# Biopsy or not?



## thatbrian (Dec 11, 2009)

Just got back from the Dr and he told me that an ultrasound revealed a "large" nodule in/on my thyroid gland. Unfortunately it's NOT a cyst, it's a hard mass 3 cm x 2 cm

This lump in my throat is making it difficult to swallow at times so I think it needs to go regardless of malignancy.

My question is whether or not to have a biopsy done. If it that large, will a surgeon remove it without first performing a biopsy?

Thanks!


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## Andros (Aug 26, 2009)

thatbrian said:


> Just got back from the Dr and he told me that an ultrasound revealed a "large" nodule in/on my thyroid gland. Unfortunately it's NOT a cyst, it's a hard mass 3 cm x 2 cm
> 
> This lump in my throat is making it difficult to swallow at times so I think it needs to go regardless of malignancy.
> 
> ...


Hi, thatbrian and welcome. Interesting. Are you hyperthyroid or hypothyroid?

It probably would be a good idea to go ahead and have the FNA because the outcome could affect your treatment choices and decision making process. Does that sound logical to you?

For instance, if they find "certain" Hurthle cells which are indigenous to Hashimoto's, you may opt to try to shrink the nodule by taking thyroxine replacement. If you are cancer free but hyperthyroid, you may opt to try anti-thyroid meds for a while and/or have RAI or surgical removal.

You see?

It would be good to have more of your history for example, have you had any antibodies tests, are you on any meds at this time.................stuff like that?


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## thatbrian (Dec 11, 2009)

Hi Andros,

I am having symptoms of both hyper and hypo. They just drew blood yesterday to test for antibodies (only after I told the Dr that I wanted it!), so I don't know yet. I am not on any meds yet.

The biopsy is scheduled for Tuesday. Originally I was afraid that a biopsy might spread cancer if I did have a malignancy, but I have decided to let them do it.

The scary thing is that there are calcifications in the nodule, and it's size.

Also, there are many signs/symptoms that seem to indicate that I have Lyme disease, and I have talked to many people with Lyme who develop Grave's or Hashimoto's.


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## Andros (Aug 26, 2009)

thatbrian said:


> Hi Andros,
> 
> I am having symptoms of both hyper and hypo. They just drew blood yesterday to test for antibodies (only after I told the Dr that I wanted it!), so I don't know yet. I am not on any meds yet.
> 
> ...


Nothing like taking the bull by the horns. Good for you. I will be anxious to see what antibodies were run, what the results are and we will need the ranges also.

I cannot promise you that thyroid cancer is usually not "seed" cancer but I have never heard of it. There are some cancers that are indeed best left alone; that is as far as the scalpel is concerned.

I believe you have made the right decision. Will be anxious to hear all about that as well. Hopefully, this will be a non-malignant calcification. None the less; we need to know and the truth is, thyroid cancer is pretty well contained and comparatively easy to treat by way of surgery and some nuking.

Not a surprise that you are flitting back and forth. It's a roller coaster ride.


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## thatbrian (Dec 11, 2009)

New labs. I have no idea what any of this means:

TSH, 3rd gen .42 (.40-4.5)

T4 Free 1.4 (.8-1.8)

Thyroglobulin Antibodies <20 (<20)

FSH 1.7 (1.6 - 8.0)

LH .4 (1.5 -9.3)


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## Andros (Aug 26, 2009)

thatbrian said:


> New labs. I have no idea what any of this means:
> 
> TSH, 3rd gen .42 (.40-4.5)
> 
> ...


Your thryoid labs look good but I do wish they would have done a FREE T3 as that is your active hormone and while the FT4 is slightly above mid-range in range, because your TSH is so low (which is okay if FREE T3 is in range), I wonder if the FT4 is converting fast to the FT3 making you in hyperthyroid state.

Are you male or female? I see Brian but I never assume. thatbrian could be someone's hubby or it could be a guy's moniker.

I ask because LH and FSH have different things to say based on gender.

Here is the site; you can read for yourself if you will.........
http://www.labtestsonline.org/understanding/analytes/fsh/test.html


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## thatbrian (Dec 11, 2009)

Thanks Andros,

I'm male (44 yr old). I'm a bit worried about the low LH and possible pituitary problem although, I had a brain MRI a month ago that was clear.

I'm almost certain that I'm B12 deficiency, and I wonder how that would play into all of this.



Andros said:


> Your thryoid labs look good but I do wish they would have done a FREE T3 as that is your active hormone and while the FT4 is slightly above mid-range in range, because your TSH is so low (which is okay if FREE T3 is in range), I wonder if the FT4 is converting fast to the FT3 making you in hyperthyroid state.
> 
> Are you male or female? I see Brian but I never assume. thatbrian could be someone's hubby or it could be a guy's moniker.
> 
> ...


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## Andros (Aug 26, 2009)

thatbrian said:


> Thanks Andros,
> 
> I'm male (44 yr old). I'm a bit worried about the low LH and possible pituitary problem although, I had a brain MRI a month ago that was clear.
> 
> I'm almost certain that I'm B12 deficiency, and I wonder how that would play into all of this.


Interesting; I just found this................... and this statement leads me to think that Thyroid problems period would affect the axis.

Primary hypothyroidism: This can lead to hypogonadism through hyperprolactinemia. A low thyroxine (T4) level results in a high thyrotropin-releasing hormone (TRH) level, which stimulates prolactin secretion.

