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Old 05-27-2012, 02:47 PM   #1
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ultrasound & bloodwork results please help me to understand correctly..

I finally got my ultrasound results and bood test and was hoping for clarification if possiible.

Aug, 2011 - US

Rt lobe 7.1 x 2.1 x 2.3 - Echodensity is heterogeneous without focal mass.
Isthmus is thickened measures 7mm
Lft lobe 6.5 x 2.9 x 2.4 - enlarged with subtle hypervascular solid mass nearly isoechoic posterior lower pole.
Mass measures 3.5 x 2.2 x 2.1cm

May, 2012 - US
Rt lobe 6.1 x 2.8 x 2.3
Isthmus Same as Aug 2011
Lft lobe measures 6.9 x 3.0 x 2.5 cm echodensity is heterogeneous with again solid mass measuring 3.5 x 2.6 x 2.2cm

Impression persistent indeterminate solid mass left lobe and diffuse goiter.

Bloodwork results
Cortisol - AM is low 0.7
T4 Free (direct) is low 0.81
T3 is 133ng/dl
TSH is 1.140
Prolactin is low 3.0
sed rate & C reactive are slightly elevated

If anyone could help explain these results to me I would truly appreciate it so much!

Thank you.

Last edited by marcee; 05-27-2012 at 02:54 PM.

 
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Old 05-29-2012, 07:27 AM   #2
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Re: ultrasound & bloodwork results please help me to understand correctly..

Are you medicated for your thyroid? You are obviously under medicated, and that may be making this goiter grow. But to be honest, this is a very big goiter, with a very large mass growing on it. Have you had a needle biopsy on the mass?

I would first try to meet with someone that is good to help with the blood work and such and properly medicate you, especially if you will need this out you want someone to manage your medication, and then I would meet with some good ENT surgeons with thyroid specialty to discuss getting this tremendous thing out.

 
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Old 05-29-2012, 07:51 AM   #3
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Re: ultrasound & bloodwork results please help me to understand correctly..

Hi Reece... Thank you for responding to my post as I was beginning to lose hope that anyone would respond at all.

Yes, i am on meds: 200 mcg levoxyl
5 mcg Cytomel

My dr is an Endo. They are scheduling me for fna but going to tell them I want TT. Under these cirumstances, don't you think a TT is warranted?

I am also concerned about my bloodwork. Can you help me PLEASE with the right words/understsnding of my thyroid lab results for when I talk to my dr?

Honestly I feel so crappy, like I'm just plain sick. Waking up with headache every morning, sluggish, actually I'm having to take naps throughout the day. I really don't know how to describe how I feel...just that I don't feel well. I ache everywhere even the bottoms of my feet hurt when I walk on them like the bones in my feet are bruised or something--so very strange. At times my hands feel swollen--just so weird.

Anyway, agaii thank you so much for responding

Last edited by marcee; 05-29-2012 at 07:54 AM.

 
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Old 05-29-2012, 08:10 AM   #4
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Re: ultrasound & bloodwork results please help me to understand correctly..

Please try to realize that due to the long holiday weekend, it might take some time for people to reply.

I have no knowledge as far as the mass and ultrasound goes, other then that I can only agree that you're undermedicated. (you need a dosage increase).

Can you help me PLEASE with the right words/understsnding of my thyroid lab results for when I talk to my dr?

T4 Free (direct) is low 0.81
T3 is 133ng/dl
TSH is 1.140

those are the thyroid related levels (cortisol (which are adrenal glands) and prolactin aren't thyroid levels -> although they can be influenced by it).

TSH = thyroid stimulating hormone, produced by the pituitary gland.
T4 and T3 are the actual thyroid levels. You want to have FT4 (or T4 free) and FT3 tested since those measure the available thyroid hormone.

any idea about the T3 which is tested? (normally an additional word should be mentioned on the labform).

In case of hypoT: TSH will increase, FT4 and FT3 will decrease
in case of hyperT: TSH will decrease, FT4 and FT3 will increase.

