# newly diagnosed hypo and nodules.



## retk (Feb 18, 2012)

I was recently diagnosed as hypothyroid and had a thyroid ultrasound where 3 nodules were found on the left side of my thyroid. I have been referred to an endocrinologist, but my appointment is 10 days away so I am trying to educate myself on what might be going on with me. The short version of my issues are that I am hypothyroid, all my tests came back normal except my TSH is slightly elevated and I have 3 nodules on my thyroid, the biggest one is 2.5 cm. This is a more detailed explanation of what is going on:

I have had hypothyroid symptoms for at least 15 years, but my tests have always come back normal. Since my tests would come back normal I would get diagnosed with depression and put on antidepressants. Antidepressants would not help much and usually just make me more tired than I already was, but I continued to take them from the time I was 16 until I became pregnant at the age of 28. Four months before I became pregnant I had my yearly physical and blood work done. Everything came back normal except my cholesterol was slightly elevated. My doctor mailed my results to me with a prescription for Lipitor. That upset me because I had told him my husband and i were wanting to have a baby and you can't take Lipitor while you are pregnant. I was only 28 and it was the first time my cholesterol was high (208 total cholesterol) and he mailed me a prescription rather than talk to me about reasons it might be high and ways to try to lower it myself. After that I decided I would find a new doctor.

Four months later I became pregnant. The blood tests I had done at my first prenatal appointment came back normal except I was hypothyroid and my OBGYN put me on 25 mcg of Synthroid a day. Even though I had suspected that I was hypothyroid for years, that is the first time a blood test confirmed it. I asked about my cholesterol, but my OBGYN said they are not concerned with cholesterol during pregnancy and don't test it. I had blood tests at each of my prenatal appointments and my OBGYN kept me on 25 mcg of Synthroid during my entire pregnancy. After I had my baby I got tested again and results came back normal so they told me to stop taking my Synthroid. I was thinking if my levels are normal while I am taking Synthroid then wouldn't they stop being normal if I stop taking it. I decided I would follow up on this with a regular doctor as soon as I found one to replace the doctor that prescribed me Lipitor. Two years passed before I finally picked a new doctor and made an appointment. I know I should not have waited so long.

I went to my first appointment with the new doctor Monday 2/13. I told her my symptoms and had a physical and blood work done. She said she would run some extra thyroid tests on my blood that are not always done. I think I had only had T4 tests done in the past except while I was pregnant because I didn't realize there was more than one test that should be done. Two days after my appointment I got a call from the doctor's office and was told that my TSH was slightly elevated meaning that I am hypothyroid. The nurse told me that the doctor wanted me to get a thyroid ultrasound. I got the ultrasound done the next day (Thursday) and then Friday I got a call from an endocrinologist office saying I was referred to them by my doctor and made me the soonest appointment they had which is 10 days away. I called my doctor and spoke with a nurse that told me they found 3 nodules on the left side of my thyroid and the largest was 2.5 cm. That is all the info I got because I didn't know what other questions to ask.

I have a copy of the blood test from 2008 (the one from 4 months before I got pregnant) and the one I took on Monday. I will list some of the results If I left out anything important let me know and if I have it I will add it.

2012 TSH result: 6.83 normal range is 0.55 - 4.78
2008 T4 free result : 0.93 normal range is 0.89 - 1.76
2012 T4 free result: 0.86 normal range is 0.80 - 1.76

2008 cholesterol : 208 total normal is under 200 
143 LDL normal is <130 
49 HDL normal is >40

2012 cholesterol: 188 total normal is under 188
121 LDL normal is <130
44 HDL normal is >40

Any advice would be appreciated! I want to educate myself as much as possible before my appointment with my endocrinologist. Thank you!


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## joplin1975 (Jul 21, 2011)

Hi. 

I think what you'll want to find any characteristics you can about the nodules-are they cystic, solid, etc.

I presume your next step after your endo visit will be to get a fine needle aspiration (FNA or biopsy) and/ora radioactive iodine uptake scan (RAIU)

I was in a similar stitch and had the RAIU first. The RAIU shows how quickly or slowly the thyroid sucks up iodine, which tells the doctors how well the thyroid is functioning. The FNA will allow them to examine the cells for abnormalities.


