# I need help understanding Iodine thyroid scan and bloodwork labs for nodule



## Capo (Feb 26, 2015)

Hello. I'm having a hard time understanding my lab results, and was hoping someone here can help me with them.

On Feb. 10th, I had a TSH with reflex at 3.371 (range is 0.340-5.600 uIU/ml)

On Feb. 19th, I had a thyroid scan with radioactive iodine. The 24 uptake to the thyroid was 29.7% (range is 10-30%). The 6 hr. Uptake was 18.9% (range 7-17%).

Then on Feb.25th, I had:

TSH 1.338 (0.400-5.000)
T4 Free 1.1 (0.7-1.5)
T3 Free Lvl 3.0 (1.8-4.2)
Thyroglubin Abs 2.3 (


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## joplin1975 (Jul 21, 2011)

Both your frees are right at mid-point. Some people feel ok at that spot, some people need them to be a bit higher. Your uptake is lean *slightly* hyper, which is interesting.

Did they note any discrete nodules on the scan? Did you have an ultrasound, too? Or just the radioiodine scan?

Do you have symptoms that made you think thyroid?


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## Andros (Aug 26, 2009)

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583
(Copy and paste into your browser)

Blocking TRAbs (also known as Thyrotropin Binding Inhibitory Immunoglobulins (TBII)) competitively block the activity of TSH on the receptor. This can cause hypothyroidism by reducing the thyrotropic effects of TSH. They are found in Hashimoto's thyroiditis and Graves' disease and may be cause of fluctuation of thyroid function in the latter. During treatment of Graves' disease they may also become the predominant antibody, which can cause hypothyroidism.

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism.
http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test
(Copy and paste into your browser)

Substances not found in normal serum
http://www.thyroidmanager.org/Chapter6/Ch-6-6.htm
(Copy and paste into your browser)

According to that uptake, you are hyperthyroid. What did the doctor say?

Have you had these antibodies' tests? You will see when you read "substances" that one should not have any Thyroglobulin Ab. Did you have the range for that test? It did not show on your post.

The healthy patient has a little thyroglobulin but should not have thyroglobulin Ab.


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## Capo (Feb 26, 2015)

Thanks for your replies.

Joplin, nodules weren't detected on the thyroid scan, but I had an ultrasound that showed 3 smaller hypoechoic on the left side and the larger one on the right side. I don't have any symptoms except fatigue, anxiety, and i feel warmer than I used to. I've just been doing these tests for the nodule.

Andros, sorry I forgot to put the range for the Thyroglobulin. It is (<=4.1). I also had the TPO Abs 2.0 (<=5.6). I didn't have any other antibody tests. The Doctor's office called with all my test results and said they were normal. The endocrinologist that I saw, was just talking about giving me Synthroid for my nodule. I don't even know if he noticed the high uptake on the thyroid scan. He just said my second TSH test that was lower, was after the scan, so I think he was dismissing it. I was more concerned about the nodule biopsy results at this appt. and didn't know much about the thyroid blood level and antibodies, and thyroid scan levels. Now I'm afraid to take the Synthroid because I think it's supposed to lean you more to hyperthyroid.

Thanks for your help!


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## Capo (Feb 26, 2015)

Andros, I meant thyroglobulin Abs in the previous post. It is 2.3 (range <=4.1). Does that sound ok? Thanks for the links, I will read them.


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## joplin1975 (Jul 21, 2011)

Do you have your ultrasound report? I'm wondering how big the large nodule is and if they gave you a description/characteristics of the nodule?


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## Capo (Feb 26, 2015)

Joplin, this is what the ultrasound says about the larger nodule:

Under the "Findings": The right gland measures 4.9 by 1.5 by 1.5 cm. There is a focal complex solid and cystic measuring 1.4 by 1.0 by 1.3 cm.

Under the "Impression": The overall thyroid gland is normal in size and homogeneous in echogenicity. There is a well-circumscribed, ovoid solid and cystic nodule in the mid right gland.

Thanks for you help!


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## joplin1975 (Jul 21, 2011)

Capo said:


> Joplin, this is what the ultrasound says about the larger nodule:
> 
> Under the "Findings": The right gland measures 4.9 by 1.5 by 1.5 cm. There is a focal complex solid and cystic measuring 1.4 by 1.0 by 1.3 cm.
> 
> ...


Ok, gotcha.