You will have to scroll way down but you should scan the entire article to see if anything else applies............

http://emedicine.medscape.com/article/118810-overview

Why do you suspect B12 deficiency? Have you had that lab done?
http://www.merck.com/mmhe/sec12/ch154/ch154h.html#sec12-ch154-ch154j-184b

I truly feel it best to cross one bridge at a time here. When is the biopsy scheduled?


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## thatbrian (Dec 11, 2009)

Thanks again Andros,

Re B12: I can't test it now because I started supplementing with sublingual mega doses. I felt like a new man after starting, but I have stopped now.

I suspect B12 because I have been using PPIs (Nexium) long term, I have stomach digestion problems. I may not be able to digest/absorb it. Also, I have a LOT of symptoms that match.

The biopsy is scheduled for tomorrow. I've also made an appointment at Yale. They have a great endo surgical team there I understand.


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## Andros (Aug 26, 2009)

thatbrian said:


> Thanks again Andros,
> 
> Re B12: I can't test it now because I started supplementing with sublingual mega doses. I felt like a new man after starting, but I have stopped now.
> 
> ...


You will be heavy in my thoughts tomorrow.

Aha; the site did mention that as one of many possible causes re B12. Well, the proof seems to be in the pudding. If you felt better; most likely, you were deficient!!

Please don't worry too much; as I mention, one step at a time here is the best philosophy so as to not overwhelm.

Best of luck tomorrow.


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## thatbrian (Dec 11, 2009)

Well. . . that's over with.

The biopsy was not too bad, and the Dr and staff were among the best I've seen.

Now I just have to wait for the results - 5-7 business days!!!


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## Andros (Aug 26, 2009)

thatbrian said:


> Well. . . that's over with.
> 
> The biopsy was not too bad, and the Dr and staff were among the best I've seen.
> 
> Now I just have to wait for the results - 5-7 business days!!!


I am glad to hear that the experience was as pleasant as possible. I will wait w/ you. I am most anxious and I know you are as well.

Any bruising? They say ice packs to the area to reduce pain and swelling if any.


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## thatbrian (Dec 11, 2009)

More labs:

Calcitonin 6 (< 10)

T3 Total 207 (76-181)

TSI 97 (<125% baseline)

Sex Binding Globulin SHBG 17 (9-45 for my age group)

FSH 1.7 (male 1.6 -8.0)


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## Andros (Aug 26, 2009)

thatbrian said:


> More labs:
> 
> Calcitonin 6 (< 10)
> 
> ...


It is rare that Total 3 (T3) is helpful because that is bound and unbound hormone but in this instance, it is clearly over the top which indicates (probably)hyperthyroid and then we look at the TSI (thyroid stimulating immunoglobulin) and pretty much can come to the conclusion that the patient is in hyperthyroid state.

The patient should have no detectable TSI; if it is present, it is responsible for the hyperthyroid state.

What do the test results mean?
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that this abnormal antibody is responsible for causing the person's hyperthyroidism.
http://uimc.discoveryhospital.com/main.php?t=enc&id=1516

I think treating the thyroid issue is going to clear up the other hormone issues. It will take time but they will come back up to where they should be.

And the Calcitonin. It is interesting that I just told another poster that we often do see hyperthyroid symptoms in the thyroid cancer patient.

What does the test result mean?

An elevated concentration of calcitonin means that excessive amounts are being produced. Significantly elevated levels of calcitonin are a good indicator of C-cell hyperplasia or medullary thyroid cancer; however, the doctor will use other procedures, such as a thyroid biopsy, scan, and ultrasound, to establish the diagnosis.

http://www.labtestsonline.org/understanding/analytes/calcitonin/test.html For complete reading.

Let me tell you this; do not worry. They have this all down to an exact science. You ARE going to be fine; super fine. Inconvenienced, yes! A little scary, yes! But they have a handle on this stuff like never before and it usually is always self-contained.

Plus, I am saying prayers for you, sending good karma, white light plus more!


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## thatbrian (Dec 11, 2009)

wow! thanks again!

Do you think that I have an elevated level of calcitonin? Now I am scared! I thought that under 10 was OK?


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## Andros (Aug 26, 2009)

thatbrian said:


> wow! thanks again!
> 
> Do you think that I have an elevated level of calcitonin? Now I am scared! I thought that under 10 was OK?


It is not really that elevated for the range is less than 10 but it is not far from 10 and that could mean that something is up and that is why all these other tests are so important including the FNA.

A normal value is less than 10 pg/ml (picograms per milliliter). So, you are good with that. It just raised a question in my mind because of the calcification.

Under 10 "is" okay!


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## thatbrian (Dec 11, 2009)

Well, it looks like I have to worry about this through Christmas because my doctor is away and his staff absolutely refuses to give me the results when they get them. I called Yale Pathology and they won't give me the results either. I'm really frustrated.


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## Andros (Aug 26, 2009)

thatbrian said:


> Well, it looks like I have to worry about this through Christmas because my doctor is away and his staff absolutely refuses to give me the results when they get them. I called Yale Pathology and they won't give me the results either. I'm really frustrated.


Ah so! Well; it probably is best that the doctor speak with you. I don't know many staff that would be able to accurately interpret stuff like this anyway.

Take a very very deep breath and do your best to enjoy the holidays if you can.

I hate this for you; the wait can be agonal. But in the meantime, you have got to pamper yourself and try not to get agitated as it could make matters worse.

Just know that we are all here for you when needed.


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## thatbrian (Dec 11, 2009)

The problem is that this is in direct violation of HIPAA. A patient has the right to all of his medical records. Besides being illegal, it's also the height of arrogance for Drs to have this kind of policy.

