# Do I need a Thyroid Scan?



## rachel0611 (Oct 8, 2009)

..........


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## Andros (Aug 26, 2009)

rchlrch said:


> I have a small nodule on my thyroid gland (shown by an ultrasound test) and a lot of symptoms of hyperthyroidism, however the hormone blood test my doctor did came back normal. She seems to want to ignore the fact that I have a nodule because of that. However, I've heard that if hyperthyroidism is caused by a nodule, blood tests can be inconclusive, because the nodule may not be affecting your hormone levels all the time. I was just wondering if that's true, and if I should request a Thyroid Scan, to be more conclusive?


Welcome to the board. Would you know what hormone test the doc ran? Would you know the result and the range? If so, post it here as that would be most helpful.

Your hormones, TSH, FT4 and FT3 can be in normal range but meanwhile the antibodies are raging and the patient is very ill.

What are your symptoms? What made you get the ultrasound to begin with? I am glad you did.

Actually, it would be good to get some antibodies tests done which are indigenous to the thyroid such as TPO (antimicrosomal antibodies), Thyroglobulin Ab and TSI (thyroid stimulating immunoglobulin.) The TSI would tell if you are hyperthyroid or not.

Here is info on TSI......
http://uimc.discoveryhospital.com/main.php?t=enc&id=1516

Please note that the healthy person should have no TSI.

Here is a place where you can look up other labs..
http://www.labtestsonline.org/understanding/analytes/thyroglobulin/test.html

I got you started w/ the thyroglobulin.

It is a good idea to learn this stuff so you can be proactive.

If I were doing this, I firstly would insist on the above antibodies' tests. If you have TSI, then I would insist on a radioactive uptake scan.

If you have a high titer of TPO but no TSI with high Thyroglobulin, I would think about an FNA (fine needle aspiration) to make sure you don't have cancer of the thyroid and also to determine if "certain" Hurthle Cells are present which are indigenous to Hashimoto's which is often referred to as Thyroiditis.


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## Andros (Aug 26, 2009)

rchlrch said:


> I have a small nodule on my thyroid gland (shown by an ultrasound test) and a lot of symptoms of hyperthyroidism, however the hormone blood test my doctor did came back normal. She seems to want to ignore the fact that I have a nodule because of that. However, I've heard that if hyperthyroidism is caused by a nodule, blood tests can be inconclusive, because the nodule may not be affecting your hormone levels all the time. I was just wondering if that's true, and if I should request a Thyroid Scan, to be more conclusive?


Have not heard from you; wondering how you are doing?


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## Andros (Aug 26, 2009)

rchlrch said:


> Hey- I'm sorry for taking so long to post here again, but it's taken this long for me to even get back to the doctor to talk about my thyroid more and to be able to answer you about the TSH level (she had me go get a chest x-ray when I told her I had pain in my thyroid that spread into my chest... then she made me go to a urologist because of the frequent urination... and he made me go get a renal ultrasound... all of which checked out fine)
> 
> So yeah, to finally answer you!
> 
> ...


Gee; I do agree w/ you about not taking the levothyroxine. TSH is in the basement and while this could be fine "provided" your Free T3 and Free T4 are mid-range or a bit higher, it does suggest hyperthyroid combined w/ the clinical symptoms you describe.

Are you saying that the urologist did a renal ultra-sound but that no one did a glucose test for diabetes? Have you ever had the glucose test described here...........................?

http://www.labtestsonline.org/understanding/analytes/glucose/test.html

Glad to see you, I have been concerned.


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## rachel0611 (Oct 8, 2009)

Oh yeah, they did a fasting blood glucose check way back when I first starting going in. The level wasn't dangerously low, but it was on the lower side, around 67 I believe. Then they checked it again when they did the blood work for my physical. It was a little better but not much, around 71 I think. But they haven't given me sugar and then waited to see what it did to me or anything like that. I did tell them about the reactive hypoglycemia, but as I said before, it seems like my primary doctor really just wants to give me the runaround, or like she's only really there to establish the fact that I need to go see another doctor or something.

So I made an appointment today with an endocrinologist. It's next Wednesday, the 18th. I'm really hoping productive things will start to actually get done after that.