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## retk (Feb 18, 2012)

Thank you for your response. I will call my doctor tomorrow and ask about the type of nodules they are. I have a feeling they are the solid type because of something the ultrasound tech said to me. After the ultrasound was done I asked how soon I could call my doctor to find out the results. She said my ultrasound would be looked at the same day and sent back to my doctor by the next day. She said she was sorry she could not tell me what she found and to expect that I might not be told my results over the phone if they find a tumor. The way she said it I felt like she was giving me a clue. Maybe I am just over analyzing what she said to me. From what I have read I think a tumor would be the solid type of nodule. Hopefully I will know for sure tomorrow. Do you know if they will give me a copy of the ultrasound report if I request it?

I am glad you mentioned FNA and RAIU. I have read a little about the FNA and figured I would probably have to do that, but I have not read much about the RAIU. Since I might need to have a RAIU I am going to read more about it now. I want to read as much as possible about tests or procedures I might need before I go to the doctor because I get extremely nervous at doctors appointments and things go better when I prepare myself. Doctor's appointments have always made me nervous and even a simple check up will send me into a panic for no reason. I think that's what I waited so long after I had my baby to pick a new doctor. Just calling to make the appointment was very hard for me.


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## joplin1975 (Jul 21, 2011)

Nodules don't automatically = a tumor. Nodules can benign, too. You won't know from the u/s what kind of abnormality it is, but, yes, solid is more concerning.

The RAIU was interesting...I found out half my thyroid was nonfunctioning despite only slightly elevated TSH & normal free t3 & t4. But, truthfullly, if I had to do it again, I would have preferred to go right to the FNA. Then you know for sure if you are dealing with cancer or autoimmune issues. FYI, I'm not good with doctors and found the FNA to be easy. My prominent nodule was measured 2.5 on the u/s and was easy to palpitate, so the process was quick.

Oh, you may want to ask about having your blood tested for antibodies, too.


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## retk (Feb 18, 2012)

I am hoping I can get a copy of the ultrasound report so I will know a little bit more about the nodules even though I wont have a lot of the important answers until after I see the endocrinologist and have more tests. I think they should give me a copy of the results if I ask, but I don't know what the policy is. I will call tomorrow morning and ask.

Your blood test results sound similar to mine since my TSH level was slightly elevated and my T4 was normal. I either didn't get tested for T3 or they didn't give me that result. My biggest nodule is also 2.5 cm.

I am hoping they will give me the FNA right away. I am glad to hear that is was easy for you. I hope it goes easy for me too, but I am really scared of needles so I will probably freak out about it and then it wont end up being that bad. Do they do the FNA and RAIU at the endocrinologists office or at the hospital?

I will ask about an antibody test. Should I ask my regular doctor or the endocrinologist about that?

Thanks for everything you have told me so far and if you think of anything else please let me know. I appreciate any advice or feedback I can get.


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## joplin1975 (Jul 21, 2011)

Either your regular doctor or endo can do the antibodies tests - I imagine your endo will be on top of that. 

I believe you will have to do your RAIU (if you do it) at the hospital...since its a radioactive material, it is usually handled by a radiologist/nuclear medicine.

My FNA was done by my surgeon. I know some folks have their endos do it, some have radiologists (if done with the guidance of a u/s)...it just depends on the expertise of your medical team.

I know some people felt the FNA was uncomfortable. I think I got lucky because my nodules was so close to the surface, so he didn't need to squish things with an u/s or poke around to find the nodules. I only felt the needle go in once, it felt like a minor bee sting, and he actually took five samples - four of which I did not feel.

Let us know how things go!


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## joplin1975 (Jul 21, 2011)

Oh, sorry, meant to say the FNA was done in my surgeon's office. I went in for a consult and he said he could do it, so I jumped on it.