If I choose to push this, I run the risk of ****ing off the guy that might have a very sharp knife at my throat in a few weeks. . .



Andros said:


> Ah so! Well; it probably is best that the doctor speak with you.


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## Andros (Aug 26, 2009)

thatbrian said:


> The problem is that this is in direct violation of HIPAA. A patient has the right to all of his medical records. Besides being illegal, it's also the height of arrogance for Drs to have this kind of policy.
> 
> If I choose to push this, I run the risk of ****ing off the guy that might have a very sharp knife at my throat in a few weeks. . .


Yes; it is in direct violation. And I get angry over that sort of thing also. These days, doctors treat their patients like they are all non-informed dummies and worse.

And you are right about the knife too! They have us backed into a corner; yes indeed!


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## thatbrian (Dec 11, 2009)

Just got a copy of the biopsy report that my endo has had since 12/17!!! It states that the cells are not consistent with benign grows, but indeterminate. So, it's probably not benign, but not malignant either, or they can't determine if it is. They got a good sample, but just can't tell. . .

Also, the endo said that a TSI of 97 was "normal". I thought that any TSI (or over 2) meant Grave's. Who is right?


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## Andros (Aug 26, 2009)

thatbrian said:


> Just got a copy of the biopsy report that my endo has had since 12/17!!! It states that the cells are not consistent with benign grows, but indeterminate. So, it's probably not benign, but not malignant either, or they can't determine if it is. They got a good sample, but just can't tell. . .


Oh, Lord! It may be best to have the gland extricated so they can get a "good" look at it. Anyway, you can't swallow (did you not say that or am I thinking of someone else?); those are two very good reasons to opt for ablation (surgical removal of the gland.)

What do you think? Do you think you should have "another" pathologist go over the slides? That might be a good idea?


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## thatbrian (Dec 11, 2009)

I can swallow, but I can also feel the "lump" in my throat when I do (sometimes)

Yale Labs looked at the sample; I'm not sure that I can do better than that. The report states that my case was shown to an interdepartmental conference, so I think that I have multiple opinions on this already.

Although it is indeterminate, it does say "consider papillary"

Meeting with the surgeon on Monday; I'm sure that he will want to remove it.

I suppose that "indeterminate" is better than malignant... Even though it still could be.


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## Andros (Aug 26, 2009)

thatbrian said:


> I can swallow, but I can also feel the "lump" in my throat when I do (sometimes)
> 
> Yale Labs looked at the sample; I'm not sure that I can do better than that.
> 
> Meeting with the surgeon on Monday


That is top of the line to be sure! Hope to hear what the surgeon has to say. So, if you are available, please let us know.


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## thatbrian (Dec 11, 2009)

Met with the surgeon today. He wants to perform surgery. My decision is to either keep half of my thyroid or none of it.

I'm borderline hyper, which could be caused by the nodule. He said that there is a chance that I have a multi-nodular goiter (I think that's what he said) or a thyroid producing nodule? Also, he claims that 30-40% of nodules that are "indeterminate" are actually malignant.

I'm leaning toward keeping the good half, but worried about be hyper afterward. Any thoughts?

Thanks!


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## Andros (Aug 26, 2009)

thatbrian said:


> Met with the surgeon today. He wants to perform surgery. My decision is to either keep half of my thyroid or none of it.
> 
> I'm borderline hyper, which could be caused by the nodule. He said that there is a chance that I have a multi-nodular goiter (I think that's what he said) or a thyroid producing nodule? Also, he claims that 30-40% of nodules that are "indeterminate" are actually malignant.
> 
> ...


Your surgeon is most knowledgable. Did your surgeon mention what he would do if it was his thyroid? Are we certain that the other half is healthy?

When leaving thyroid tissue intact, the thyroid will grow back. That could make it hard to adjust your thyroxine replacement. However, I have to tell you that I personally wish that I could have had part of my thyroid salvaged.

If your surgeon is willing to comment on what he would do if it were his decision to make, I would rely heavily on that. He sounds very experienced.

Please let me know and he is right about the malignancy. That's why I have been pushing.


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## thatbrian (Dec 11, 2009)

He said that he would slightly lean toward removing it all.

One reason I would not (remove it all), is that he said that the nodule might be producing (over producing) thyroid hormone, making me slightly hyper. In other words, if it's benign, and if it is producing hormones, then removing just the nodule will "fix" me.

Also, if it is malignant, then I really wont mind a second surgery.



Andros said:


> Your surgeon is most knowledgable. Did your surgeon mention what he would do if it was his thyroid? Are we certain that the other half is healthy?
> 
> When leaving thyroid tissue intact, the thyroid will grow back. That could make it hard to adjust your thyroxine replacement. However, I have to tell you that I personally wish that I could have had part of my thyroid salvaged.
> 
> ...


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## chopper (Mar 4, 2007)

If it were me I would remove the half with the nodule. My mom had a partial due to a nodule and hashis. They removed half and she got about 8 good years out of that sucker before it died off from the hashi's but she was easily regulated thereafter.

Im not so keen on not having ANY of a very important gland. Im not sure if it's the right move or not but I would probably roll the dice on the nodule causing the hyper flare ups. If nothing else I would imagine after a partial, even if the "good side" is hyper you can probably use the extra juice the removed side is no longer producing. Later you can always RAI the remaining side if you need to. Just my thoughts about it but its almost a 60/40 split to me. Flip a coin.

I've never heard a partial work out in the long run without requiring meds. Perhaps others have but I know of at least 4 stories of partials that all ended in the good side quitting eventually, some longer than others.


