# Ultrasound and Lab results



## JenKay (Mar 3, 2013)

Hi,
I just received my ultrasound report and labs in the mail and am looking for some feedback. I was really surprised to see that my TSH was 1.5 (range 0.4-4.5) because I have more hypo symptoms now than when my TSH was higher. It has been as high as 3.66 in 6/2009, but my last one in 1/2012 was 2.9. 
My Free T4 was 1.3 (range 0.8 - 1.8), which is the highest that it has been since 2007. 1/2012 was 1.1
For my antibodies, the results were:
thyroglobulin antibodies < 20 (range <20)
thyroid peroxidase AB 212 (range <35)
thyroglobulin 48.0 (range 2.0 - 35.0)

I don't have any idea how to interpret the ultrasound except that they say it suggests Hashimoto's.

Sonographic examination of the thyroid gland revealed the right lobe to measure 5.00 x 1.74 x 1.79 cm and the left lobe to measure 5.15 x 1.80 x 1.68 cm in size. the isthmus of the gland measures 0.64 cm in thickness. Both lobes of the gland are somewhat heterogeneous in their echotexture. Micronodular changes are present bilaterally. Overall gland vascularity is found to be within normal limits to slightly increased. Overall the sonographic features are felt to be consistent with Hashimoto's thyroiditis. There is a small echogenic nodule identified in the midportion of the right lobe measuring 0.23 x 0.18 x 0.19 cm most likely representing a small area of hyperplastic nodule. No other discrete large focal nodules can be seen in either lobe.

Lymph nodes in the right neck region measuring 2.31 x 0.46 x 0.95 cm and 0.79 x 0.46 x 0.62 cm are seen. Lymph nodes in the left neck region measuring 0.54cm x 0.35cm, 1.45 x 0.64 x 0.72 cm, and 0.85 x 0.43 x 0.81 cm are seen. These appear to be sonographically benign.

Impression: Heterogeneous echotexture to the right and left lobes of the thyroid gland with micronodular changes felt to be most consistent with changes of Hashimoto's thyroiditis. A small echogenic nodule in the mid portion of the right lobe most likely represents a small hyperplastic nodule as well.

That is the end of the report. So, it looks like from the quick search i did, that my thyroid is a little bigger than normal. I don't know about the lymph nodes, though. I don't have an appointment to see my doctor until April, 8th. I was able to get the receptionist to mail this to me. I guess at this point, I am looking for insight into what this means - why do I have so many hypo symptoms? Also, I have an endocrinologist who treated me when I was originally hyperthyroid back in 2007. Would it be wise to make an appointment with him before seeing my doctor, or should I see an ENT? How do you decide who to go see? 
Thanks so much for your help!


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## JenKay (Mar 3, 2013)

Any input really would be appreciated. My doctor absolutely will not speak to me until my appointment on April 8th, and I'd like to understand more.
Thanks in advance!


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## lexi731 (Dec 6, 2012)

JenKay said:


> Hi,
> I just received my ultrasound report and labs in the mail and am looking for some feedback. I was really surprised to see that my TSH was 1.5 (range 0.4-4.5) because I have more hypo symptoms now than when my TSH was higher. It has been as high as 3.66 in 6/2009, but my last one in 1/2012 was 2.9.
> My Free T4 was 1.3 (range 0.8 - 1.8), which is the highest that it has been since 2007. 1/2012 was 1.1
> For my antibodies, the results were:
> ...


Your labs look okay, the T4 is little low. Do you have any tests for T3? If your T3 is low, that may be why you're having hypo symptoms.

The ultrasound looks normal, for the most part. The hetergeneous echotexture is what is indicative of Hashimotos. Unless the ultrasound tech says anything, I always assume my lymph nodes are normal but they record the size whenever they are doing an u/s on your neck.


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## JenKay (Mar 3, 2013)

Thank you! I have been wondering about the lymph nodes because I can actually see them sticking out of my neck by my collar bone on each side. I even had someone tell me my neck was lumpy once. I have not ever had my T3 measured. That gives me something to ask for. Thanks for your help!


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## lexi731 (Dec 6, 2012)

JenKay said:


> Thank you! I have been wondering about the lymph nodes because I can actually see them sticking out of my neck by my collar bone on each side. I even had someone tell me my neck was lumpy once. I have not ever had my T3 measured. That gives me something to ask for. Thanks for your help!


I've always had large lymph nodes, especially when I get sick. They just always stick out but every time I ask about them, the doctor says it's normal.

Make sure to ask for a Free T3 test. Some endos will just do totals.


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## Andros (Aug 26, 2009)

JenKay said:


> Hi,
> I just received my ultrasound report and labs in the mail and am looking for some feedback. I was really surprised to see that my TSH was 1.5 (range 0.4-4.5) because I have more hypo symptoms now than when my TSH was higher. It has been as high as 3.66 in 6/2009, but my last one in 1/2012 was 2.9.
> My Free T4 was 1.3 (range 0.8 - 1.8), which is the highest that it has been since 2007. 1/2012 was 1.1
> For my antibodies, the results were:
> ...


There are a couple of things that raise a red flag in my mind. Micronodular changes, increased vascularity and Thyroglobulin. You should have a bit of Thyroglobulin but not a lot. Yours is over the top of the range.

http://theoncologist.alphamedpress.org/content/13/2/105.full

Thyroglobulin Ab
A negative test is normal. A negative test means no antibodies to thyroglobulin are found in your blood.
http://www.nlm.nih.gov/medlineplus/ency/article/003557.htm
(The normal thyroid has Thyroglobulin in low titers but should not have Thyroglobulin Ab)

Also, sonograms can leave a lot out. That concerns me also because you do have something going on. Antibodies and a thyroid that is failing you.

You may be better off to go straight on to ENT. Humble opinion.


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## Andros (Aug 26, 2009)

JenKay said:


> Thank you! I have been wondering about the lymph nodes because I can actually see them sticking out of my neck by my collar bone on each side. I even had someone tell me my neck was lumpy once. I have not ever had my T3 measured. That gives me something to ask for. Thanks for your help!


Hmmmmmmmmmmmmmmm; maybe FNA (fine needle aspiration would be a smart move?


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## JenKay (Mar 3, 2013)

Thank you so much for your opinions, and for the links to read!
I will make an appt with an ENT soon, and call my doctor to see if they will write an order for Free T3.


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## Andros (Aug 26, 2009)

JenKay said:


> Thank you so much for your opinions, and for the links to read!
> I will make an appt with an ENT soon, and call my doctor to see if they will write an order for Free T3.


Good! And you have our attention so do let us know how this unfolds.


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