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Old 10-05-2012, 11:32 PM   #1
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Thyroid Nodule and medication question

Hi - I just joined but I have been reading the post here for years.

I'm pretty foggy and very fatigued, so I apologize if I don't give enough info or make all that much sense. (and accidently posted to general health, yup, foggy)

I am 37, diagnosed fibromyalgia and have just about every hypo symptom imaginable. I have always had far less energy than anyone I know and lately it has been debilitating.

Every doctor I have ever seen has commented that my thyroid looks swollen (I have a huge fat roll around my neck - think Honey Boo Boo's mother, far bigger than it should be for my level of overweight.) TSH has always tested normal, and I didn't know to ask for other tests.

I was on levothyroxine (25mg or is it mcg?), prescribed by a doctor filling in for mine while she was on vacation, despite the normal levels. It did nothing and I stopped taking it after a couple years. I haven't been on it for about 2 years.

Recently, I started getting hot flashes at the least amount of exertion and sweating like crazy, sometimes for no reason. I thought maybe early menopause, but my doctor decided to check my TSH levels again. I mentioned that they always come back normal and since my neck is obviously swollen is there anything else we can do. She agreed to a thyroid U/S.

Here are my lab results and U/S findings:

In 2010 my TSH was 1.77
On 9/27/12 TSH was 2.68

The right thyroid lobe measures 2.0 x 1.6 x 4.5 cm and demonstrates
mildly heterogeneous echogenicity and contains a well-defined hypoechoic
nodule in the upper pole measuring 0.8 x 0.7 x 0.6 cm. This nodule
demonstrates peripheral vascularity and no microcalcifications. Other smaller
well defined hypoechoic nodule in the mid thyroid lobe measures approximately
3 mm.

The left thyroid lobe measures 1.9 x 1.3 x 3.5 cm and demonstrates
heterogeneous echogenicity with normal vascularity. No discrete nodules are
identified in the left thyroid lobe.

The thyroid isthmus measures 2 mm in AP dimension.

IMPRESSION: Heterogeneous thyroid gland with a hypoechoic nodule in the upper pole of the right thyroid lobe measures 0.8 cm in greatest dimension.
Recommend sonographic surveillance with followup thyroid ultrasound in one
year.



I got a letter from my doctor saying that we will do a follow up in a year and to keep taking my current prescribed thyroid medication.

I'm not currently on any thyroid medication - and we discussed that at the last visit. My feeling is that I would like to try Armour and see if it makes me feel any better.

I would love any advice on how I should proceed. Is waiting a year good advice regarding the nodule? Should I ask to try Armour? What is a good way to convince her it might work better than the levothyroxine?

Thank you!

 
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Old 10-06-2012, 10:36 AM   #2
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Re: Thyroid Nodule and medication question

Wow. Sorry for what you've been through. Let's try to get you 'unstuck'.

First, 25 mcgs of levoT is rarely if ever a true therapeutic dose. Fifty mcgs is the least amount that will do some good. The fact that you were left on that little for 2 years is testament to how bad your MD was at treating hypothyroidism. That's not unusual, unfortunately.

Second, generic levoTs are often not up to the standards set by the name brand ones. It's probably best to start with a name brand one like Synthroid, Levoxyl, or Unithroid. Any one of those may have worked better for you, but still... It was probably the paltry "dose" that was your main problem.

You need to find a doctor ASAP who will prescribe you the right hormone in the right dose that will prevent your gland from enlarging even more and growing more nodules!

You have a significant-sized nodule. It's only 2 mm away from the size where it must be biopsied to check for thyroid cancer. I don't represent myself as an expert (or even amateur) on nodules. It might be okay to watch and wait for it to grow, or it may not. One thing is sure... There is a chance that replacing your thyroid hormones in the optimum dose can prevent it from growing and may even shrink it.

My advice is not to push for Armour just yet. Most people do fine with a levoT product, but it must be the right dose, not just a token one. If after your free T4 level reaches the upper part of its range, you find that your free T3 doesn't follow suit in a proportionate way... then you can add T3 to your daily regimen, either in the form of Armour or the synthetic, Cytomel. I just think it's smarter to go the levoT route first, because MDs are so reluctant to prescribe Armour or T3 that they know very little about how to do it.

I hope this helps you find a way to get the thyroid care you need.
Best of luck!
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Last edited by midwest1; 10-06-2012 at 10:37 AM.

 
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Old 10-06-2012, 01:39 PM   #3
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Re: Thyroid Nodule and medication question

Thank you for your answer - it is very helpful.

I think she has been busy treating my other symptoms. For example, I was put on celexa 10 years ago for the fibromyalgia and it was raised a year ago to help with post partum depression. I have never been on any pain meds, I just control it the best I can with advil.

I have sleep apnea and circadian rhythm disorder (delayed sleep phase) treated by cpap, melatonin and klonapin (I can't take sleeping pills because of the sleep apnea.

When I was working, I was also on provigil to enable me to be safe to drive in the morning. After a period of great stress I was unable to work normal hours at all. No matter how much I sleep I am just too tired to get to work at a normal time and unable to focus on the task at hand. So, I am unemployed and NEED to work, but even as I apply for jobs I know I won't really be able to handle it.

I am also diagnosed ADD (Inattentive type, no hyperactivity here!) I take adderall for that.

What a mess, lol! I have been reading quite a bit since I got the U/S and I have found journal articles that relate hypothyroid to circadian melatonin, fibromyalgia and of course inability to concentrate and energy. I really wonder if all my ailments are just untreated hypo.

Any thoughts on the new symptoms of heat intolerance? (anything over 70 degrees and I am dying) Also, the sweating and shakiness?

Should I ask for a reference for an endocrinologist or a new GP?

 
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Old 10-06-2012, 02:25 PM   #4
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Re: Thyroid Nodule and medication question

First of welcome to the board although I'm sorry for the reason you're here.

I second everything Midwest said and could not have explained it that well.

All the symptoms you describe might be caused by your sluggish thyroid. also please note, fibro can be a symptom of hypo.

hang in there! things will get better!

 
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