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## Andros (Aug 26, 2009)

thatbrian said:


> He said that he would slightly lean toward removing it all.
> 
> One reason I would not (remove it all), is that he said that the nodule might be producing (over producing) thyroid hormone, making me slightly hyper. In other words, if it's benign, and if it is producing hormones, then removing just the nodule will "fix" me.
> 
> Also, if it is malignant, then I really wont mind a second surgery.


Not to mention the fact that once he is in there and has a look see, provided you give permission, he may yank the whole thing.

So.....................what you have told us sounds like a plan; a good one. The main thing is that you, the patient, is happy w/ the decision making process.


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## thatbrian (Dec 11, 2009)

Thanks for the replies.

I do have one concern. If I am hyper after surgery (half) would my insurance company want me to do RAI to destroy the other half rather than surgery? I would prefer surgical removal to RAI.

I think that I have been hyper for years, but I don't have any blood work to prove it.

Also, has anyone had to have a CT scan of their thyroid pre-surgery? I think that they want me to have one, but I had so many CT scans in the past 3 months that I glow at night!


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## Andros (Aug 26, 2009)

thatbrian said:


> Thanks for the replies.
> 
> I do have one concern. If I am hyper after surgery (half) would my insurance company want me to do RAI to destroy the other half rather than surgery? I would prefer surgical removal to RAI.
> 
> ...


If your doc thinks the other half has to come out surgically, I would cry malignant, malignant to the insurance company; that is for sure and I am positive your doc would back you up because even if you don't see it, does not mean it is not there and with your present history.........................?? You see? You may have to fight tooth and nail but I would do it. Let's hope it does not come to that.

I did not have CT scan but then I had RAI. I must say, the surgeon will probably find it to be most helpful. I personally would not want to rely on an old scan if I was doing the surgery.

Are you slotted in?


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## thatbrian (Dec 11, 2009)

I am not slotted in yet because they are off until Monday. Also, I have a appointment for a second opinion from and ENT surgeon on Monday. I'm interested to hear his take on the whole thing, but I'm almost definitely going to Yale for the surgery.

More blood work for a physical next week revealed that deficient in Vitamin D. My level is 28 (30-100). Still trying to figure out what is wrong with me beside my thyroid nodule - Lyme disease fits the bill for all of my symptoms. . .


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## Andros (Aug 26, 2009)

thatbrian said:


> I am not slotted in yet because they are off until Monday. Also, I have a appointment for a second opinion from and ENT surgeon on Monday. I'm interested to hear his take on the whole thing, but I'm almost definitely going to Yale for the surgery.
> 
> More blood work for a physical next week revealed that deficient in Vitamin D. My level is 28 (30-100). Still trying to figure out what is wrong with me beside my thyroid nodule - Lyme disease fits the bill for all of my symptoms. . .


Will be anxious to hear what the second opinion is. Have you had antibodies' for Lyme run?

Try to get more sun shine, milk, yogurt, cod.

Studies show the supplementing w/ Vitamin D may raise the antibodies in some individuals; you would not want that.

Vitamin D may exacerbate autoimmune disease................

http://www.physorg.com/news158425579.html


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## thatbrian (Dec 11, 2009)

Andros,

I can't wait for the second opinion too. I'm preparing a list of questions for the poor guy. He wont know what hit him!

I had the blood drawn on Monday for Lyme antibodies and related stuff. Results should be in next week sometime.

It's so difficult to know what to do for treatment. Is vit D deficiency the cause of autoimmune disease or an effect of it? Not sure that there will be consensus on that one for awhile. Also, low vit D has been linked to cancer, so I'm damned if I do (supplement) and damned if I don't.

Treating symptoms is what I want to avoid, but it's what modern medicine is so good at, so what choice do I have? It's easy to see why people end up with holistic practitioners. While I'm not there yet, I'm close.

Feeling frustrated today -

Brian



Andros said:


> Will be anxious to hear what the second opinion is. Have you had antibodies' for Lyme run?
> 
> Try to get more sun shine, milk, yogurt, cod.
> 
> ...


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## Andros (Aug 26, 2009)

thatbrian said:


> Andros,
> 
> I can't wait for the second opinion too. I'm preparing a list of questions for the poor guy. He wont know what hit him!
> 
> ...


Brian..........................I am glad you had the Lyme test; please let us all know. Also, the second opinion. This should be very interesting and I hope you get the answers you seek.


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## thatbrian (Dec 11, 2009)

Second opinion is that the entire gland be removed. He also thinks that there is closer to 70% chance of malignancy rather than 30%, because of the features of the nodule.

The new guy is an ENT surgeon with16 years experience; he specializes in thyroid surgery. The original guy is an endo surgeon, but with 4-5 years experience.

I'm not sure who I should choose.

Also, if I have the whole gland removed, how long will it be before I am able to function normally? Will I get thyroid replacement right away?


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## Andros (Aug 26, 2009)

thatbrian said:


> Second opinion is that the entire gland be removed. He also thinks that there is closer to 70% chance of malignancy rather than 30%, because of the features of the nodule.
> 
> The new guy is an ENT surgeon with16 years experience; he specializes in thyroid surgery. The original guy is an endo surgeon, but with 4-5 years experience.
> 
> ...


You should get the Rx for thyroxine replacement right away w/ instructions that as soon as you feel you are going hypo, to get started on it. It just depends on how hyper you are at this time.

I "definitely" am very happy you got the second opinion and that truly is more in keeping with what I personally would do. However, it is your body, your gland and your decision to make. Of course we will back you up either way.

