# Thyroid Nodule & Hashimoto



## ann.olscv (Dec 29, 2009)

Hi All,
I am new to this group. I was diagnosed 18 years ago with Hashimoto hypothyroidism. I was on Synthroid for 17 years. A year ago I switched to NatureThroid. I have small nodules on my thyroid/neck. I had a biopsy done on the right nodule. The microscopic description was: "Specimen is predominated by lymphocytes in various stages of transformation, tingible body macrophages, and sheets of Hurthle Cells." Does anyone know what this means? Also, I need to find a really good Endocrinologist who specializes in Hashimoto's and doesn't mind taking the time to explain things. I live North of Los Angeles. My anitbodies were at 2383 a year ago. I haven't checked my antibodies recently because I haven't found a Dr that is knowledgeable about Hashimoto's and autoantibodies.
Although I have had Hashimoto's for 18 years I don't know alot about it except that it attacks the body and it's an autoimmune disease.
Any help would be greatly appreciated.
Sincerely,
Ann


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## ANI25 (Nov 5, 2009)

Hi, do not know about the nodules but can help with the Hashi's, if thats what you are after?

Wow your number of peroxidase (if that is the number you posted) is high. Mine was 850 region and that made me feel quite unwell.

I only know a little about it but will try to help. Firstly hashi's is an autoimmune and the peroxidase is the thyroid antibody present in patients with hashimoto's. The thyroid antibody will eventually destroy the thyroid making it unable to function properly. This means that you will eventually become underactive or hypothyroid, if you are not already.

Symptoms of hashimoto's can swing between underactive and overactive symptoms this is because hashimoto's can cause fluctuations in the thyroid levels. This why some doctors can find you hard to diagnose, but then again with numbers like yours it shouldn't be to difficult to tell.

Treatment can be as simple as Levothyroxine as this will stable the thyroid levels over time and act as a substitute to the natural thyroxine. This is what i am on.

If any of this is incorrect let me know and i will correct. Hope this helps.


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## ann.olscv (Dec 29, 2009)

Hi...

Thank you very much for responding. There is so much I don't know. I really didn't think it was a big deal all of these years. The Dr's (18 years ago) told me to take this pill and all will be good. So that's what I did.

Is Levothyroxine the same as synthroid or is Levothyroxine specific to Hashimoto?

What happens with the antibodies? Do they eventually go within normal levels? I am definately Hypo. I have all of the symptoms. I also do fluctuate, which I didn't realize was Hashi. Apparently neighter did the Dr's I was seeing. haha ... They were just treating the thyroid. Also, my thyroid is enlarged again. Is that a sign that it is starting to die off?

When I was diagnosed (18 yrs ago) I had a huge goiter and the synthroid shrunk it.

Sorry for so many questions!!

Sincerely,
Ann


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## Andros (Aug 26, 2009)

ann.olscv said:


> Hi All,
> I am new to this group. I was diagnosed 18 years ago with Hashimoto hypothyroidism. I was on Synthroid for 17 years. A year ago I switched to NatureThroid. I have small nodules on my thyroid/neck. I had a biopsy done on the right nodule. The microscopic description was: "Specimen is predominated by lymphocytes in various stages of transformation, tingible body macrophages, and sheets of Hurthle Cells." Does anyone know what this means? Also, I need to find a really good Endocrinologist who specializes in Hashimoto's and doesn't mind taking the time to explain things. I live North of Los Angeles. My anitbodies were at 2383 a year ago. I haven't checked my antibodies recently because I haven't found a Dr that is knowledgeable about Hashimoto's and autoantibodies.
> Although I have had Hashimoto's for 18 years I don't know alot about it except that it attacks the body and it's an autoimmune disease.
> Any help would be greatly appreciated.
> ...


Hi, Ann and welome to the Board.

Well, firstly.........I urge you to find out what kind of Hurthle cells those are. Some are indigenous to Hashomoto's and some are indigenous to cancer.

Here is info on that.......

Cancer.......... http://www.oncolink.org/types/article.cfm?c=7&s=26&ss=770&id=9607

Hashimoto's........ http://www3.interscience.wiley.com/journal/57028/abstract?CRETRY=1&SRETRY=0

Here is info on Macrophages........ http://erc.endocrinology-journals.org/cgi/content/abstract/ERC-08-0036v1

Has your doctor not commented at all? Do you have a copy of the pathology report? The pathologist "usually" recommends what the follow-up should be.

I am concerned and I humbly suggest you get in to see a doctor who understands all this stuff. I hope it is all a false alarm but we do need to rule in or rule out. Preferably the latter.

Here is some really good info re FNA and pathology with pictures of slides.....

http://erc.endocrinology-journals.org/cgi/content/abstract/ERC-08-0036v1

Please let us know what your game plan is.

