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Thyroid Ultrasound, Other Tests Necessary?

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Old 06-02-2007, 08:24 AM   #1
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Thyroid Ultrasound, Other Tests Necessary?

I recently went to a new dr, of the integrative medicine variety, who is really great! Right up front she recognized my FT3 was low and offered to start me on Armour in combo with my levothyroxine. She also offered adrenal and other tests like nutirional status, food allergies, and celiac tests for example. The only problem is I am self pay.

She did examine my thyroid gland and stated it was quite large and followed up asking me if I had had an ultrasound or any other tests like FNA. Of course, my HMO dr never offered and I doubt she would think it was "necessary" . I would like to know, however, how important it might be?

I am hypo, and while I realize that hyper people seem to talk more about nodules and scans and cancer, I would like for my own peace of mind to have a more precise exam of my thyroid.

I just have this feeling, that in other diseases, the actual organ is examined, not just common function tests via blood - like my mom had elevated liver enzymes, and was sent to a hepatologist for further exam; she also has suspected diverlicuosis, and went to a gastro enterologist. My father has cardiac difficulites and they give him a heart scan. Am I crazy to believe that the thyroid should be treated similarly?

Finally, if people agree asking for an ultasound (or something else too) is a good idea, how do I approach the stingy HMO dr?

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Old 06-02-2007, 10:54 AM   #2
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Re: Thyroid Ultrasound, Other Tests Necessary?

I've never been bothered by goiter or nodules; but if I had been, you bet your booties I'd have wanted the gland imaged. It's a very good idea to know if you have nodules, how large they are, whether there is only one or several.

As for the HMO... I can't help. I've been fortunate in my life to have had good insurance, so I just don't know how they work. There is an appeals process if you're refused a test or treatment, though, isn't there?

Old 06-02-2007, 05:35 PM   #3
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Re: Thyroid Ultrasound, Other Tests Necessary?

thanks midwest

I am not sure about the appeal process with HMOs.

I was wondering how commonly thyroid patients have ultrasounds performed ... I was only thinking of nodules, not goiters, but that is interesting. If the ultrasound is commonly performed without the apparent presence of nodules/goiters, I might have some success with the HMO Dr.

Otherwise I might try to find out what size goiter (western standards that is) is considered a good candidate for the ultrasound.

I was thinking about it today, and it is possible that I do have some symptoms of enlarged thyroid that have been causing me distress, but in the bigger picture, seemed trivial or I just got used to it. I have had a choking feeling for years, which was attributed to anxiety by my drs. But, now that I don't have much clinical anxiety and the feeling is still present, maybe there is room for discussion.

Old 06-02-2007, 09:24 PM   #4
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Re: Thyroid Ultrasound, Other Tests Necessary?

I have a thyroid node and get an ultrasound every 2 years to track it. As long as there are no changes my endocrinologist is fine (it's small). Before you even call your doctor, you might want to call your insurance company to see what's required. My endocrinologist is the ONLY out-of-network I see and even though he orders the tests, as long is the lab is within network I don't even need a referral from my primary. I think it's covered 100% or if there's a co-pay it's very small. Don't remember and didn't ask when I called the insurance company (I'm having it done next week) but in general, they were very helpful so yours might be able to guide you as well.

Old 06-03-2007, 09:50 AM   #5
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Re: Thyroid Ultrasound, Other Tests Necessary?

Back before ultrasounds were popular, they often (and sometimes still) do "uptake scans"---have you had one of these?

If you have hashis, it helps confirm diagnosis, analyze the size of the thyroid, and if you have any cold or hot nodules, they'd show as well. In some ways, it might be a bit better of a test for someone with thyroid disease than an ultrasound, which shows size of the gland, if there are nodules, but now if the thyroid "uptakes" iodine and the health of the thyroid in general.

I imagine insurance would cover an RAI uptake scan for someone with thyroid issues, because it's a routine test, but I don't know much about HMO's. I think both the uptake and the ultrasounds are relatively inexpensive tests.

Old 06-03-2007, 07:47 PM   #6
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Re: Thyroid Ultrasound, Other Tests Necessary?

No, I have not had any such tests. Initially, my Dr gave me a TSH along with the FT4 and TSI. My last test from the HMO Dr was this past September. I called the her office a few months ago and asked if I could have a blood test - general cbc and also thyroid. She said no need at the moment, see ya this September...

Well, what she did not know is that I have been doing self pay since last Dec. with another dr. But, in a weak moment, strapped for cash, I called HMO dr, hoping I could get a "freebee", i.e., have my HMO pay for what it should. Pretty sad.

The other day, I was reading about goiter and ultrasound on the one of those general medicine sites, and it said that while the ultrasound was good, CT was actually better at determining the effect of the thyroid gland on nearby structures - which was actually one of my concerns re swallowing. I will also look into the uptake scan as well.

That is good to know the ultrasound or uptake is not too expensive. I certainly cannot imagine paying for a CT scan! I will try to see if I luck with my HMO doc.

Unfortunately, she as many others in the medical profession, seem to treat the thyroid as if it is a simple matter - here take a pill, and you will be better, no further exam needed. I just find the attitude incomprehensible. I thought my dr being a woman would not have the same attitude as male drs, but she reacts to the supposed "hysterical woman" syndrome any time I query about my condition or ask for anything more. Weird.

BTW, what did your scan show? How does it confirm Hashis? My antibodies tests were neg, but then again, they were taken after I had been on levothyroxine for a few months.

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