# Hashimoto's Diagnosis, Need Advice Please



## SonyaB492 (Mar 23, 2018)

I have been having the following symptoms for over 2 months: fatigue, low-grade fever, itching, night sweating, headaches, and occassional cough/sore throat. PCP had bloodwork done and got the following results: blood culture - negative, thyroglobulin Ab 2.8 (0 - 4), thyroid peroxidase antibodies - 520.2 (0 - 9), hepatitis - negative, t3 free 3.21 (2.18 - 3.98), free t4 1.00 (0.76 - 1.46), tsh receptor Ab <0.90 (<=1.75), tsh 1.710 (0.358 - 3.74), procalcitonin <0.05 (<0.05), rheumatoid factor <10.0 (<15), ana positive 1:640 speckled homogenous pattern, c reactive protein 5.54 (<3.0), esr 24 (0 - 20). Also ordered thyroid ultrasound. Results were: right lobe measures 5.3 x 1.4 x 1.5 cm is heterogeneous in echogenicity. There is a 13 x 7 mm hypoechoic mass of the upper pole. There is a 10 mm nodule in the midportion of the gland. The left lobe measures 4.6 x 1.8 x 2 cm is heyerogeneous in echogenicity as well. There is a 9 x 5 mm nodule in the upper pole. There is a complex mixed solid and cystic nodule measuring 10 x 9 mm in the lower pole. The isthmus measures 6 mm is heterogeneous as well. No lymphadenopathy or parathyroid nodule identified.

PCP said that biopsy is not recommended on the us report but the bloodwork and us were abnormal so I am being referred to an endocrinologist. PCP said nothing to worry about though. She did go ahead and schedule a thyroid uptake scan in 2 weeks. Still waiting for endo appointment to be scheduled.

Should I push for a biopsy? I think it would make me feel better to have one. Is there anything important that the spot on the right lobe is called a mass and not a nodule? Are they considered the same thing? I'm concerned with the results and i now have a jellybean size hard knot on the right side of my neck. I don't want to panic or overreact but I am nervous.

Also, any tips on how to help some of the symptoms? When I do finally see the endo, what questions should I ask?


----------



## jenny v (May 6, 2012)

Usually biopsies are performed on anything over 1cm, which one of yours is (10mm = 1cm) and the rest are right on the border. Anything with "complex" and "solid" is something to keep an eye on and usually something that is biopsied if big enough. Do you know when you'll hear back from the endo? Usually those are the ones to schedule a biopsy, if your PCP won't.


----------



## SonyaB492 (Mar 23, 2018)

My PCP sent a referral to an endocrinologist last week but I haven't heard from them yet. Talked to PCP this morning and they called endo to check status. Endo office said they will call me tomorrow. Hopefully I won't have to wait too long to see doctor.


----------



## SonyaB492 (Mar 23, 2018)

I saw Endo today and she said that everything looked fine and that I did not have Hashimoto's because my tsh was normal. She didnt think a biopsy was necessary or medication. Said to just come back in 6 months and have another sonogram. I finally convinced her to schedule a biopsy on April 11th but she thinks its a waste of time. I think she is only requesting biopsy on the 1.3 cm mass. Can I request that they also biopsy the complex mixed nodule at the FNA? I'm really confused. Everything I have been reading says that some treatment should be neccessary and my PCP said the same.

Any advice??


----------



## joplin1975 (Jul 21, 2011)

You DO have hashi's based upon your antibody result and ultrasound. I don't know why your endo told you that, but if find a new doctor.

Your cystic nodule just meets biopsy criteria. It might not be as superficial as the other nodule and therefore harder to "hit" with a needle. I don't know if I would push to have it sampled.


----------



## jenny v (May 6, 2012)

Yeah, this endo doesn't sound like she knows what she's talking about (which is not uncommon with endos, unfortunately). At least you got a biopsy scheduled, but I would keep looking for a new doctor. An ENT might be a good bet.


----------