I guess the antibodies that were so high were TPO (antimicrosomal?) Have you ever had any other antibodies run such as TSI (thyroid stimulating immunoglobulin) and Thyroglobulin Ab?

Since your goiter is enlarging again; I am very very suspicious. What does your thyroid panel look like? TSH? FT3? FT4?


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## ann.olscv (Dec 29, 2009)

Hi and thank you for welcoming me! I am very impressed with this website and how knowledgeable and nice everyone is.

I just looked up my autoantibodies from a year ago. They are Thyroid Peroxidase Autoantibodies (aka TPA?), you are correct. Do you know the significance of TPA?

I will look at the links you sent...Thank you very much!

I am looking for an endocrinologist. There is an endo on Thyroid-info.com in Pasadena that I thought I would contact, unless you have a suggestion?

I will request that my labs & complete pathology report be faxed to me and will post them as soon as I get them.

Thank you again!!!
Ann


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## Andros (Aug 26, 2009)

ann.olscv said:


> Hi and thank you for welcoming me! I am very impressed with this website and how knowledgeable and nice everyone is.
> 
> I just looked up my autoantibodies from a year ago. They are Thyroid Peroxidase Autoantibodies (aka TPA?), you are correct. Do you know the significance of TPA?
> 
> ...


I will be very interested in your future postings re labs (we need the ranges also as different labs use different ranges.) It is a good idea to start and keep a file folder of all labs and goings ons including how you feel on those labs. It will prove to be very helpful as you roll along here.

Yes; TPO are TPA (antimicrosomal) while they are found in thyroid disease, their presence also suggests other autoimmune diseases such as Lupus, RA and so on. However, many docs who are clinically observant claim that high titers of TPO mean Hashimoto's. I am not in agreement w/ that. What I have learned is that only FNA whereupon the Hurthle cells indigenous to Hashmoto's are found, can one conclude that the patient has Hashimoto's.

What does the test result mean?

Mild to moderately elevated levels of thyroid antibodies may be found in a variety of thyroid and autoimmune disorders, such as thyroid cancer, Type 1 diabetes, rheumatoid arthritis, pernicious anemia, and autoimmune collagen vascular diseases. Significantly increased concentrations most frequently indicate thyroid autoimmune diseases such as Hashimoto's thyroiditis and Graves' disease.

There is much more so I hope you will go to the URL and continue reading and also, this site is terrific. I hope you bookmark it for you can look all your labs up here.

What does the test result mean?

Mild to moderately elevated levels of thyroid antibodies may be found in a variety of thyroid and autoimmune disorders, such as thyroid cancer, Type 1 diabetes, rheumatoid arthritis, pernicious anemia, and autoimmune collagen vascular diseases. Significantly increased concentrations most frequently indicate thyroid autoimmune diseases such as Hashimoto's thyroiditis and Graves' disease.

It is also possible that you are going into Graves' Disease and that is why I recommend the TSI and other tests. Many w/Hashimoto's end up with Graves'; sadly.

From reading only the excerpt above about TPO, you can see why I am worried about cancer; I hope?? That is why I recommend the Thyroglobulin Ab.

TPO means "many" things and high titers like yours should really raise a question for further in-depth testing.

I don't know any docs out your way; I am in Georgia. However in the 1960's I lived in Altadena which over looks Pasadena. OMG!!! Such gorgeous Mountainous terrain. I wish I still lived there although coming down the mountain was a bit scary. Yikes!!! But, young and restless does not consider things like that!! Ha, ha!


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## ann.olscv (Dec 29, 2009)

Hi...I'm back and I have my labs.

My ultrasound said I had 2 nodules, one on the right and one on the left. The one on the right was a hypoechoic nodule. I figure that's why they only biopsied that one.

I received the full pathology report. The report reads as follows:

Final Diagnosis:
Ultrasound guided FNA, right lobe thyroid nodule
-Negative for malignant cells
-Hashimoto's thyroiditis

Specimen Source:
Ultrasound guided FNA, right lobe thyroid nodule

Clinical History:
Bilaterial Thyroid Nodules

Additional Comments:
History of Hashimoto's Throiditis

Gross Description:
Three passes with and six slides processed

Preliminary Impression:
Adequate material

Microscopic Description:
The specimen is predominated by lymphocytes in various stages of transformation, tingible body macrophages, and sheets of Hurthle cells.

It doesn't seem like the final diagnosis matches the microscopic description, but I'm still learning.

I will send you the labs as another reply.