Generally speaking, it takes about 18 months to get to where you are feeling human again. What is good about that is that you are on the pathway to restoring health instead of the opposite way around.


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## thatbrian (Dec 11, 2009)

I don't want to start a new thread, but I have a question about Toxic Adenoma.

My symptoms and labs seem to match:

Nodules that produce thyrotoxicosis are virtually always *greater than 3 cm* in diameter. Laboratory studies show *suppressed TSH* and marked *elevation of T3* levels, often with only *borderline elevation of T4*. Toxic adenomas are almost never malignant. They can usually be managed by antithyroid drugs; however, these medications do not inhibit the proliferative effects of the cellular defect. Thus, the nodule will usually continue to increase in size and more definitive therapy such as I-131 or unilateral lobectomy may be pursued.

I know that I will find out for sure after they remove this nasty thing from my neck, but I need something to keep me busy in the mean time


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## thatbrian (Dec 11, 2009)

Cough

Could this nodule cause me to cough? It feels a bit like bronchitis, like a tickle in the upper respiratory area. I might just be getting the flu. Hopefully nothing more scary.


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## Andros (Aug 26, 2009)

thatbrian said:


> Cough
> 
> Could this nodule cause me to cough? It feels a bit like bronchitis, like a tickle in the upper respiratory area. I might just be getting the flu. Hopefully nothing more scary.


It most certainly could. If it is causing a bulge in the air-way, fluid/phlegm could be accumulating and causing a slight cough. Are you running a temperature?

For me, I acquired the annoying habit of always clearing my throat. Do you do that? Can you stand anything around your neck?


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## Andros (Aug 26, 2009)

thatbrian said:


> I don't want to start a new thread, but I have a question about Toxic Adenoma.
> 
> My symptoms and labs seem to match:
> 
> ...


That is some cool info that you turned up. To bad you don't have a link for your excerpt to the entire article as I and others would love to read it. Also, a link would provide credibility.

Thank you so much for sharing this.


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## thatbrian (Dec 11, 2009)

I feel as though it's the start of bronchitis or pneumonia, but I'm trying to avoid thinking about somthing worse than that (the C word). After all I've been through, nothing would supprise me.

Probably just an upper respiratory infection, but I worry since I have the nodule.



Andros said:


> It most certainly could. If it is causing a bulge in the air-way, fluid/phlegm could be accumulating and causing a slight cough. Are you running a temperature?
> 
> For me, I acquired the annoying habit of always clearing my throat. Do you do that? Can you stand anything around your neck?


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## thatbrian (Dec 11, 2009)

Sorry, here's the link: http://www.google.com/url?sa=t&sour...ZJ04S2JJqB30-X33A&sig2=0TQWIxFNLRsWAXLKsserYg



Andros said:


> That is some cool info that you turned up. To bad you don't have a link for you excerpt to the entire article as I and others would love to read it. Also, a link would provide credibility.
> 
> Thank you so much for sharing this.


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## Andros (Aug 26, 2009)

thatbrian said:


> Sorry, here's the link: http://www.google.com/url?sa=t&sour...ZJ04S2JJqB30-X33A&sig2=0TQWIxFNLRsWAXLKsserYg


That is awesome and thank you for taking the time to furnish the entire article via link. We need to provide links when we use excerpts because of copy right issues and I see you know to do that.

Very very "cridible" source I might add.

Once again, thank you!


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## thatbrian (Dec 11, 2009)

Well. . . Monday is the big day.

After examining the slides himself, the surgeon has decided to try a frozen section, while I'm under, to see if he will leave me with half a thyroid or not.

Hope to be reporting good news once I feel well enough to post.

Brian


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## Andros (Aug 26, 2009)

thatbrian said:


> Well. . . Monday is the big day.
> 
> After examining the slides himself, the surgeon has decided to try a frozen section, while I'm under, to see if he will leave me with half a thyroid or not.
> 
> ...


Brian; we are so glad to hear from you and you will be in our thoughts and prayers for Monday. 1/26/10

When you think you can crawl to the PC, let us hear from you. Meanwhile, do as the surgeon says and take very good care of yourself. You deserve a little pampering so do it.

I like the way your surgeon is thinking.


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## Andros (Aug 26, 2009)

Andros said:


> Brian; we are so glad to hear from you and you will be in our thoughts and prayers for Monday. 1/26/10
> 
> When you think you can crawl to the PC, let us hear from you. Meanwhile, do as the surgeon says and take very good care of yourself. You deserve a little pampering so do it.
> 
> I like the way your surgeon is thinking.


Thinking of you today, Brian and I hope all is going well for you!! I will be very very interested in the pathology report when you are able.

And.............remember to do as the doc says, take it easy and pamper yourself.


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## thatbrian (Dec 11, 2009)

Thanks Andros,

That was one of the worst experiences of my life. I was so sick from the anesthesia that I vomited violently, they had to catheterize me after I couldn't urinate (6 hours after surgery), and I had no food until I got home just now.

On the bright side, after spending 1/2 hour looking at samples from the nodule (mid-surgery), they found no malignancy, so they left me with 1/2 of a thyroid. The official lab results should be finished in about a week.

Going to try to get some sleep now. The hospital is no place to get rest!


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## Andros (Aug 26, 2009)

thatbrian said:


> Thanks Andros,
> 
> That was one of the worst experiences of my life. I was so sick from the anesthesia that I vomited violently, they had to catheterize me after I couldn't urinate (6 hours after surgery), and I had no food until I got home just now.
> 
> ...


