# Should I be concerned?



## bily (Mar 18, 2013)

Should I be concerned, and seek further testing - but what, or just monitor?

Hi, sorry for the essay, maybe too much info, but I'm not sure what path to take if any from here. Ie should I look for an endocrinologist or naturopath? Or should I leave it and get my bloods re checked in a year or so? Thanks for reading. I wasn't sure if I should be putting this in the intro or general section.

I am a 45 yo mother of 4 children, living in Australia. I am a healthy weight for my height, I think I'm reasonably fit and I exercise daily and apart from the symptoms that I'll list further down, I think I'm healthy and always have been. I've also been a vegetarian for the almost 2 years. I don't want to read more into my enlarged thyroid and lump, than there is, but I am a worrier when things can't be explained logically and personally have heard of health issues that were not picked up in the early stages, and things progressed to a much bigger problem, later on down the track.

Around 6 years ago I started to feel a small lump in my throat when I would swallow, and could tell something was there, and it's only been in the last few months that I have started to look into it, as it used to come and go, but of late, say the last year seems to be there more often than not. I went to an ear nose and throat specialist, who scoped my throat and couldn't see anything, but humored me in giving me a referral for an ultrasound. This is the US report:-

_Clinical history and findings: History of a sensation of a lump in the throat.

Thy thyroid gland is slightly asymmetrical in size, the right lobe being larger at 6.1ml compared with 2.2ml on the left. It has a slightly heterogeneous echotexture with several small hypoechoic micronodular spaces and flecks of calcification. However, no focal lesions are identified and there is normal vascularity.

A well circumscribed ovoid soft tissue structure with central vascularity is seen just inferior to the lower pole of the thyroid on the left measuring 4mm in short axis. This is thought to relate to a reactive lymph node.

No fluid collections of masses are seen in the region of where the patient describes her symptoms.

IMPRESSION:
1.	Heterogenous thyroid glad with small flecks of calcification and normal vascularity. This is no-specific but could relate to chronic thyroiditis. Correslation with throid function tests would be useful.
2.	No cause for the patients symptoms identified.

A CT may be useful for further assessment.
_
The radiographer needed to call in two more doctors to look at my results, and they described the lump as vascular and not sure as to what it was, as well as a bit of talking I did not understand. Not to worry, they said, but did I have any thyroid issues, and they said the lump was actually lower than where I had thought it was.

I have been to my General Practitioner ( GP), who ordered blood tests, results below, and she is happy with everything except the Vit D level, (more sunlight and a supplement needed she would prefer it to be around 100). So didn't think I needed to see anyone else.
_
Ferritin 19 ug/L (15-200) Iron stores borderline low
IgA	1.91 g/L (0.70-4.00) (I have a first degree relative that is a coeliac)
TSH	1.7 mU/L (0.50-4.4)
Anti-Tg	48 IU/mL (<116)
Anti TPO 15 IU/mL (<35)
25 -OH Vit D	76 nmol/L (51-140)
General Chemistry and Haematology not all listed, but I can update if needed.
Chol.	4.5 mmol/L (3.5-5.5)
Albumin	51 g/L (35-50)
Calcium	2.63 mmol/L (2.10-2.60)
Ca (corr)	2.43 mmol/L (2.10-2.60)_

My symptoms, as the GP has explained, can be explained by things other than a thyroid issue I know, except possibly the Ultrasound results, but I will list them anyway,

Ultra sound results
Feeling tired
Hair loss, it seems to break off an inch or so from the scalp, or just falls out, nails are good
Finding it hard to concentrate and remember things
Menstral cycle a little bit unpredictable and heavier and longer periods every 3-4 times
Libido dropping off
Finding it harder to shed excess kilo's, needing to exercise for longer to balance my energy in/output
Feeling the cold
20/20 vision deteriorating 
Some muscular/bone aches and pains
Some bowel changes frequency and kind of noisy, so a bit embarrassing, not constipation. (I've been tested for Bowel cancer and that was clear, it could be dietary (vegetarian) and I'm just not on top of it yet)

Lastly, my dad who isn't alive anymore, had a scar on the lower front part of his neck. He kept things to himself, and didn't discuss it in anymore detail than was needed with his wife. It was day surgery to remove a lump, and there were no further complications. So no one can shed any further light on it, and the hospital has destroyed his records, but it seems as though the operation was done around ten years ago.