Ann


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## ann.olscv (Dec 29, 2009)

Hi again,

My labs are as follows:

July 2, 2008
Mean Platelet Volume = 7.7 (range 7.8-11.0) Low
Neutrophils % Auto = 79.0 (Range 40.0-70.0) High
Lymphocytes % Auto = 13.5 (Range 22.0-44.0) Low
Albumin = 5.9 (Range 3.6-4.8) High
Free T4 (Free Thyroxine) = 1.2 (Range 0.70-1.40) Normal
Thyroid Stimulating Hormone = 3.69 (Range 0.45-4.68) Normal
Thyroid Peroxidase Autoantibodies = 2383 (Range <60) High

August 27, 2009
ALT (SGPT) = 7 (Range 11-66) Low
TSH = 5.44 (Range 0.46-4.68) High (Note: Meds 1 grain NatureThroid)
Neut % Auto = 9.5 (Range 10.0-14.0) Low
Lymph % Auto = 77.9 (Range 40.0-70.0) High
Mono % Auto = 13.1 (Range 22.0-44.0) Low

September 17, 2009
Neutrophils = 78 (Range 40-74) High
Lymphs = 11 (Range 14-46) Low

October 25, 2009
Epinepherine = <1 (Range 2-24) Low

December 09, 2009
TSH = 5.670 (Range 0.450-4.500) High **Note: Currently 1/2 grain NatureThroid
Triiodothyronine, Free, Serum = 3.0 (Range 2.0-4.4) Normal
T4, Free (Direct) = 0.90 (Range 0.82-1.77) Normal
Neutrophils = 76 (Range 40-74) High
Vitamin D, 25-Hydroxy = 23.0 (Range 32.0-100.0) Low

I do not see any T3's, etc. I think I definately need to get in to see an endo who specializes in Hashi. I was just diagnosed with Lyme disease a few months ago so it's hard to decipher which symptoms are Hashi, which are lyme or which are nodule related. I also have nodules in my lungs. I had 1- 3mm on my left lung a year ago. I just had a new ct done in Dec and my 3mm left nodule grew to 4mm and now I have a new 3mm on my right lung. They are still small so Dr wants to wait 3 months for another scan to see if they grow. I'm wondering if all of this is related or if I really have seperate issues.

I hope this wasn't too much information all at once!

Thanks again for your thoughts!!
Ann


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## Andros (Aug 26, 2009)

ann.olscv said:


> Hi again,
> 
> My labs are as follows:
> 
> ...


Hi there, Ann. Not too much info. You are hypothyroid. AACE recommends the range for TSH be 0.3 to 3.0 and truth be told, most of us feel best down around 1.0 or less. If my TSH was where yours is at, I would be non-functional.

This is your FREE T3 Triiodothyronine, Free, Serum = 3.0 (Range 2.0-4.4) Normal (Don't feel bad; I was confused once upon a time also.)

Also, in order to get those antibodies down, the TSH needs to be suppressed.

You could have ectopic thyroid tissue on your lungs. It is not unheard of.

http://jtcs.ctsnetjournals.org/cgi/content/extract/138/1/231

http://chestjournal.chestpubs.org/content/112/6/1684.full.pdf?ck=nck

I hope this is not that case but it is possible. I would recommend that you see a Thoracic guy and a pulmonary guy (or gal.)

Perhaps the neutrophils are low due to the lyme disease? (August, 2009)

Decreased neutrophil levels may be the result of severe infection or other conditions, such as responses to various medications, particularly chemotherapy. http://www.labtestsonline.org/understanding/analytes/differential/test.html

Did you have the Western Blot run for Lyme Disease? When did this take place? Are you on any other medications besides the Naturethroid?

That is a very very small amount. I believe one grain is 65 mgs.? So you are on about 32.5 mgs. which would be 19 mcgs. of T4 and 4.5 mcgs. of T3. That is barely enough to keep a person alive; I kid you not.

Try to get a little sun each day. Try to get out for about 15 minutes a day or more if you have the time. I caution you against taking a Vitamin D supplement as they have shown that it causes the antibodies to rise........

Here is support of that statement.......
http://www.physorg.com/news158425579.html

Now it is my turn to say I hope I did not inundate you. I note that the doctor ruled out pheochromocytomas as per the catacholines (epinepherine.)


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## ann.olscv (Dec 29, 2009)

Hi...Sorry for the delay.

I was only diagnosed with lyme a few months ago. My Dr put me on oral antibiotics in October but I was having reactions to them. The latest was temporary loss of hearing. So I am now on IV antibiotics which started yesterday. I had a western blot which confirmed the diagnosis. I also had a CD57 done and it came back '7' (1%). According to labcorp below 20 = severe illness. From what I read the CD57 is a strong indicator for lyme disease.

My Dr happens to be a pulminologist so he is keeping an eye on the lung nodules. I was wondering why he was asking about the thyroid nodules. The information you sent makes sense. He does want to do another ct in 3 months.

I finally received a message from my 'women's' Dr stating that the thyroid biopsy came back normal/unremarkable. I'm not too sure about all of that because they are not thyroid specialists at all. Also, thanks for telling me about Vitamin D because they prescribed Vitamin D for me. I definately don't want the anitibodies to go any higher. haha

I'm thinking of going back on synthroid, unless you've heard of other meds working better for people with Hashimoto's? I will make an appt for endo after the new year. Trying to get this lyme under control.

