the number of recommended practitioners in Nassau County alone. I don't have that "luxury" here in NJ and I'm only 35 miles west of Manhattan.
Thankfully, I was able to find a thyroid-savvy doctor without having to make the trek into the city.
I hate to burst your bubble but, many in the medical community do not understand thyroid needs during pregnancy based upon what I've read on thyroid forums for the past 5 years.
Yup I guess you're right! I was being a little too optimistic because of the different reference ranges for pregnancy noted as a footnote on my lab results. That is definitely not enough evidence!
Quote:
Originally Posted by sammy64
I must admit, I was quite impressed with the number of recommended practitioners in Nassau County alone. I don't have that "luxury" here in NJ and I'm only 35 miles west of Manhattan.
Thankfully, I was able to find a thyroid-savvy doctor without having to make the trek into the city.
There were quite a few folks listed. Although I'm finding that some of the people are no longer available at the phone # or web site listed. That's a little worrisome. I'm about 35 miles East of Manhattan & don't mind if I have to go there - I am more interested in getting in touch with knowledgeable people (& find myself becoming impatient because I'm feeling poorly). I'll let you know what happens.
Is it alright to post information on this site about practitioners? Thanks & respect.
Yup I guess you're right! I was being a little too optimistic because of the different reference ranges for pregnancy noted as a footnote on my lab results. That is definitely not enough evidence!
The problem with any type of thyroid lab ranges lies with the doctors focusing on them and them only.
For example, I'm hypo as a natural progression of Graves' so, my TSH is suppressed (below-range) because of my Graves' antibodies. My current thyroid doctor (#5) understands this. My former doctors (3 of them endos) didn't.
Those lab ranges for pregnant women wouldn't help one with Graves. In fact, if a doctor medicated only based upon those ranges, a pregnant Graves' patient would be very sick and likely miscarry or give birth to a child with defects.
Quote:
Originally Posted by OnSafari
There were quite a few folks listed. Although I'm finding that some of the people are no longer available at the phone # or web site listed. That's a little worrisome. I'm about 35 miles East of Manhattan & don't mind if I have to go there - I am more interested in getting in touch with knowledgeable people (& find myself becoming impatient because I'm feeling poorly). I'll let you know what happens.
Is it alright to post information on this site about practitioners? Thanks & respect.
JoAnn
I had a similar experience when trying to contact some of the NJ practitioners. I've also heard that some of the doctors weren't as thyroid-savvy as their patients seemed to think they were. Unfortunately, it seems to be the only list out there.
Another idea is to get contact info from local pharmacists for doctors that Rx Armour or Cytomel. Doctors that prescribe these two types of thyroid meds tend to be more thyroid-savvy. You'll want to be sure to speak directly to the pharmacist vs. the counter help. Don't give up if the first pharmacist doesn't help you - just move onto the next one.
Armour used to have a physician locator service on their website but, no longer. I actually called them to ask about it and was told that they decided to eliminate it rather than be interpreted as "favoring" certain practitioners. My 20/20 Hindsight is kicking me in the butt for not copying the listings for my state before it was discontinued.
You could also trying finding holistic/alternative MD's through their respective association websites. And, The Broda Barnes Foundation also offers referrals by state but they charge something like $18 for their information packet ( I bought one because I do like the idea of a backup plan )
There have been discussions on here from time-to-time about different doctors - just no exchange of contact info in the open forum.
If you do find a good doctor, I hope you'll share here. I recently started maintaining a file of doctors recommended on forums in the hopes that it might help someone one day.
I meant to tell you that the fact that you have a multinodular goiter means you are much less likely to have thyroid cancer. Nodules 1cm or larger are biopsied just to play things safe but, I wouldn't worry if I were you. In fact, some nodules resolve on their own.
As you already recognize, getting the proper treatment for your hypothyroidism is most important....and could be challenging but, it's not impossible.
I just wanted to share with you a doctor that does surgery at Columbia. A friend of mine highly recommended him as she had just had surgery herself and said he was great. The info for him is - I would REALLY suggest you call Dr. James A Lee at Columbia. 212.305.0444 My SIL also had surgery a year or so ago and lives on Long Island. She said her doc was fabulous as well, but I can't remember his name right now. I will touch base with her and get it for you as well as his location to see if he might be an option for you as well.
I just wanted to share with you a doctor that does surgery at Columbia. A friend of mine highly recommended him as she had just had surgery herself and said he was great. The info for him is - I would REALLY suggest you call Dr. James A Lee at Columbia. 212.305.0444 My SIL also had surgery a year or so ago and lives on Long Island. She said her doc was fabulous as well, but I can't remember his name right now. I will touch base with her and get it for you as well as his location to see if he might be an option for you as well.
