# confused about what is wrong with my thyroid



## texan (Jun 21, 2010)

Hi all - I'm confused about what I have/don't have so hopefully someone can provide some insight.

TSH tested at 0.41 on a CBC so gyno sent me to an endo just to get it looked at. Full thyroid panel revealed:

TSH - 0.92
FT4 - 1.3 (0.8-1.8)
FT3 - 306 (230-420)
Thyroid Peroxidase Ab - <10 (<35)
Thyroglobulin Ab <20 (<20)
TSI - 98 (<125)

THe doctor did an ultrasound at the appointment and said my thyroid was big and that I had a 1cm nodule (will be having FNA). I think my official diagnosis was subclinical hyper (no symptoms at the time of the appointment).

However, I got a copy of my ultrasound and it says that the changes in my thyroid are "consistent with chronic thyroiditis" which I found out meant Hashi's (I think?). However, I tested negative for TPO and some other antibody which I thought were the Hashi's antibodies. I do, however, have TSI antibodies.

I am very confused about what I have. I have had two episodes of heart racing/palpitations but besides that I don't think I have any symptoms. I had them take blood a couple of days after one of the episodes and my TSH and FT4 were unchanged (0.92 and 1.3, respectively). They didn't test anything else. Can anyone shed light on this?

Here is my US report if it helps:
Right lobe: 5.69 x 1.88 x 1.65
Heterogenous in consistency. In the inferior aspect of the right lobe there is a possible cystic appearing nodule measuring 0.27 x 0.20 x 0.27cm in size. THis nodule did not appear to contain increased internal vascularity on Doppler interrogation.

Left lobe: 5.72 x 1.97 x 2.10. Also heterogenous in consistency. No distinct nodules were noted.

In the right side of the isthmus there is a complex nodule measuring 1.00 x 0.42 x 0.93 in size. This nodule does not appear to contain increased internal vascularity on Doppler interrogation.

Impression: Miidly enlarged, heterogenous thyroid gland with *changes suggestive of chronic thyroiditis. *

What do I have???


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## Andros (Aug 26, 2009)

texan said:


> Hi all - I'm confused about what I have/don't have so hopefully someone can provide some insight.
> 
> TSH tested at 0.41 on a CBC so gyno sent me to an endo just to get it looked at. Full thyroid panel revealed:
> 
> ...


If you look up chronic thyroiditis you will see that this term is used interchangeably with Hashimoto's.

I don't happen to agree as your labs do not concur with someone who is hypothyroid. You would "expect" to see TSH high in the range and the Frees low in the range.

I think you are hyperthyroid and the evidence is there with the TSI. The healthy person should have NO TSI and if you do,that is the immunoglobulin that is responsible for hyperthyroid.

Several things come to mind. It would be good for you to get a radioactive uptake scan. Sonograms are wonderful tools but not always the best. Cancer needs to be ruled out. If possible, FNA (fine needle aspiration) should be done on nodules and sent out to a cystopathologist.

Read this on Hashi's and tell me if you think you have this after you have read it.

http://www.thyroidmanager.org/Chapter8/8-frame.htm

And here is information on TSI (thyroid stimulating immunoglobulin.)

While the normal range is <130% activity, individuals who are normal do not produce TSI and have levels <2% activity. http://graves.medshelf.org/Lab_Tests

http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

http://www.hopkinsmedicine.org/endocrine/graves/Answer.asp?QuestionID=22

Here is info on nodules..........
http://www.aafp.org/afp/2003/0201/p559.html

Your instincts seem to be right on.


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## texan (Jun 21, 2010)

Thanks for the great info. I do not think I have Hashi's (but I was already pretty certain that I don't!)

Do people with different types of thyroid disease (hypo, Hashi's, Graves, etc) have different changes in their thyroid? (i.e. does a person with hyperthyroidism have a distinctly different thyroid than a person with Hashi's?)


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## Andros (Aug 26, 2009)

texan said:


> Thanks for the great info. I do not think I have Hashi's (but I was already pretty certain that I don't!)
> 
> Do people with different types of thyroid disease (hypo, Hashi's, Graves, etc) have different changes in their thyroid? (i.e. does a person with hyperthyroidism have a distinctly different thyroid than a person with Hashi's?)


From a pathological point of view, the answer would be yes for the most part as there are certain Hurthle cells that are indigenous to Hashmoto's and in reality, as far as I know, FNA is the only test that could be considered definitive for Hashimoto's if those Hurthle cells are present.

So, if you do not have those particular Hurthle cells but you are hyperthyroid, I would say the answer would be yes.

An experienced pathologist/cytopathologist would certainly be able to pick up on a lot of differences I would think.


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