I am on Verapamil for high blood pressure & persistent tachycardia.
I am on my 2nd day of IV Rocephin for Lyme Disease. (I was off antibiotics for about a week)
I am also taking an iodine pill (every other day) for the past year or so, when I switched from Synthroid to Naturethroid.
I was taking probiotics too when I was on the oral antibiotics for the past few months. I will start them up again now that I am on the rocephin.

I will check out the "pheochromocytomas as per the catacholines (epinepherine)" to see what that means. The Dr didn't comment on the epinepherine.

The information you have sent me has been so helpful and informative. I really like to learn as much as I can so you haven't sent me too much. The thyroid stuff is confusing to me sometimes. haha

Thanks again!!!
Ann


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## Andros (Aug 26, 2009)

ann.olscv said:


> Hi...Sorry for the delay.
> 
> I was only diagnosed with lyme a few months ago. My Dr put me on oral antibiotics in October but I was having reactions to them. The latest was temporary loss of hearing. So I am now on IV antibiotics which started yesterday. I had a western blot which confirmed the diagnosis. I also had a CD57 done and it came back '7' (1%). According to labcorp below 20 = severe illness. From what I read the CD57 is a strong indicator for lyme disease.
> 
> ...


Ann, that is correct about the CD57; have you had another CD57 to see if things are improving? Gosh; you poor kid! Yikes!

I appreciate your meds and supplement list. The only thing that I see that could be contraindicated and in fact dangerous would be the iodine.

That is provided that you do indeed have Hashimoto's.

Here is info on that...
http://thyroid-disorders.suite101.com/article.cfm/iodine_and_hashimotos_thyroiditis

I am so glad that you have a pulmonologist on board. Please discuss the possibility of ectopic thyroid tissue with him/her if you will.

You should be able to get another pathologist's opinion on the original biopsy. That might be a good idea.

You can get a little sunshine when the sun is out. It won't hurt you. Plus it will set the circadian cycle re your pineal gland. People don't realize that it is not good to be indoors all the time for more than one reason. Also, eat some yogurt.

Here are some other foods that are high in D...................
http://www.whfoods.com/genpage.php?tname=nutrient&dbid=110

Eat these things in moderation and get sun in moderation.

I have to agree; the thyroid (endocrine system) is very very confusing to the max. Especially for us lay persons.

Synthroid should be fine for you if you feel well on it. If not, that has to be addressed.


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## ann.olscv (Dec 29, 2009)

Hi...

Do you know how I go about getting a 2nd opinion on pathology report?
I had my picc line put in last week for the lyme treatment. It was interesting to say the least. I think I now have a handle on it so thought I could get back to the thyroid nodules. haha

Also, I stopped the iodine. I didn't want to add any more 'stuff' if I didn't need it, especially if it may be harmful. I started eating more broccoli & yogurt.

Thanks again!!!
Ann


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## Andros (Aug 26, 2009)

ann.olscv said:


> Hi...
> 
> Do you know how I go about getting a 2nd opinion on pathology report?
> I had my picc line put in last week for the lyme treatment. It was interesting to say the least. I think I now have a handle on it so thought I could get back to the thyroid nodules. haha
> ...


Good for you, Ann re the iodine and a better diet! Ugh. What happened w/ the pick line. Fortunately I have never had to have that done. If you care to share, I care to listen.

I would firstly ask my doctor how to go about that. If he/she is no help, I would call the path lab directly; I sure would.


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## ann.olscv (Dec 29, 2009)

Hi...
I normally check things out before I do them and just assumed the picc line would be like putting in a regular iv. However, when I got to the hospital it was like a very mini procedure. They had 2 Dr's & nurse, sterile equipment, drapings, covered my hair & had a face mask like each of them. I didn't realize the picc went to the heart. Guess I was having a brain fart!! haha It didn't hurt at all and they were wonderful. My arm was sore for 2 days but that was about it. We had trouble getting a nurse in who was certified in picc lines so we had to go back to the Dr 3 days in a row. My Dr was sooo very nice and even met with us on New Years day to make sure we knew how to administer the medicine. The pharmacist didn't give us all parts of the medicine (which we didn't know) so we had to get a rush order on the rest. haha It's been fun to say the least. But, the pharmacist was wonderful and was able to get everything else needed very quickly. And we finally got a nurse on Tuesday to change the dressing. Each week the nurse will be coming in to change the dressing. It worked out in the end!! haha We just didn't realize that once the picc line goes in, it can't sit idle. It has to be flushed and used within a day.