This is the standard scenario, but not always true in practice. I'm afraid your doctor might be dosing your thyroid medication based on TSH.
dosing on TSH can be compared at looking at the gas pedal in order to know how hard on is driving. the actual thyroid hormone levels (being FT4 and FT3) are much more important.

Within ranges aka normal is not good enough in order to feel good when it concerns thyroid. Most people need their free levels at least midrange or 60-80% of the ranges. (since your FT4 is low, it's obvious you're not there yet and this can cause symptoms).

Hang in there!

 
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Old 05-29-2012, 08:15 AM   #5
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Re: ultrasound & bloodwork results please help me to understand correctly..

When one is taking T4/T3 medication one can expect TSH to be very low when optimally treated. Your doctor should know this if he's prescribing T3 (I'm not sure how to make your doctor aware of the fact). He should also know that low TSH itself is not an issue as long as there are no hyperT symptoms and freeTs are (pretty much) within range. Your TSH could be fine for someone on T4 only. If he's adamant that your dose should not be increased based on your current TSH you need to find another doctor - you just can't adjust combination treatment succesfully based on TSH.

Your FT4 is low in the range - it's too low for practically everybody and there's plenty of room to increase it. FT3 would tell you how much of the active hormone is available for use, when total T3 also measures the T3 that's "out of use". Most people need to have their freeTs above midrange - if they are below midrange the T4 dose should be increased by 25 or 12 mcgs at a time to see if that'll help with the symptoms, 5 mcgs of Cytomel is a low dose so it's very possible you need more.

Also are you taking your meds on an empty stomach with plain water to make sure it's absorbed properly, a good while before eating anything or taking any other meds or supplements?

Last edited by FinnMaid; 05-29-2012 at 08:18 AM.

 
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Old 05-29-2012, 08:37 AM   #6
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Re: ultrasound & bloodwork results please help me to understand correctly..

Finnmaid, thank you.

I take my thyroid meds first thing in morning before breakfast. But I do take with coffee and not water. Do you think coffee could be hindering the absorption of thyroid meds? I do put 2% milk in my coffee.

I was kind of hoping you were replying with the suggestion of a good thyroid book title for me so that I could purchase it and educate myself on all things about the thyroid gland. There are so many thyroid books out there, I just thought it would be best to go with a recommendation.

Thank you.

Last edited by moderator2; 05-29-2012 at 03:10 PM.

 
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Old 05-29-2012, 08:43 AM   #7
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Re: ultrasound & bloodwork results please help me to understand correctly..

Quote:
Originally Posted by marcee View Post
I take my thyroid meds first thing in morning before breakfast. But I do take with coffee and not water. Do you think coffee could be hindering the absorption of thyroid meds? I do put 2% milk in my coffee.
The coffee may indeed be an issue, there's a study on this too. Your med should work better with plain water.

Check out "Lisa's thread" on the book issue

Last edited by moderator2; 05-29-2012 at 03:09 PM.

 
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Old 05-29-2012, 08:46 AM   #8
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Re: ultrasound & bloodwork results please help me to understand correctly..

Indeed coffee might be an issue, you want to take your thyroid meds with water.
Although I do think coffee might influence the absorption, not sure whether that alone might bring up your levels sufficiently.

 
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Old 05-29-2012, 08:57 AM   #9
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Re: ultrasound & bloodwork results please help me to understand correctly..

Yes there is another word next to T3...triiodothyronine (T3) is 133 ng/dl.

I also didn't mention that my creatin kinase isoenzymes were checked as well. I have tried to research these results but I'm not sure about the CK MM whether it is right on target or considered elevated.
Results:
creatine kinase, total serum is 66.
Ck mm is 100
Ck mb is 0
Ck bb is 0
Like I said, I'm thinking these are okay. Really though, the only one I'm not sure about is the ck-mm at 100 because I read where this indicates muscle issues and then the opposite that it is normal. I don't know why none of this is sinking in. I'm not usually so dense really.

Last edited by marcee; 05-29-2012 at 08:58 AM.

 
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Old 05-29-2012, 09:04 AM   #10
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Re: ultrasound & bloodwork results please help me to understand correctly..