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## Andros (Aug 26, 2009)

retk said:


> I was recently diagnosed as hypothyroid and had a thyroid ultrasound where 3 nodules were found on the left side of my thyroid. I have been referred to an endocrinologist, but my appointment is 10 days away so I am trying to educate myself on what might be going on with me. The short version of my issues are that I am hypothyroid, all my tests came back normal except my TSH is slightly elevated and I have 3 nodules on my thyroid, the biggest one is 2.5 cm. This is a more detailed explanation of what is going on:
> 
> I have had hypothyroid symptoms for at least 15 years, but my tests have always come back normal. Since my tests would come back normal I would get diagnosed with depression and put on antidepressants. Antidepressants would not help much and usually just make me more tired than I already was, but I continued to take them from the time I was 16 until I became pregnant at the age of 28. Four months before I became pregnant I had my yearly physical and blood work done. Everything came back normal except my cholesterol was slightly elevated. My doctor mailed my results to me with a prescription for Lipitor. That upset me because I had told him my husband and i were wanting to have a baby and you can't take Lipitor while you are pregnant. I was only 28 and it was the first time my cholesterol was high (208 total cholesterol) and he mailed me a prescription rather than talk to me about reasons it might be high and ways to try to lower it myself. After that I decided I would find a new doctor.
> 
> ...


She made it in!!! Yay!! No easy feat, was it? Hope we all make it worth your while and welcome!










See if you can find out if the nodules are solid, or cystic or any other notable irregularities and find out if an FNA (fine needle aspiration) would be the thing to do here.

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

Here are some strongly suggested tests.
TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/

It is common for cholesterol, glucose and BP to run high when hypo. So, getting this under control will be most helpful. AACE recommends that TSH be between 0.3 to 3.0.

Most of us feel best w/TSH @ 1.0 or less and the FREES slightly above the mid-range of the ranges given by your lab.

Here is info on the FREES.
Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.

http://www.drlam.com/articles/hypothyroidism.asp?page=2#diagnosis: standard laboratory test


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## retk (Feb 18, 2012)

Thank you for your reply and welcoming me to the forum! I just called and asked for a report of the ultrasound and they said I could come get it so I post what it says after I pick it up.

I will look into those tests and links you posted when I get back from picking up my report. I really appreciate the info.

My blood pressure, glucose and cholesterol are in the high end of normal, so I really want to get those things under control.

My glucose in 2008 was 97 with a normal range of 74-106.
My glucose in 2012 was 98 with a normal range of 70-99.

My blood pressure is usually just a little above normal, but goes way up when I go to the doctor. At my last doctors appointment my blood pressure was actually right around normal which surprised me because I knew I was going to have a blood test and that usually makes it go really high.

I have brought my cholesterol down into the normal range, but it could still be a lot better. I have been taking fish oil for about a year now and feel like that has helped.

So many things are starting to makes sense for me now that I know I am hypothyroid. I am going to pick up my report now. The place is an hour away from my house so I will post what I find out later today.


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## Octavia (Aug 1, 2011)

Welcome, retk!

Sounds like you are on the right track to getting this all figured out.

An hour away...can't they mail it to you?


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## Andros (Aug 26, 2009)

retk said:


> Thank you for your reply and welcoming me to the forum! I just called and asked for a report of the ultrasound and they said I could come get it so I post what it says after I pick it up.
> 
> I will look into those tests and links you posted when I get back from picking up my report. I really appreciate the info.
> 
> ...


Very much looking forward to reading the ultra-sound results.


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## retk (Feb 18, 2012)

Thank you! I am a little sad that I have been diagnosed hypothyroid, but so happy that I am getting answers and I finally have hope that I am going to start feeling better.

They said I have to sign for the report so I guess I have to go in person to get it. I will be happy to have it so I don't mind the drive. I am leaving now so I will post when I get back. Thanks again to everyone that has posted!!!


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## Andros (Aug 26, 2009)

retk said:


> Thank you! I am a little sad that I have been diagnosed hypothyroid, but so happy that I am getting answers and I finally have hope that I am going to start feeling better.
> 
> They said I have to sign for the report so I guess I have to go in person to get it. I will be happy to have it so I don't mind the drive. I am leaving now so I will post when I get back. Thanks again to everyone that has posted!!!


Drive carefully and enjoy the respite.


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## retk (Feb 18, 2012)

OK. I am back home with my results. I thought the nurse had told me on the phone that the biggest nodule is 2.5 cm, but I guess it is 2.4 cm. I doubt that makes much difference though. I am looking forward to my endocrinologist appointment to see what the next step will be.