Ann


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## Andros (Aug 26, 2009)

ann.olscv said:


> Hi...
> I normally check things out before I do them and just assumed the picc line would be like putting in a regular iv. However, when I got to the hospital it was like a very mini procedure. They had 2 Dr's & nurse, sterile equipment, drapings, covered my hair & had a face mask like each of them. I didn't realize the picc went to the heart. Guess I was having a brain fart!! haha It didn't hurt at all and they were wonderful. My arm was sore for 2 days but that was about it. We had trouble getting a nurse in who was certified in picc lines so we had to go back to the Dr 3 days in a row. My Dr was sooo very nice and even met with us on New Years day to make sure we knew how to administer the medicine. The pharmacist didn't give us all parts of the medicine (which we didn't know) so we had to get a rush order on the rest. haha It's been fun to say the least. But, the pharmacist was wonderful and was able to get everything else needed very quickly. And we finally got a nurse on Tuesday to change the dressing. Each week the nurse will be coming in to change the dressing. It worked out in the end!! haha We just didn't realize that once the picc line goes in, it can't sit idle. It has to be flushed and used within a day.
> 
> Ann


Well, go throw stones at icebergs!! I would never ever have dreamt that so I learned something today. No way would I have thought that went into the heart!

Talk about tense! Ann; you are a doll for having shared that and I truly am sorry you had to go through it but I am very very glad that this is going to make you well. That is the important part.

Can you go about your normal activities?


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## ann.olscv (Dec 29, 2009)

Yes...can do everything except get it wet. So I ordered a waterproof cover, which should be coming soon. In the meantime we've been wrapping it with press'n'seal and tape. haha The only thing that limits me are the symptoms. That's why I want to get the thyroid under control so I know the only symptoms I'm dealing with are lyme related.

When you said to ask the pathologist for a 2nd opinion, did you mean to call the same place I had it done to begin with? Or can I call around for a pathologist and have them get in contact with the existing lab? I'm not sure how this all works. The ordering Dr is not thyroid literate so it's up to me until I find an endo.


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## Andros (Aug 26, 2009)

ann.olscv said:


> Yes...can do everything except get it wet. So I ordered a waterproof cover, which should be coming soon. In the meantime we've been wrapping it with press'n'seal and tape. haha The only thing that limits me are the symptoms. That's why I want to get the thyroid under control so I know the only symptoms I'm dealing with are lyme related.
> 
> When you said to ask the pathologist for a 2nd opinion, did you mean to call the same place I had it done to begin with? Or can I call around for a pathologist and have them get in contact with the existing lab? I'm not sure how this all works. The ordering Dr is not thyroid literate so it's up to me until I find an endo.


I don't know how they work things in your state but perhaps a call to the lab to ask these questions? I see no reason why they should not be forthcoming on your behalf.

What? No duct tape? Gosh; I thought you could use that on anything and everything. :anim_03:

And how long do you have to have the picc line in?


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## ann.olscv (Dec 29, 2009)

:anim_63: Never thought of duct tape. It's like windex...it works on everything. haha

Right now I am scheduled for 6 weeks with the picc and antibiotics.


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## Andros (Aug 26, 2009)

ann.olscv said:


> :anim_63: Never thought of duct tape. It's like windex...it works on everything. haha
> 
> Right now I am scheduled for 6 weeks with the picc and antibiotics.


Are you taking probiotics? That is going to be a long six weeks but if it makes you well; it will be worth it.

Keeping you in my prayers for all good things.


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## ann.olscv (Dec 29, 2009)

Yes, I am on probiotics (14 billion 2 per day).

I am looking for a lab for a 2nd opinion on my FNB. I think I found one in Santa Monica. I will keep you posted on everything.

Thank you soooo much for being so helpful. It's so nice to know there are still people like you out there wanting to help others.

P.S. The duct tape works wonderfully!!! haha...Just Kidding:anim_63:


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## Andros (Aug 26, 2009)

ann.olscv said:


> Yes, I am on probiotics (14 billion 2 per day).
> 
> I am looking for a lab for a 2nd opinion on my FNB. I think I found one in Santa Monica. I will keep you posted on everything.
> 
> ...


Giggles are good; I thought the duct tape remark funny!arty0006:

Good for you on the second opinion. I will be waiting w/ bated breath to hear all about it.

I just hope I am a help. If nothing else, I am supportive. LOL!!

Hope you are feeling better, Ann!


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## ann.olscv (Dec 29, 2009)

Hi Andros,

I asked my Dr for a referral to an endocrinologist who is familiar with lyme. He said he wanted to run more labs and he would let me know. Anyway, he ran them last week and my labs came back today and I am now Hyper...??? Is that normal for Hashimoto people? This is also a different lab than I normally use.

My levels are as follows:
Carbon Dioxide - L 19 (range 21-33)
Billirubin - H 1.6 (range .2-1.2)
TSH, 3rd generation - N 3.49 (range .4 - 4.50)
T4, Free - N 1.0 (range .8-1.8)
T3, Free - H 485 (range 230-420)

That's all the abnormal (& normal thyroid) labs.