Well, you have some semi-conflicting results: slightly hyper uptake, pretty normal labs, and then this ultrasound. Regarding the ultrasound, if you had an autoimmune issue or issues, you'd expect a heterogeneous appearance to the thyroid. You would also expect it to be larger or inflamed. On those points, it all looks very normal.

But, then you have a large, mostly solid nodule. That description -- solid and above 1cm -- really raises the red flag for thyroid cancer and I can only assume that's my your doctor ordered the radioiodine scan. That said, usually cancerous nodules uptake the iodine differently than the surrounding tissue. So it's puzzling that they weren't seen on the radioiodine scan.

So, the only way you are going to get clarity on this is to follow up with a biopsy, or FNA (fine needle aspiration). It's really not so bad. It's quick and its your best bet to sort out this issue. I'm sure by now you are sick and tired of all the tests -- we all understand that! -- but it will be your best option to get clarity.


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## Capo (Feb 26, 2015)

I already had the biopsy and it came back with no malignant cells seen. Then I went to the Endocrinologist and he wants me to go on Synthroid to keep the nodule from growing. I was wondering if he saw the uptake, because he didn't mention it being high and he didn't mention it conflicting with the bloodwork. I thought he mumbled that my TPO Abs was positive, but not sure. It's only 2.0(range <=5.6).

Now, I got a copy of my surgical report and it says the radiologist biopsied the nodule on the left side rather than the right side. Hopefully that didn't happen. The injection spot is pretty close to the middle of my throat. I'm hoping he just made mistake on the paperwork, and didn't biopsy the small nodule.

Thanks for your help!


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## joplin1975 (Jul 21, 2011)

Oh, ok! I'm sorry. Serves me right for reading too quickly. 

You can certainly try the synthroid. If you don't like how you feel on it, you'll know. Your numbers aren't awful, so you could always go off it again if its just not working for you.


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## Capo (Feb 26, 2015)

So, do my antibodies seem ok?? Andros wrote that that the healthy patient has a little thyroglobulin, but shouldn't have thyroglublin Abs. My thyroglobulin Abs looks fine according to the labs range (mine 2.3)(range <=4.1) I didn't have the thyroglobulin test.
My TPO Abs was 2 (range <=5.6).

Joplin, when you wrote that it's puzzling why my nodules didn't show up on the radioiodine scan, you made it sound like the nodules are cancerous and should have shown up. Isn't a good sign that they didn't show up? The ultrasound says the larger nodule is complex, but doesn't say if it's mostly solid or mostly cystic.

I am very happy that my fna came back benign, but I know it's only 90% to 95% accurate, so I want to understand if my bloodwork is pointing towards thyroid cancer, or other disease as Andros seemed concerned, and Joplin seemed perplexed that my nodules didn't show on the thyroid scan.

Thank you again for you help!


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## joplin1975 (Jul 21, 2011)

Capo said:


> Joplin, when you wrote that it's puzzling why my nodules didn't show up on the radioiodine scan, you made it sound like the nodules are cancerous and should have shown up. Isn't a good sign that they didn't show up? The ultrasound says the larger nodule is complex, but doesn't say if it's mostly solid or mostly cystic.


 Oh, I didn't mean to imply anything, really. Sorry for the confusion!

*Usually* nodules are either caused by cancer or an autoimmune condition (either Hashi's or Grave's). That's particularly true when you are talking about large nodules over 1cm. And *usually* those nodules will "behave" differently on the RAIU scan because there's damage by the cancer or autoimmune process (the have a higher uptake in Grave's and a lower uptake in Hashi's or cancer). The fact that they weren't seen on the scan at all means they are behaving like "normal" thyroid cells.

A lot of people have nodules and a lot of them are just normal thyroid tissue. But you usually don't see a larger than 1cm nodule behave normally. So, yes, it's a good thing...it's just not seen often!


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## Capo (Feb 26, 2015)

Thank you Joplin for helping me understand about the nodule and the thyroid scan.

Is there anything that I should be concerned about or look into regarding the antibody bloodwork? The TPO Abs and Thyroglobulin Abs are in the normal lab range, but should I have them? While reading online, I saw that most people have different ranges that their labs give them. I was told that a healthy person shouldn't have them, but also read a little can be normal, that they get rid of dead cells. My antibody information got cut off in my first post. They are TPO Abs 2.0 (<=5.6), and Thyroglobulin Abs 2.3 (<=4.1).

Thanks again for helping me.


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