This is all just confusing and scary because it seems like if you have hyperthyroidism the only permanent solution is to have your thyroid either destroyed with radioactive iodine, or surgically removed (either entirely or just the part with the nodule) and then you have to take something like Levothyroxine for the rest of your life... and that's confusing to me because the possible side effects of taking Levothyroxine seem to be some of the exact same problems I'm already experiencing now, only with some possible hair loss on top of it.  I'm starting to feel like this is a damned-if-you-do, damned-if-you-don't situation. Like if you aren't lucky enough to just have healthy hormone levels naturally, then you are just screwed.


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## Andros (Aug 26, 2009)

rchlrch said:


> Oh yeah, they did a fasting blood glucose check way back when I first starting going in. The level wasn't dangerously low, but it was on the lower side, around 67 I believe. Then they checked it again when they did the blood work for my physical. It was a little better but not much, around 71 I think. But they haven't given me sugar and then waited to see what it did to me or anything like that. I did tell them about the reactive hypoglycemia, but as I said before, it seems like my primary doctor really just wants to give me the runaround, or like she's only really there to establish the fact that I need to go see another doctor or something.
> 
> So I made an appointment today with an endocrinologist. It's next Wednesday, the 18th. I'm really hoping productive things will start to actually get done after that.
> 
> This is all just confusing and scary because it seems like if you have hyperthyroidism the only permanent solution is to have your thyroid either destroyed with radioactive iodine, or surgically removed (either entirely or just the part with the nodule) and then you have to take something like Levothyroxine for the rest of your life... and that's confusing to me because the possible side effects of taking Levothyroxine seem to be some of the exact same problems I'm already experiencing now, only with some possible hair loss on top of it.  I'm starting to feel like this is a damned-if-you-do, damned-if-you-don't situation. Like if you aren't lucky enough to just have healthy hormone levels naturally, then you are just screwed.


I am glad you are seeing an endo on the 18th. After you have your thyroid removed, it does take a few months to get stabilized on thyroxine replacement and Levothyroxine is not the only replacement available on the market. There are many of us who feel perfectly fine now having weathered the storm.

That is why we are here for one thing; to help folks like you get on track. Knowledge is key here so you can advocate for yourself.

Please please let us know what the endo does and what the endo has to say. We all want you to feel better.


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## Andros (Aug 26, 2009)

rchlrch said:


> Hello again, just wanted to update about what the endocrinologist has done. He ordered some more in-depth blood tests back when I first saw him on Nov 18th, and this past Tuesday I went back, and he said the results were "normal" however he also advised that I get a biopsy of the nodule (which I'm going to have done in about nine hours, actually).
> 
> I'm kind of confused about what he said though... he told me that by having the fluid from the nodule drained by the biopsy, the nodule should go away, and therefor my symptoms should go away, too. But the one thing I could find online about draining a thyroid nodule said that "some nodules will stay gone, but most will return." Also, if my blood results were all "normal" why would making the nodule go away make my symptoms subside? :confused0033:


Good to hear from you and glad you are getting the biopsy. Please let us know the results.

Well, all that sounds like a bunch of poppy**** to me but I am just a lay person.

Did you get the TSI I recommended?


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## chopper (Mar 4, 2007)

Sounds like doctor-speak for "I'm not quite sure what's going on"


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## rachel0611 (Oct 8, 2009)

Well, I just got home from the hospital- where after waiting almost two hours, I was told my nodule is too small for a biopsy, and sent away....

This is all just getting so, so fun. 

I tried to mention the TSI test that you recommended, but I'm not 100% sure if the endocrinologist listened, and did one, or not. I will ask about it as soon as someone from his office calls me back (which will hopefully be _today_, seeing how the guy totally just sent me to get a procedure which is apparently not even possible to have done....) and then the next time I'm in his office I will request a copy of my labs so I can tell you exactly what was done and what the levels were, etc.

@nasdaqphil Sadly, that's the feeling I'm starting to get about every doctor that I see....


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## Andros (Aug 26, 2009)

rchlrch said:


> Well, I just got home from the hospital- where after waiting almost two hours, I was told my nodule is too small for a biopsy, and sent away....
> 
> This is all just getting so, so fun.
> 
> ...


Well; durn. In my humble opinion, I would recommend a radioactive uptake scan if you have not had one beings the nodule is too small.