Your thoughts greatly appreciated.


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## Andros (Aug 26, 2009)

bily said:


> Should I be concerned, and seek further testing - but what, or just monitor?
> 
> Hi, sorry for the essay, maybe too much info, but I'm not sure what path to take if any from here. Ie should I look for an endocrinologist or naturopath? Or should I leave it and get my bloods re checked in a year or so? Thanks for reading. I wasn't sure if I should be putting this in the intro or general section.
> 
> ...


When it comes to thyroid, the word calcifications raises an eyebrow. Also thefact that the 2 lobes are not the same size and the vascularity comments do suggest that you are way over due for another ultra-sound and possibly FNA (biopsy) to make sure you do not have cancer.

And these tests are very important.

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.

Negative test results means that the autoantibodies are not present in the blood at the time of testing and may indicate that symptoms are due to a cause other than autoimmune. However, a certain percentage of people who have autoimmune thyroid disease do not have autoantibodies. If it is suspected that the autoantibodies may develop over time, as may happen with some autoimmune disorders, then repeat testing may be done at a later date.
http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583

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/

TSH alone is not a reliable diagnostic test.


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## bily (Mar 18, 2013)

Thanks for the reply and and the welcome!

It's now almost a year since I had the first neck US. As things move slowly here, I have only recently seen an endocrinologist and had some more bloods taken and had another US, results of both below.

Date 19/12/2013

*25-OH Vit D 63 nmol/L* (51-140)

*Anti Tg 442 IU/mL* (<116)

*Anti - TPO 57 IU/mL* (<35)

*Free T4 13.1 pmol/L* (8.2-22.0)

*Free T3 4.0 pmol/L* (2.0-7.0)

*TSH 1.7 mU/L* (0.50-4.4)

*Vit. B12 225 pmol/L* (>170) Last time tested was 2011 and it was 405 pmol/L

Ultrasound dated 31/12/2013 - report reads,

*US NECK*

*Referral Notes*

Discomfort left side of neck. Please assess area indicated by the patient also query Hashimoto's thyroiditis.

*Report*

The right lobe thyroid has a volume of 6.9 ml and the left lobe a volume of 4.8ml. This is at the upper limits of normal. The thyroid is heterogeneous with increased vascularity. There are a few small nodules on the right with the largest measuring up to 9mm inferiorly. There is a small focus of dense calcification within the mid left lobe of the thyroid. No suspicious nodules are seen. There are a few adjacent small lymph nodes. No suspicious changes are seen. The palpable area probably overlies a small lymph node to the lateral aspect of the trachea on the left. The patient more descried a sensation in this area rather than a lump.

*Comment*

The appearance would be consistent with a more nodular form of Hashimoto's with increased vascularity and coarse echogenic stroma.


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## Andros (Aug 26, 2009)

It may be a good idea to see an ENT. This is not a healthy thyroid by any stretch of the imagination. High Thyroglobulin Ab is strongly suggestive of cancer as are the words vascular (suggesting independent blood source) and calcification.

Let us know what you decide to do here. It is worrisome. Keep a cool head and follow through.

We are here for you!


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## HotGrandma (Sep 21, 2012)

You may benefit from an iron suppliment expecially since you are vegeterian and menstrating. This could also be the problem with energy, hair loss, period problems and weight. And it shows in your labs.


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## francineS (Jan 6, 2014)

Hello!