I haven't gotten the 2nd opinion on the nodules in my neck yet. I'm waiting till next month because the 'new' lab charges out of pocket. Could any of this be related to the neck nodules or nodules in my lungs?

Wondering what your thoughts are. Thanks!!!!
Ann


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## Andros (Aug 26, 2009)

ann.olscv said:


> Hi Andros,
> 
> I asked my Dr for a referral to an endocrinologist who is familiar with lyme. He said he wanted to run more labs and he would let me know. Anyway, he ran them last week and my labs came back today and I am now Hyper...??? Is that normal for Hashimoto people? This is also a different lab than I normally use.
> 
> ...


Hi, Ann! Are you on any med that could be taxing your liver?

Oh, yeah.....................FT3 indicates hyper and FT4 below mid-range indicates super fast conversion and you see that TSH? I have been trying to explain to others how important the FREES are because the TSH does not always get a move on when one would think that it should do so. Your labs are a "classic" example of why the Frees are so so important.

Okay, if in fact you have had Hashimoto's for 18 years, it is unlikely that it would now be causing hyper. Not impossible but unlikely. Many who have Hashi's do acquire Graves' or so I have read. I am not sure about this and that is why the initial diagnosis re FNA looking for the Hurthle cells indigenous to Hashi's is so important for the patient "may" have had Grave's/Hyper the whole time and then lastly, I have seen hyper in many cancer patients.

Sure could be related if as previously discussed there is a possibility of ectopic thyroid tissue in the lungs. That would "put out" just the same as the thyroid.

I know out of pocket. Just take your time and get to it when you are able.


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## ann.olscv (Dec 29, 2009)

Hi Again,

Ok...this may sound silly and I apologize in advance, I just don't understand what this means _".....and FT4 below mid-range indicates super fast conversion and you see that TSH? I have been trying to explain to others how important the FREES are because the TSH does not always get a move on when one would think that it should do so. Your labs are a "classic" example of why the Frees are so so important."_

If you don't mind, can you explain _"fast conversion"_ and what that means and how_ "TSH does not always get a move on when..."? _

No new meds...I stopped the Iodine. I wonder if that is what was making me hypo?

Thanks!!!
Ann :confused0033:

BTW...still using the duct tape!!! haha


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## Andros (Aug 26, 2009)

ann.olscv said:


> Hi Again,
> 
> Ok...this may sound silly and I apologize in advance, I just don't understand what this means _".....and FT4 below mid-range indicates super fast conversion and you see that TSH? I have been trying to explain to others how important the FREES are because the TSH does not always get a move on when one would think that it should do so. Your labs are a "classic" example of why the Frees are so so important."_
> 
> ...


FT4 is below the mid-range which means that it is converting to FT3 faster than it can produce T4. That is typically hyperthyroid.

And therein we have the answer about the TSH (thyroid stimulating hormone) because the pituitary is sending signals to produce produce but the thyroid is unable to produce fast enough to keep up with the conversion rate.

TSH should be going down because the FT3 is going up but your thyroid is in a confused state of mind. The antibodies are doing this. There are Binding, Blocking and Stimulating antibodies and autoantibodies flying around in there issuing orders. The phone lines are overwhelmed at this time.

Please do not apologize. I must tell you that at one time I did not know my anatomy at all much less what my thyroid did. LOL!! And I still have trouble remembering my name!!:jumping0047:

And here is a professional explanation......................

http://www.thyroidwellness.com/page/1/How-does-it-work.jsp


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## ann.olscv (Dec 29, 2009)

:anim_63: Yes...I can understand that! I think my whole insides are in a confused state.

Now that I am hyper maybe I can lose some weight??? haha


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## Andros (Aug 26, 2009)

ann.olscv said:


> :anim_63: Yes...I can understand that! I think my whole insides are in a confused state.
> 
> Now that I am hyper maybe I can lose some weight??? haha


Perhaps, if your appetite does not increase which is usually the case. If you can keep a handle on the "hungries"; yes............you can lose some weight. But, the hungries are very very subtle and insideous.

Aha; duct tape on the mouth? Ha, h!!arty0006:


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## ann.olscv (Dec 29, 2009)

WOW....great idea!
Maybe we can market duct tape as a new 'diet fad' and make some money????
haha We can even make it several different colors to attract all ages!! :jumping0047:

So.... do you suggest I see an endocrinologist or thoracic specialist or ask my pulminologist? But...I think my pulminologist is getting a bit overwhelmed with me... haha He's a great Dr but now my stool tests came back weird and we are waiting for explanation on that. haha arty0006:

Do you know what tests should be ordered to test my "Binding, Blocking and Stimulating antibodies"? Or is this combined with other tests? Lately I have been checking the labs so I can have a little peace with the direction my health is taking. The more I know the less worried I get. I know alot of people are the opposite, what can I say??? Maybe I will buy myself some duct tape. haha


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## ann.olscv (Dec 29, 2009)

FYI....I was doing a quick read on the board about Graves Disease. Nova had a post that stated "I also had weight gain (which is atypical in GD) and it was just another symptom throwing my docs off track - they didn't seem to compute how I started to gain weight but had a high resting heart rate and all the other fun stuff that goes with GD - " That's me....I gain(ed) weight & have a high resting heart rate that cardiologists can't explain yet. I wonder!!! I'll keep reading.


