# so confused



## mire229 (Mar 9, 2011)

have been experiencing symptoms of hypothyroid for a long time. a noticeable bump at the base of my neck prompted me to go to the doctor.

i had an u/s which showed 4 nodular cysts on the left side and a large hetergenous complex mass on the right measuring 3.5 cm x 3cm

a biopsy came back negative

my endo said that the antibody test came back negative for hashimotos

my tsh is .5
my t3 is 32
my free t4 is 2.4

he wants me to take synthroid.

should i seek a 2nd opinion?


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## Andros (Aug 26, 2009)

mire229 said:


> have been experiencing symptoms of hypothyroid for a long time. a noticeable bump at the base of my neck prompted me to go to the doctor.
> 
> i had an u/s which showed 4 nodular cysts on the left side and a large hetergenous complex mass on the right measuring 3.5 cm x 3cm
> 
> ...


Welcome to the board!

Wonder what the ranges are for the t3 and t4? Your TSH is awfully low and ranges would help me better on the other as different labs use different ranges.

Hetergenous complex mass raises suspicion. If it were me, I would request RAIU (radioactive uptake scan) as sonograms have their limitations. 
Also, what did they biopsy, the mass or one nodule, all the nodules?

You have a lump on your neck which means a lymph node;is this correct? What test did you have for Hashimoto's? Do you mean the biopsy?

Sorry for all the questions but they are necessary.

US features that should arouse suspicion about lymph node metastases include a rounded bulging shape, increased size, replaced fatty hilum, irregular margins, heterogeneous echotexture

Transverse sonogram of the left lobe of the thyroid shows a heterogeneously hypoechoic enlarged thyroid (arrows) with no

You will find the above here...........
http://radiographics.rsna.org/content/27/3/847.full

With your TSH so low, I wonder what symptoms you have because if one were to judge on TSH alone (and I don't but I need the ranges for the other 2 things), one would say hyper.

So, what are your symptoms?

I think a second opinion would be most wise; I really do.


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## mire229 (Mar 9, 2011)

hi there!

they did a biopsy on the complex mass on the right side. after they took 7 FNA biopsy samples, 6 were found to be non-diagnostic results and 1 was negative. they did not further investigate the 4 nodular cysts on the left side. he said that slight, visible enlargement at the base of my neck is my enlarged thyroid. and this is why he wants to put me on synthroid.

for hashimotos he did an antibody panel. i do not have a copy of that yet. but he called me last night to tell me i tested negative for hashimotos

my symptoms are:
chronic fatigue
muscle aches
joint aches
always feel really hot
insomnia
dry skin, coarse hair, hair loss
weight gain and inability to lose weight
moodiness, irritability
problems with memory
very heavy periods
diarrhea

as for the thyroid panels here is what i have

TSH - .57 (.50 - 5.50 being normal range)
T3 uptake - 32 (reference range being 22-35%
T4 total - 7.3 (4.5 - 12 being normal)
FREE T4 - 2.4 (.7 - 2.0 being normal)


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## Andros (Aug 26, 2009)

mire229 said:


> hi there!
> 
> they did a biopsy on the complex mass on the right side. after they took 7 FNA biopsy samples, 6 were found to be non-diagnostic results and 1 was negative. they did not further investigate the 4 nodular cysts on the left side. he said that slight, visible enlargement at the base of my neck is my enlarged thyroid. and this is why he wants to put me on synthroid.
> 
> ...


Thank you so much for the ranges!! And that has helped me to think that you are hyper, not hypo. You FT4 is over the top of the range and TSH is quite low in the range. Too bad doc did not do FREE T3 as that would be very telling.

Combine that w/your symptoms list and I do suspect hyperthyroid coming on. I say coming on because it waxes and wanes.

There is one test that could settle this issue.

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

I hate also for you to start on Synthroid w/o having had a FREE T3 test.

This article explains the importance of FREE T3 test and also how antibodies can skew some of these tests.
http://www.thyroid-info.com/articles/freet3woliner.htm

So, my humble opinion is if you can get the FREE T3 and the TSI; we can find out if you should take that Synthroid or not. How much Synthroid did he Rx?

I am also wondering if a second opinion would not benefit.


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## mire229 (Mar 9, 2011)

from what i recall of our conversation, he advised me that he was prescribing 50mcg of synthroid. he called it in to the pharmacy and i havent even gone to pick it up yet.

i worry about the complex mass because it measured 3.5cm x 3cm on monday. a month ago it measured 3.3cm x 2.1cm at the ultrasound.

also i have an aunt in mexico with thyroid cancer, another aunt in mexico with that goes back and forth between hyper and hypo and a cousin with graves. so there is family history on my fathers side. on my mothers side, my aunt had a similar growth in her thyroid but her DR chose not to do a FNA as he felt that it would not be completely accurate. he chose to do a partial thyroid removal because it was also large and had grown significantly between ultrasounds. he felt that her other side was fine and allowing her to function within normal ranges. so he did not remove it. its been five years and her levels get checked 2x a year and theyve come back fine without the need for medication

also, ive tried getting an appointment for a second opinion and its become a mission!! so perhaps i will call my endo and request that he run a FREE T3. since in not sure what kind of antibody panel he ran, i will ask the nurse for a copy to see if the TSI was done or not.

thank you so much for your response.


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