Quote:
Originally Posted by marcee View Post
Yes there is another word next to T3...triiodothyronine (T3) is 133 ng/dl.
T3 is short for triiodothyronine. It should say "free" or "F" too to mean FT3.

 
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Old 05-29-2012, 09:28 AM   #11
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Re: ultrasound & bloodwork results please help me to understand correctly..

Coffee is definitely a no-no if you want to maximize T4 absorption.

http://www.ncbi.nlm.nih.gov/pubmed/18341376?dopt=Citation

I know that significantly increasing my fiber intake affected my T4 absorption since my FT4 level decreased quite a bit when I did that.

I suspect your coffee intake could very well be having a similar effect.
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Old 05-29-2012, 04:13 PM   #12
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Re: ultrasound & bloodwork results please help me to understand correctly..

I'm not sure why my dr didn't order a free T3 when he ordered a free T4.

I remember probably 6 yrs ago I had an MRI of my pituitary and it came back that my pituitary was okay but my pituitary stalk was thickened. I had asked my dr back then if that was something to be concerned about and he said 'No'. So I didn't concern myself further with my thickened pituitary stalk. Now I'm thinking that may have been foolish on my part back then to dismiss so freely.

When i was 42 yrs old (now 56), I just quit having periods...basically overnight. No hot flashes, nothing. Up until that time, I had always had very regular menses, then they just stopped. I haven't had a period since. My GYN felt of my neck and said I needed to go to Endo because he felt a goiter and this may be why my periods ceassed.

Sure enough he was correct and after much testing, I was dx'd with hashimotos.
My new question is has anyone else been told their pituitary stalk was thickened? I'm wonderig if this is perhaps why my thyroid is having issues and my thyroid hormones are off? I'm sure my apparently very large thyroid mass has something to do with this as well.

You know I am starting to feel very worried about this mass and the fact that I just don't feel right. I am really not myself healthwise that is. And now I'm feeling like part of this is my own fault because I so easily have trusted my drs advice. I really should have questioned drs further way back then. I hope this is not gonna end up badly as a result.

From now on I will be taking my thyroid meds with water only and will watch my fiber intake. How soon after you taking them can you eat breakfast though?

Last edited by marcee; 05-29-2012 at 04:34 PM.

 
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Old 05-29-2012, 10:47 PM   #13
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Re: ultrasound & bloodwork results please help me to understand correctly..

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Originally Posted by marcee View Post
From now on I will be taking my thyroid meds with water only and will watch my fiber intake. How soon after you taking them can you eat breakfast though?
An hour would be great but 20-30 min is ok.

 
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Old 05-29-2012, 11:06 PM   #14
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Re: ultrasound & bloodwork results please help me to understand correctly..

over here they recommend half an hour, others do an hour. I do think consistency is important, whatever you chose, stick to it and do it the same every day.

 
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Old 05-31-2012, 01:12 PM   #15
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Re: ultrasound & bloodwork results please help me to understand correctly..

I just wanted to say thank you to everyone and let you know that i have been setting my alarm for 5am and the first thing I do is take my thyroid meds with water only. I cannot begin to tell you the difference this has made energy wise. I wait a full 1 hr before I make my coffee. Watching my fiber is a bit more difficult since I have been trying to add more fiber to my diet.

I had my dr's appt and tried very unsuccessfuly to convince him to just schedule TT as I have already had attempted bx but developed hematoma immediateely and the dr was only able to get 1 specimen.

This time the radiologist is going to do the biopsy though but I still have my doubts that he will be able to do any better since my thyroid is engorged with blood.

My dr wants to get the results of thyroid biopsy first before ordering cranial MRI to see if any changes to my pituitary. HAS ANYONE EVER HEARD OF THICKENED PITUITARY STALK BEFORE AND IF THIS IS REALLY JUST THE SAME AS AN ENLARGED PITUITARY?

I was hoping I could get the MRI done sooner as I am really starting to worry especially given all the 'low' levels (cortisol, Free T4, prolactin) and although my TSH of 1.14 and T3 is 133 are not out of the range they are not at optimal levels right?

Last edited by marcee; 05-31-2012 at 01:17 PM.

 
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