Findings:
Sonographic evaluation of the right lower thyroid gland demonstrates the right lobe to measure 5.4 x 1.8 x 2.1 cm. The gland is the right thyroid lobe and is heterogenous in echogenicity. Evaluation of the left thyroid lobe demonstrates the left lobe to measure 5.8 x 2.2 x 2.7 cm. There are 3 hyperechoic nodules within the left thyroid lobe. The largest measures approximately 2.4 cm in diameter. The second largest nodule measures 2 cm in diameter and the third nodule measures 1.08 cm in diameter.

Impression:
1. There is diffuse heterogenous echogenicity of both thyroid lobes.
2. There are three adjacent hyperchoic nodules in the left thyroid lobe. The largest measures 2.4 cm in greatest transverse diameter.

I would love to hear thoughts or comments anyone might have about the results. Thanks!!!


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## joplin1975 (Jul 21, 2011)

We'll have to rely on folks more well-versed than me (I find u/s stuff to be confusing!)...with that said, it's my understanding the malignant nodules tend to be hyPOchoic (not reflecting u/s waves well) while benign nodules tend to be hyPERchoic, so that's encouraging!

They don't tell you if the nodules are solid, calcified, cystic, or if the margins are ill- or well-defined, so there's not much more I could add, but maybe someone else could. Again, the u/s tells us what things look like, they there are real limits beyond that. You certainly have nodules large enough to biopsy (they like to have them 1cm or larger) and I hope you doctor would be open to moving forward with that.


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## Octavia (Aug 1, 2011)

I'm not an expert on ultrasounds, either. My guess, with nodules that size, is that your next step will be Fine Needle Aspiration (FNA) biopsy of those nodules, where they stick a tiny needle in and pull some liquid/tissue out of the nodules to see what they're made of. As joplin mentioned, the nodules are large enough to do so, and it does seem like a logical next step. Are they causing discomfort in your neck? (Sorry...you may have mentioned that in your original post, but I'm afraid to click back to there and lose what I just typed!)


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## retk (Feb 18, 2012)

I find ultrasound results to be confusing too! I had a feeling I wouldn't understand the results, but I am still glad to have them.

That is good to know that hyperechoic nodules are usually benign.

I am hoping to have a FNA done right away. It does look like my nodules are a size that a FNA should be done. I would probably want to do that even if they were smaller. I don't think the nodules are causing me any discomfort. I am not really sure if I even feel them at all or if I do maybe I am just used to them. My older sister has a lot of the same hypothyroid symptoms I have but has also had normal blood tests has a lump in her throat that she can feel when she is swallowing pills or taking a big drink. Since her tests always came back normal she figured that she was just imagining things. Now that I have finally come up hypothyroid on a test she is going to call her doctor and ask for the extra thyroid tests. I hope she does it sometime this week.

Thanks again for replies! I am reading as much as I can find about thyroids, but it is also nice to hear from real people too.


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## Andros (Aug 26, 2009)

retk said:


> OK. I am back home with my results. I thought the nurse had told me on the phone that the biggest nodule is 2.5 cm, but I guess it is 2.4 cm. I doubt that makes much difference though. I am looking forward to my endocrinologist appointment to see what the next step will be.
> 
> Findings:
> Sonographic evaluation of the right lower thyroid gland demonstrates the right lobe to measure 5.4 x 1.8 x 2.1 cm. The gland is the right thyroid lobe and is heterogenous in echogenicity. Evaluation of the left thyroid lobe demonstrates the left lobe to measure 5.8 x 2.2 x 2.7 cm. There are 3 hyperechoic nodules within the left thyroid lobe. The largest measures approximately 2.4 cm in diameter. The second largest nodule measures 2 cm in diameter and the third nodule measures 1.08 cm in diameter.
> ...


Your thyroid clearly is not in a healthy state. However, it would appear that nothing notable was detected re the nodules. That could be a very very good thing. It's not me, but I still would push for FNA. You just never know.

A lot depends on the skill of the technician.

That leaves a window for error.

Ultra-sound limitations http://www.radiologyinfo.org/en/info.cfm?pg=us-thyroid


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## retk (Feb 18, 2012)

Thank you for your response! I meant to respond sooner but I keep getting distracted because I can't stop reading everything possible about hypothyroidism. It is amazing how everything is starting to make sense.