Aaaaaaaaaaaaaaaaaw; I am so glad you are home and boy are you lucky to be able to keep the other half of your thyroid!! Whoooooooooooohoo!

You take care now and rest.


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## thatbrian (Dec 11, 2009)

I have had a temp of 100.0 since 10-11 PM last night. Also, There has been some weeping of the wound overnight, both Tues and Wed.

Any advice?


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## Andros (Aug 26, 2009)

thatbrian said:


> I have had a temp of 100.0 since 10-11 PM last night. Also, There has been some weeping of the wound overnight, both Tues and Wed.
> 
> Any advice?


Indeed; definitely call your doctors and let them know. Sounds like some infection trying to set in.

And then please let us know. Is there a lot of swelling? Do you have a drain inserted?


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## thatbrian (Dec 11, 2009)

PRAISE GOD! Biopsy results are back and there was NO evidence of cancer!!!!!!


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## Andros (Aug 26, 2009)

thatbrian said:


> PRAISE GOD! Biopsy results are back and there was NO evidence of cancer!!!!!!


Praise God is right! What wonderful and awesome news!

Let's do the Snoopy Dance!
http://www.darkharbor.com/snoopydance/ arty0006:


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## thatbrian (Dec 11, 2009)

If I had gone with another surgeon, I would have lost my entire thyroid.


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## Andros (Aug 26, 2009)

thatbrian said:


> If I had gone with another surgeon, I would have lost my entire thyroid.


This is good; you may not have to take any thyroxine replacement. I hope that is the case and the remaining thyroid will grow some as well.

Did you call the doc about possible infection and the fever you are running?


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## thatbrian (Dec 11, 2009)

Yes, but by the time I did, the temp was back to normal.



Andros said:


> Did you call the doc about possible infection and the fever you are running?


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## Andros (Aug 26, 2009)

thatbrian said:


> Yes, but by the time I did, the temp was back to normal.


Blessings all around. How cool is that??? Good for you!! Now you can settle down and have a nice recuperation this weekend. Make it a long one!! Ha, ha!!!

How does the incision feel?


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## thatbrian (Dec 11, 2009)

I'm actually going back to work tomorrow.

The incision doesn't hurt so much, but the muscles all around my chest, neck and shoulders are sore. They must have your head literally hanging off of the operating table when the do thyroid surgery!



Andros said:


> Blessings all around. How cool is that??? Good for you!! Now you can settle down and have a nice recuperation this weekend. Make it a long one!! Ha, ha!!!
> 
> How does the incision feel?


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## Andros (Aug 26, 2009)

thatbrian said:


> I'm actually going back to work tomorrow.
> 
> The incision doesn't hurt so much, but the muscles all around my chest, neck and shoulders are sore. They must have your head literally hanging off of the operating table when the do thyroid surgery!


Yes; it is hanging off the end of the table.

This is a good thing you going back to work. Just take it easy and don't over do it. Yay!

You are the "bomb!"


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## thatbrian (Dec 11, 2009)

I've had a temp of about 100 all day! I'm sick of feeling sick. Is this normal?


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## Andros (Aug 26, 2009)

thatbrian said:


> I've had a temp of about 100 all day! I'm sick of feeling sick. Is this normal?


It is possible you could be dumping a bit of thyroxine which could make temp go up, or the surgical site could have a wee bit of infection or...............a cold, flu or virus?

Gee. You know I am going to tell you to call the doctor come Monday and should you get worse (higher temp), please go to walk-in or ER.

I know you are sick and tired of being sick and tired but hope is on the horizon. You have been through a lot and I do mean a lot.

Maybe you should not have gone into work?


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## thatbrian (Dec 11, 2009)

Thanks Andros,

Actually, I never made it to work. The temp was normal this morning, but then it climbed up to 99.4. I've got other stuff going on (Lyme) so that might be why I feel so unwell.

Seeing the surgeon on Monday morning to have the stitches removed, so I'll see if he wants to do some blood work. Also seeing the endo later in the day on Monday, and I'll try to press her for answers.

I'm concerned about my very low testosterone, LH and FHS? Maybe that's why I feel like crap too. I'm 45, but I feel like I'm 75. Something has to give.

Now I'm thinking that this thyroid nodule was a red herring. I feel the same, or even worse with it gone.



Andros said:


> It is possible you could be dumping a bit of thyroxine which could make temp go up, or the surgical site could have a wee bit of infection or...............a cold, flu or virus?
> 
> Gee. You know I am going to tell you to call the doctor come Monday and should you get worse (higher temp), please go to walk-in or ER.
> 
> ...


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## Andros (Aug 26, 2009)

thatbrian said:


> Thanks Andros,
> 
> Actually, I never made it to work. The temp was normal this morning, but then it climbed up to 99.4. I've got other stuff going on (Lyme) so that might be why I feel so unwell.
> 
> ...


Now, now............you just had the sucker out. Give yourself time to heal. Your body has been through hell and back. It will bounce back but not as quick as you might like it to.

Not unusual to have the other hormones messed up with this disease. That should correct it's self also but I recommend you talk to the doc about supplementing the Testosterone in the meantime. There is no reason for you to suffer.


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## thatbrian (Dec 11, 2009)

Just read the pathology report. GOITER!!! Firstly, how in the world did I have a goiter at 45? Secondly, why were they not able to tell that it was?

So. . . it was a red herring, and we are back to square one. Trouble is, we are going to have to move on over to the pituitary section of the board. With low T, low LF, and low FSH, there is no other conclusion to draw, than a problem with my pituitary gland.