I am like you, exhausted, without hope, desperate to have a baby with my husband coz my darn thyroid issues are messing up with my body and making it a dangerous place for my unborn child. :sick0026:

I spoke to my friend from HongKong a month ago and she said she has been cured of her thyroid issues, and all her nodules (calcified and not) and cysts have disappeared. She was on hypothyroid meds for 10 years. She introduced me to Thyroid Throu. This product has some rave reviews on forums, youtube and websites. They claim they can heal any thyroid problem.

- Don't dwell on the site name. They cure hyperthyroid and nodules too.

So I bought some and I am on it now for a week and I'm feeling great! I can't wait until I am completely healed!
I will keep you all posted on my recovery.

This could be our biggest break. I pray.

*- I am not a product endorser. Just an enthusiastic friend looking for a cure.*


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## CA-Lynn (Apr 29, 2010)

No evidence to support that any of it works.

And DEFINITELY should not be used on pregnant women.


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## bily (Mar 18, 2013)

Thanks for the replies. It is a good feeling having knowing that you have some support  .



Andros said:


> It may be a good idea to see an ENT. This is not a healthy thyroid by any stretch of the imagination. High Thyroglobulin Ab is strongly suggestive of cancer as are the words vascular (suggesting independent blood source) and calcification.
> 
> Let us know what you decide to do here. It is worrisome. Keep a cool head and follow through.
> 
> We are here for you!


What results should I be specifically asking about? I thought the Tg ab and TPO ab blood results, and ""the thyroid is heterogeneous with increased vascularity" "there is a small focus of dense calcification within the mid left lobe of the thyroid" " the appearance would be consistent with a more nodular form of Hahimot'os with increased vascularity and coarse echogenic stroma".

I initially saw an ENT early 2013 when I felt the lump when swallowing, after I dismissed the knowledge of something being in my neck for a few years. To be fair, he focused his scope on the area that I thought I felt the lump in, not finding anything, or looking elsewhere inside my throat, or at least I don't remember him looking elsewhere. He did humour me by giving me a referal to get the first US early 2013. That sonographer looked in the spot I was indicating I thought the lump was located, but didn't see anything, so she looked at my thyroid, and noticed a few things.

Fast forward roughly a year and I saw and Endocrinologist who ordered some more blood tests and another US. Basically they said, based on their palpating the neck (nothing felt by them), and previous blood and US results it could possibly be very early Hashimoto's, NFA, and for my piece of mind I could get some more blood tests and a new US, (specifically looking at where I felt the lump and looking for signs of Hashimoto's. They said at the end of out appointment I didn't need to see them again. This Endo was very personable, answering all my questions, and could see I was concerned. They did happen to mention though, the other Endo's would have dismissed me and sent me out after 5 mins!

With these new set of results and report, I thought I would send a letter stating my concerns back to the Endo, with a follow up call to make sure they have received everything, and looked over the results.



HotGrandma said:


> You may benefit from an iron suppliment expecially since you are vegeterian and menstrating. This could also be the problem with energy, hair loss, period problems and weight. And it shows in your labs.


I was taking iron, (prescribed by myself), but the GP, said I didn't need to. That was a couple of years ago though, and yes the iron stores are pretty low now.

Does anyone know of a good online medical dictionary that can help me decipher words?


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## bily (Mar 18, 2013)

I followed up with the Endo, basically, nothing to be worried about cancer wise. Just wait for thyroid to get destroyed and TSH become elevated and then deal with it via hormone replacement, whether in 1 month or 20 years. No preventative measures to be taken apart from vit D supplementation.

Following is part of letter from Endo sent to GP Date 29/1/14.

Ultrasound suggests Hashimoto's with heterogeneous echo texture and hypervascularity. The small lymph nodes surrounding the thyroid are also consistent with this diagnosis and one of those lymph nodes measuring 5 mm long axis is present at the site of neck discomfort. Also underlying small colloid nodules with no suspicious features.

Management is regular thyroid function tests via GP, 6-12 monthly depending on clinical status. High likelihood of TSH becoming progressively elevated in future and if that happens refer back to Endo for hormone replacement.


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