I wish the results went into a little more detail, but at least I have a small idea of what I will hear at my endocrinologist appointment a week from today. I hope the week goes by quickly because I really want to find out what the next step will be.

Should I expect to be put on some kind of Sythroid or medication at my appointment or will that probably come after further testing? I have been struggling really bad with fatigue and having no energy for so long and I am curious if medication will help with that. I know when I started taking Sythroid while I was pregnant I felt better, but I never did feel completely better.


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## joplin1975 (Jul 21, 2011)

I was put on 50mcgs of Synthroid at my first endo appointment, before my FNA, but after my RAIU. I would imagine they'd be inclined to put you on some thyroid replacement meds, but every doctor is different.


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## retk (Feb 18, 2012)

I just wanted to say thanks again to everyone for responding to me. I really do appreciate it very much! My endocrinologist appointment is tomorrow and it is nice to have an idea of what to possibly expect and a better understanding of some of the things the doctor might possibly talk about. I read as much as possible about thyroids and then decided to take the last few days before my appointment to relax and try not to think about it. Now I am ready to go get this appointment over with and find out what the next step will be. If anyone has any last minute advice please let me know! I need to make a list of questions to take with me to my appointment so I don't forget to ask anything. I will go back over this thread to find questions that have already been posted, but feel free to post any important questions even if they have already been mentioned. Thanks again!!!


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## Andros (Aug 26, 2009)

retk said:


> I just wanted to say thanks again to everyone for responding to me. I really do appreciate it very much! My endocrinologist appointment is tomorrow and it is nice to have an idea of what to possibly expect and a better understanding of some of the things the doctor might possibly talk about. I read as much as possible about thyroids and then decided to take the last few days before my appointment to relax and try not to think about it. Now I am ready to go get this appointment over with and find out what the next step will be. If anyone has any last minute advice please let me know! I need to make a list of questions to take with me to my appointment so I don't forget to ask anything. I will go back over this thread to find questions that have already been posted, but feel free to post any important questions even if they have already been mentioned. Thanks again!!!


You are most certainly welcome and all of us will be anxious to hear what the endo has to say.

Wishing you the best for tomorrow!


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## joplin1975 (Jul 21, 2011)

Good luck tomorrow! Don't forget to come back and let us know how it goes.


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## retk (Feb 18, 2012)

My endocrinologist appointment was yesterday. I was really nervous and forgot every question I wanted to ask. The doctor went over the ultrasound results with me and showed me the nodules and how my thyroid is enlarged. I forgot to ask more specific information about the nodules. He said he wanted me to get a FNA next week and he put me on 50 mcg of Synthroid. He didn't mention any tests other than the FNA and of course I forgot to ask about the RAIU and antibody tests. I wish I wouldn't get so nervous at the doctor! My FNA is scheduled for Tuesday.


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## lainey (Aug 26, 2010)

Based on your history and thyroid numbers alone, your doc can make the hypothyroid diagnosis. While having antibodies tests my tell the reason why you are hypo (autoimmune disease) having the antibodies doesn't change the outcome or the treatment of the disease necessarily. They also don't really go away if you have them, so they can be tested at any time.

The RAIU is nice as a diagnostic tool, and it gives a different picture of the nodules. Your nodules, however, are all of a larger size, so once again, any questions that might come from visualizing them because they are small is a moot point. They ought to be able to get good samples during the FNA to clearly see what they are all about.

You could always call the doctor's office and ask your questions now and see what they say.

In the meantime, keep us posted on how the FNA goes.


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## retk (Feb 18, 2012)

I had my FNA Tuesday. The doctor ended up only taking samples from the largest nodule. The FNA didn't hurt too bad, but the sensation of the needles being in my throat made me feel like I was going to pass out so the doctor stopped after three samples. He said that he got what he needed because the nodule he took samples from was the most suspicious one because it was the largest and had irregular edges. I got a call with the results and the nurse said it was benign. I am very happy that the results show no cancer, but a little concerned that the 2 cm and 1.08 cm nodules were not biopsied. My next appointment with the endocrinologist is in three months. I guess I am supposed to take 50 mcg of synthroid a day until my appointment in three months, but not sure what is ging to happen next.


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