Sorry about all the "as wells" - still having my first cup of coffee this morning.
The Following User Says Thank You to BadThyroid For This Useful Post: OnSafari (06-03-2012)
I meant to tell you that the fact that you have a multinodular goiter means you are much less likely to have thyroid cancer. Nodules 1cm or larger are biopsied just to play things safe but, I wouldn't worry if I were you. In fact, some nodules resolve on their own.
Hi Sammy64,
I just received the FNA biopsy report & wanted to let you know you were right!
FNA Report:
Consistent with cyst content
Negative for malignant cells
Smears show rare follicular cells admixed with abundant hemosiderin-laden macrophages, consistent with cyst content
cell block shows hemosiderin-laden macrophages
Quote:
Originally Posted by sammy64
As you already recognize, getting the proper treatment for your hypothyroidism is most important....and could be challenging but, it's not impossible.
& now to (hopefully) get assessed/treated by a thyroid-savvy practitioner!
I have an appointment next week, will let you know how it goes.
TSH = 1.01 reference range (0.40 - 4.50 mIU/L)
T4, FREE = 1.2 reference range (0.8 - 1.8 ng/dL)
T3, FREE = 2.9 reference range (2.3 - 4.2 pg/ml)
CORTISOL, AM = 16.5 reference range (4.0 - 22.0 mcg/dl)
CORTISOL, FREE,
24 hour urine = 59.5 (H) reference range (4.0 - 50.00 mcg/24 h)
CREATININE, FREE,
urine = 1.95 reference range (0.63 - 2.50 g/24 h)
I'm bringing all recent lab results to my appointment with endocrinologist next week. Most likely he will order more tests? Which tests would be most helpful in diagnosing? Auto immune antibodies?
TSH = 1.01 reference range (0.40 - 4.50 mIU/L)
T4, FREE = 1.2 reference range (0.8 - 1.8 ng/dL)
T3, FREE = 2.9 reference range (2.3 - 4.2 pg/ml)
I'm bringing all recent lab results to my appointment with endocrinologist next week. Most likely he will order more tests? Which tests would be most helpful in diagnosing? Auto immune antibodies?
Thanks & respect for any & all insights.
I'm only able to interpret thyroid labs so, will comment on yours - you are quite hypothyroid.
Now, some doctors might get confused by your seemingly healthy TSH (most healthy people have TSH 1.0-1.5). However, a thyroid-savvy doctor will look past pituitary hormone TSH and evaluate your thyroid function by looking at your actual thyroid hormone levels: FreeT4 and FreeT3.
Per thyroid textbooks, healthy people have FreeT4 levels near the high end of the range and FreeT3 levels above mid-range. In fact, recent studies have shown that healthy people actually have FreeT3 levels in the upper third of the range.
That said, you can see that your FreeT4 level is below mid-range....and your FreeT3 level is near the bottom end of the range. This indicates hypothyroidism, without a doubt.
You really shouldn't need further testing before being started on some thyroid hormone replacement.
However, some doctors might order antibody tests to confirm/rule out that the cause of your hypothyroidism is the most common one: Hashimoto's Thyroiditis.
In fact, if the doctor is really thyroid-savvy, he/she will run the 3rd test I'm listing since it represents a less-common antibody that can cause hypothyroidism.
Here are the antibody tests a thyroid-savvy doctor would run:
Your doctor should know that a multinodular goiter is often accompanied by hypothyroidism. He/she should also know that not everyone with Hashi's tests positive for the antibodies.
Since it's now clear that you are hypo, I suggest you read "Thyroid for Dummies" to get a better understanding of your disease and its proper treatment. "What Your Doctor May Not Tell You About Hypothyrodism" is another good one - especially for people in your situation - "normal" (aka in-range) thyroid labs but, hypothyroidism.
In addition, I suggest that you prepare a symptoms list and give a copy to your doctor. There are countless lists of hypothyroidism symptoms online. Not everyone will have every symptom on any list but, having at least 5-10 would help a thyroid-doctor recognize hypothyroidism.
The list below comes from thyroid textbook "The Thyroid and Its Diseases"
Fatigue
Swelling of eyelids
Emotional instability
Lethargy
I just wanted to let you know I have my appointment later on today. I'm hopeful however carefully considering. I'm ready to move on to the next practitioner if need be. I wanted to thank everyone here at HealthBoards Message Boards for helping me & others to navigate the sometimes bumpy world of the Thyroid! A special thanks & much respect goes out to Sammy64!
I'll be back later on or tomorrow to let you know how it goes.
Thanks & respect.
The following user gives a hug of support to OnSafari: sammy64 (06-12-2012)
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