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## Andros (Aug 26, 2009)

ann.olscv said:


> WOW....great idea!
> Maybe we can market duct tape as a new 'diet fad' and make some money????
> haha We can even make it several different colors to attract all ages!! :jumping0047:
> 
> ...


I am with you. Knowledge for me, removes the fear.

Boy.......................the antibodies and autoantibodies just indigenous to the thyroid is a vast field.

And usually not necessary to have all these tests unless medical intervention is not working.

Here is a good place to start and when you are done, go to the home page of Thyroid Manager and bookmark the site. You will be glad you did. Maybe?:anim_03:

http://www.thyroidmanager.org/Chapter6/Ch-6-6.htm

Put in your search engine.

Thyroid binding antibodies

Thyroid stimulating antibodies

Thyoid blocking antibodies

Then do the same thing all over w/autoantibodies instead of the antibodies.

This will keep you busy enough. The heck with the duct tape.:rolleyes:


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## ann.olscv (Dec 29, 2009)

Hi Andros,
Just a quick update. I have an appt with a specialist on Tuesday morning.
Just wanted you to know I was still here. haha
Ann


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## Andros (Aug 26, 2009)

ann.olscv said:


> Hi Andros,
> Just a quick update. I have an appt with a specialist on Tuesday morning.
> Just wanted you to know I was still here. haha
> Ann


Oh, Ann!! I am so so glad to hear from you!! And double glad you have an appt. Tues. (2/16/10) with a specialist. You must let us know and I hope all goes well.

How are you feeling?


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## ann.olscv (Dec 29, 2009)

Thank you...
I feel sooo tired! haha Seems to be the way these days. Between the thyroid and the lyme I don't know what symptoms belong to what. haha 
I did tell them about the nodules in the lungs too and asked if they could be thyroid related. This Dr does his own blood work in his own lab and he does his own ultrasound. He has my actual slides and has reviewed them. He will give me his opinions on Tuesday. I know this sounds silly but I'm excited to get some closure to all of this.
I've decided that the lyme buggies have hitched a ride long enough in my body and it's now time for them to move on. haha ... It's like that movie years ago...The Date That Never Left! haha 
Sincerely,
Ann


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## Andros (Aug 26, 2009)

ann.olscv said:


> Thank you...
> I feel sooo tired! haha Seems to be the way these days. Between the thyroid and the lyme I don't know what symptoms belong to what. haha
> I did tell them about the nodules in the lungs too and asked if they could be thyroid related. This Dr does his own blood work in his own lab and he does his own ultrasound. He has my actual slides and has reviewed them. He will give me his opinions on Tuesday. I know this sounds silly but I'm excited to get some closure to all of this.
> I've decided that the lyme buggies have hitched a ride long enough in my body and it's now time for them to move on. haha ... It's like that movie years ago...The Date That Never Left! haha
> ...


Hey; maybe you can use some duct tape to catch the lyme buggies!!

Oh, I am definitely on the edge of my seat here. Sounds like this guy is thorough and knows his stuff.

Good for you!


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## ann.olscv (Dec 29, 2009)

Hi Andros,

I just got back from the Dr. He was wonderful and explained everything in detail. It was sooo refreshing. He told me things that I wouldn't have understood if you didn't tell me ahead of time. He was also very adimant about not taking iodine because I have hashimoto. Thank you sooo much! Anyway, he did the ultrasound and turns out that there was alot not listed on the other ultrasound. One of my nodules has alot of blood in it circulating while the lobe itself has hardly none. The other nodule not so much blood circulating yet that lobe does. He also found 2 lymphs...one on each side.

The lab who did my fnb only sent one slide over and it had alot of blood in it. We requested the rest of the slides. In the meantime he wants to do another fnb on all of the nodules & the lymps. He wanted to do it this Thursday but I will be out of town so I scheduled for Wednesday next week. He wants to rule out lymphoma or thyroid cancer. He said the one nodule that was on my initial ultrasound report was listed as hyperechoic and it is actually hypoechoic.

I forgot to ask him, if it is lymphoma, what the procedure is for that? I understand if it is thyroid cancer they can remove it...correct?

Anyway...if it wasn't for you I wouldn't have gotten the 2nd opinion or even had the slide rechecked. I would have been at a loss and constantly worrying and wondering. So THANK YOU SO VERY MUCH!!!