An MRI is scheduled for next week, and another round of blood tests: Ferritin, cortisol, IGF, ANA and ESR (just because I asked).


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## Andros (Aug 26, 2009)

thatbrian said:


> Just read the pathology report. GOITER!!! Firstly, how in the world did I have a goiter at 45? Secondly, why were they not able to tell that it was?
> 
> So. . . it was a red herring, and we are back to square one. Trouble is, we are going to have to move on over to the pituitary section of the board. With low T, low LF, and low FSH, there is no other conclusion to draw, than a problem with my pituitary gland.
> 
> An MRI is scheduled for next week, and another round of blood tests: Ferritin, cortisol, IGF, ANA and ESR (just because I asked).


Oh, wow!! The doctor thinks pituitary? Are you saying they found no malignancy for which I am grateful if that is the case?

How are you feeling? Has the MRI been scheduled on a particular day next week?


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## thatbrian (Dec 11, 2009)

The endo thinks pituitary. Absolutely no malignancy. I feel just the same as before the surgery. Maybe a bit hypo - feel cold. MRI next Thursday.

Not having a diagnosis since early Oct is starting to get me down to say the least. I've never been ill before, so I've had the common yet naive expectation of perfect heath until I'm about 95, and the peacefully pass on in my sleep.



Andros said:


> Oh, wow!! The doctor thinks pituitary? Are you saying they found no malignancy for which I am grateful if that is the case?
> 
> How are you feeling? Has the MRI been scheduled on a particular day next week?


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## thatbrian (Dec 11, 2009)

I'm glad that this thread has a record of what has been going on with me because I almost can't believe it.

Just got back from the opthamologist, and he thinks that I have thyroid eye disease! Not a full blown case, but still. . . Since I am going to have an MRI of my pituitary, he has added on a look at the orbits of my eyes.

I'm so tired. I can't keep up.


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## Andros (Aug 26, 2009)

thatbrian said:


> I'm glad that this thread has a record of what has been going on with me because I almost can't believe it.
> 
> Just got back from the opthamologist, and he thinks that I have thyroid eye disease! Not a full blown case, but still. . . Since I am going to have an MRI of my pituitary, he has added on a look at the orbits of my eyes.
> 
> I'm so tired. I can't keep up.


Aaaaaaaaaaaaaaaaaw; sugars!! I am sorry! But I am so glad you are under the care of an ophthalmologist. That is very good news.

You will live to 95 and you will die peacefully in your sleep. We who have health issues and do something about them have a tendency to live far longer than our counter parts who do not take care of themselves.

The above statement is true. I did not make that up.


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## Andros (Aug 26, 2009)

thatbrian said:


> The endo thinks pituitary. Absolutely no malignancy. I feel just the same as before the surgery. Maybe a bit hypo - feel cold. MRI next Thursday.
> 
> Not having a diagnosis since early Oct is starting to get me down to say the least. I've never been ill before, so I've had the common yet naive expectation of perfect heath until I'm about 95, and the peacefully pass on in my sleep.


We will be waiting to hear about the MRI of the pituitary and now the eyes. Wow! You poor kid. I know you are exhausted, worn out and discouraged.


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## thatbrian (Dec 11, 2009)

New Labs - Post Surgery

TSH, 3rd gen: 3.48 (.40-4.5)

T4, Free: 1.0 (.8 - 1.8)

FSH: 3.1 (1.6 -8.0)

LH: 2.7 (1.5 - 9.3)

Cortisol, AM 16.4 (4.0 - 22.0)

IGF-I: 460! (86-220) What is that all about?!

SED: 19 (< or = 15)


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## Andros (Aug 26, 2009)

thatbrian said:


> New Labs - Post Surgery
> 
> TSH, 3rd gen: 3.48 (.40-4.5)
> 
> ...


Do you feel hypo? Here is info on IGF-1... http://www.labtestsonline.org/understanding/analytes/growth_hormone/test.html

Has your doctor commented about the high titer of IGF-1?

Are you on thyroxine replacement yet? 
Are you feeling any better?


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## thatbrian (Dec 11, 2009)

Yes, I feel hypo. Slept from 7:30 PM - 7:30 AM last night

Have not spoken with Dr about results yet (appointment 24th), but that looks like pit tumor to me. MRI of brain tonight!

No, I am not on thyroxine. Does it look like I might need a little? It's 2 1/2 weeks post op.

I do not feel better, and at times I feel worse.



Andros said:


> Do you feel hypo?
> 
> Here is info on IGF-1... http://www.labtestsonline.org/understanding/analytes/growth_hormone/test.html
> 
> ...


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## Andros (Aug 26, 2009)

thatbrian said:


> Yes, I feel hypo. Slept from 7:30 PM - 7:30 AM last night
> 
> Have not spoken with Dr about results yet (appointment 24th), but that looks like pit tumor to me. MRI of brain tonight!
> 
> ...


Yeah; it would appear indicative of it but let's hope not. With thyroid, all kinds of things go bonkers and given time and proper thyroxine replacement, most things right themselves.

I am saying a prayer for you and please let us know how the MRI goes tonight. I guess you will have to wait for results??

Yes; you would benefit from thyroxine at this point. There is no need to let you suffer unless taking thyroxine would interfere with other tests the doctor has in mind?


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## thatbrian (Dec 11, 2009)

Thanks Andros,

My endo is on vacation for the next 10 days, so I will not get the MRI results or any thyroxine until the 24th. Although, I wonder if the surgeon might give me a short-term supply.

Of course, I will try to get the MRI report from the hospital, but sometimes getting my own medical records has not been as easy as it should be.