And I hope the doc was "listening" and ordered that TSI (thyroid stimulating immunoglobulin.)

Good to hear from you though. I sure hope things pan out for you!


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## Andros (Aug 26, 2009)

rchlrch said:


> Update- I went to the endocrinologist again last week to discuss what else we could do since the nodule is too small to biopsy.
> 
> I asked about the thyroid antibodies tests, and he said that he had done a TPO test and it was negative, and that he did a Thyroglobulin TG test and it was "_weakly_ positive" at 1.6. He said that because the TPO was negative, there was no need to do a TSI check, because it was like a one in a zillion chance that TPO would be negative, and someone would check positive for TSI.
> 
> ...


Gee, I sure wish I had the results and ranges. Different labs use different ranges.

Are you saying that the endo said your TPO was "0?"

I am looking some stuff up; will get back to you later and please try to get the ranges.

A thyroglobulin antibody (TgAb) test is typically ordered along with the thyroglobulin test. Source http://www.labtestsonline.org/understanding/analytes/thyroglobulin/test.html

Another careful read......... "


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## Andros (Aug 26, 2009)

rchlrch said:


> Update- I went to the endocrinologist again last week to discuss what else we could do since the nodule is too small to biopsy.
> 
> I asked about the thyroid antibodies tests, and he said that he had done a TPO test and it was negative, and that he did a Thyroglobulin TG test and it was "_weakly_ positive" at 1.6. He said that because the TPO was negative, there was no need to do a TSI check, because it was like a one in a zillion chance that TPO would be negative, and someone would check positive for TSI.
> 
> ...


This must be read very carefully..............

"Antibodies to thyroid microsomes are generally present in majority of thyroid patients." {generally and majority are 2 key words here)

Source..... http://www.medindia.net/bloodtest/Immunology/Thyroid_antimicrosomal_antibody.htm


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## hashigirl (Apr 30, 2007)

If you can't have the scan, switch endos and ask the new to do the TSI, maybe you are that one in a millioin, i have been on a few health incidents. You gotta have something to work with, I am a bit behind on your symptoms and Thyroid Panels. Can you tell me what they are? Other things can parade around as a thyroid related type of problem i am finding out after years of misdiagnosis. Bottom line, if you are suffering and can't get help where you are. then leave and get a new doctor and research that PCP or Specialisit "Individual Specialities and strengths". That is how I got my answers, I kept switching til I found someoone that was like a "HOUSE DOCTOR". I am lucky.


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## Andros (Aug 26, 2009)

rchlrch said:


> I have a small nodule on my thyroid gland (shown by an ultrasound test) and a lot of symptoms of hyperthyroidism, however the hormone blood test my doctor did came back normal. She seems to want to ignore the fact that I have a nodule because of that. However, I've heard that if hyperthyroidism is caused by a nodule, blood tests can be inconclusive, because the nodule may not be affecting your hormone levels all the time. I was just wondering if that's true, and if I should request a Thyroid Scan, to be more conclusive?


I agree with your thinking 100%. And there is always the question of possible cancer.

Yes; please request a radioactive uptake scan.

Hyperthyroid is caused by TSI (Thyroid stimulating immunoglobulin.)

Have you had that lab test?

Andros


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## Andros (Aug 26, 2009)

rchlrch said:


> Well, I finally went to the doctor again today. He said the glucose tolerance test showed that I am prediabetic. He also said something very odd occurred- that my cortisol level went up dramatically throughout the test, which is the opposite of what it's supposed to do. He said he's never seen it before... and he's not a young man. So now we will be looking further into that- they took blood for a cortisol/gland analysis and I have to do a 24 hour urine collection.
> 
> I'm honestly just out of guesses as to what's wrong with me at this point, but clearly there is something going very awry in my endocrine system- but my doctor is staying very solid on the idea that it is NOT my thyroid gland. Today the nurse told me I could trust him, that he was a very good doctor who has been known to solve "medical mysteries" and she's definitely a no B.S. kind of girl. Let's just hope he solves this mystery...
> 
> ...


Glad you had the glucose test. The Sugar Buster's Diet or the SouthBeach Diet are 2 good ones to consider to bring this under control.

Well, I hate that you are not going to hang around but will look forward to hearing from you if and when.


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