Will keep the info coming as I get it.



Andros said:


> Yeah; it would appear indicative of it but let's hope not. With thyroid, all kinds of things go bonkers and given time and proper thyroxine replacement, most things right themselves.
> 
> I am saying a prayer for you and please let us know how the MRI goes tonight. I guess you will have to wait for results??
> 
> Yes; you would benefit from thyroxine at this point. There is no need to let you suffer unless taking thyroxine would interfere with other tests the doctor has in mind?


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## Andros (Aug 26, 2009)

thatbrian said:


> Thanks Andros,
> 
> My endo is on vacation for the next 10 days, so I will not get the MRI results or any thyroxine until the 24th. Although, I wonder if the surgeon might give me a short-term supply.
> 
> ...


Tch; so we wait and we wait and we wait. Aaaaaaaaaaaaaaaargh!! I am so sorry.

Yes; your surgeon should be happy to comply. Why not?

Are you in the U.S.??? If so, shout HIPAA loud and clear. It's the law. They have to give you your records. http://www.hhs.gov/ocr/privacy/


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## thatbrian (Dec 11, 2009)

My surgeon complied and is prescribing levothyroxine 50 ug per day. Should I know anything about this "drug" before taking it? Should I take one tonight or wait until morning?


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## Andros (Aug 26, 2009)

thatbrian said:


> My surgeon complied and is prescribing levothyroxine 50 ug per day. Should I know anything about this "drug" before taking it? Should I take one tonight or wait until morning?


It is much better to take in the morning but if you took one last night, that won't harm you to go ahead and take in the morning.

Here is info on that..........
http://www.medpagetoday.com/Meeting...ailyHeadlines&utm_source=mSpoke&userid=194646

Take calcium and iron pills 4 to 5 hours away. I am sure your Rx insert has said that. Be sure you always read the pharmacy insert.

Yay! Your surgeon is a cool dude/dudess?? Ha, ha!


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## thatbrian (Dec 11, 2009)

Thanks yet again Andros!

One more question (for now).

My white blood cell count is much lower than it has been in the recent past. Could losing half of my thyroid and going hypo cause my white blood cell count to drop?

WBC 4,700 (3,800 - 10,800) 2/10/10

7,800 12/21/09


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## Andros (Aug 26, 2009)

thatbrian said:


> Thanks yet again Andros!
> 
> One more question (for now).
> 
> ...


It certainly would follow if inflammatory process has abated and antibody count has been reduced. Yes. And that of course is good.


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## thatbrian (Dec 11, 2009)

No pituitary tumor. The MRI was clean.


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## Andros (Aug 26, 2009)

thatbrian said:


> No pituitary tumor. The MRI was clean.


Whoooooooooooooohoo!!!arty0006: I did not think so and I am so so glad to have this wonderful news! I know you are too!

Your body will slowy right it's self. Be patient and do all the right things re your meds, diet, exercise, sleep and keeping your cup filled.


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## hillaryedrn (Dec 14, 2009)

Congrats on the MRI!!!

Hillary


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## thatbrian (Dec 11, 2009)

Trouble is the high level of IGF-1. From what I can gather , it would only be so high if I had a pituitary tumor, or very rarely, a tumor elsewhere in my body secreting hormone.



Andros said:


> Whoooooooooooooohoo!!!arty0006: I did not think so and I am so so glad to have this wonderful news! I know you are too!
> 
> Your body will slowy right it's self. Be patient and do all the right things re your meds, diet, exercise, sleep and keeping your cup filled.


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## Andros (Aug 26, 2009)

thatbrian said:


> Trouble is the high level of IGF-1. From what I can gather , it would only be so high if I had a pituitary tumor, or very rarely, a tumor elsewhere in my body secreting hormone.


And what has your doctor determined? What is the next course of action?

How do you feel?

Do you have any of these symptoms?

2. What signs and symptoms are seen with excess GH and IGF-1 production? 
In a child, it is unusual tallness that is often first noticed. With an adult, it may be more subtle: a larger nose, thicker lips, a more prominent jaw, or rings and shoes that no longer fit.

Other signs and symptoms may include: 
Deepened, husky voice 
Enlarged organs - liver, heart, kidneys, and spleen 
Enlarged tongue 
Erectile dysfunction 
Fatigue 
Headaches and visual disturbances 
Joint pain and swelling 
Menstrual cycle irregularities 
Muscle weakness 
Snoring 
Sweating and body odor 
Thickening of the skin, skin tags 
Trapped nerves (Carpal tunnel syndrome)

http://www.labtestsonline.org/understanding/analytes/igf1/faq.html


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## thatbrian (Dec 11, 2009)

Dr. is on vacation. Have to wait until the 24th to see her. I have some of those symptoms, but not severely.



Andros said:


> And what has your doctor determined? What is the next course of action?
> 
> How do you feel?
> 
> ...


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## Andros (Aug 26, 2009)

thatbrian said:


> Dr. is on vacation. Have to wait until the 24th to see her. I have some of those symptoms, but not severely.


And then of course, some of the symptoms listed could be true for thyroid disease as well. It sure it tough to get to the bottom of things.

That is a long wait but doctor's vacation will be over soon.

How are you feeling today?


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## thatbrian (Dec 11, 2009)

Andros said:


> How are you feeling today?


I feel unwell. I feel as if a girl scout could kick my butt. I am exhausted physically, emotionally, and spiritually. I've been sleeping 10-12 hours a night, and I still feel tired. My eyes have been bugging me too. They are burning and are red. 
:anim_03:


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