I've tried catching the lymies with duct tape but they are too fast for me!! haha

Ann


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## ann.olscv (Dec 29, 2009)

Hi...
Just had new biopsies. Does anyone know what it means when they find 'brownish fluid' in a lymp node in the neck?
Thanks,
Ann


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## ann.olscv (Dec 29, 2009)

Hi Andros...
Are you ok? I haven't see you around lately. I've gotten so used to hearing from you. Just a quick update that the biopsies on my thyroid came back benign. I don't have thyroid cancer. arty0006: I will find out tomorrow about the lymph node.
Ann


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## Andros (Aug 26, 2009)

ann.olscv said:


> Hi Andros,
> 
> I just got back from the Dr. He was wonderful and explained everything in detail. It was sooo refreshing. He told me things that I wouldn't have understood if you didn't tell me ahead of time. He was also very adimant about not taking iodine because I have hashimoto. Thank you sooo much! Anyway, he did the ultrasound and turns out that there was alot not listed on the other ultrasound. One of my nodules has alot of blood in it circulating while the lobe itself has hardly none. The other nodule not so much blood circulating yet that lobe does. He also found 2 lymphs...one on each side.
> 
> ...


 PC crashed and burned so I am playing catch up here. Thaaaaaaaaaaaaaaaaaaat's right. You definitely needed to seek out another doc. Boy, am I ever glad.

Vascular generally speaking is not good. Some signs so seem to point to ablation and then pathology can have a "good" look see.

Brown fluid? If it was remarkable and clearly it is, I do think the thyroid may have to come out.

And right you are. Cancer of the thyroid is probably the best place to have the big "C" if you are going to have it.

I am confident you are in very good hands now and I sense you do as well. Don't worry; you are going to be fine.

Saying prayers for you.


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## hillaryedrn (Dec 14, 2009)

Hi there! Sorry, I've been missing this post the whole time apparently! I'm so glad you got a specialist to look at you! Isn't it wonderful when someone finally listens to what you are saying? I know it made all the difference in the world to me! Brownish fluid? That's different, I'm not sure what to make of it. Yes, the vascularity isn't a great sign, but don't dwell.

As for the treatment for lymphoma, it varies as to how progressed it is and your health in general. You would really need to ask a specialist because we would only be speculating.

Good luck and keep us posted!!

Hillary


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## Andros (Aug 26, 2009)

ann.olscv said:


> Hi Andros...
> Are you ok? I haven't see you around lately. I've gotten so used to hearing from you. Just a quick update that the biopsies on my thyroid came back benign. I don't have thyroid cancer. arty0006: I will find out tomorrow about the lymph node.
> Ann


Boy, am I happy to hear this. I think I missed this post. Playing catch*up here. Whooooooooooooooooohoo!

There could not be better news.

Let us know about the lymph node.


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## ann.olscv (Dec 29, 2009)

Hi All,
Great news to share...I do not have lymphoma. I guess the Dr sent it away for a smear or clear or something like that. Anyway, it came back negative. I still don't know what the brown fluid means. I will have to ask him when I see him in 30 days. I heard, on one hand it's not good but on the other hand it is good because it proves that the lymph is doing its job....
I'm back on synthroid 100 mcg and new labs in 30 days.
Andros...sorry to hear about your computer. That really stinks! BUT...I am glad you are ok though.
Hillary & Andros....what could the vasculitis mean if it is not cancer? Or is this a silly question. Just curioius.
Thanks again for responding to my posts.
Sincerely,
Ann


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## Andros (Aug 26, 2009)

ann.olscv said:


> Hi All,
> Great news to share...I do not have lymphoma. I guess the Dr sent it away for a smear or clear or something like that. Anyway, it came back negative. I still don't know what the brown fluid means. I will have to ask him when I see him in 30 days. I heard, on one hand it's not good but on the other hand it is good because it proves that the lymph is doing its job....
> I'm back on synthroid 100 mcg and new labs in 30 days.
> Andros...sorry to hear about your computer. That really stinks! BUT...I am glad you are ok though.
> ...


Oh, Ann..............this is wonderful news!

Okay, I am not happy to provide this info but in lieu of your health and doing the "right" thing, I think you need another opinion.

Abstract
Two cases of papillary thyroid carcinoma presenting as a cystic lateral neck mass are reported. This tumour characteristically presents in patients under 40*years*old and in the presence of an occult primary tumour may mimic a branchial cyst. In such cases simple aspiration of the cyst will produce a chocolate*brown serous fluid which excludes the diagnosis of a branchial cyst and is characteristic of papillary thyroid carcinoma. Cytological examination of the fluid has a high degree of sensitivity and specificity in the diagnosis of thyroid malignancy and should avoid delay in diagnosis and unneccessary surgical exploration prior to definitive treatment.
http://journals.cambridge.org/actio...8DDF2D969.tomcat1?fromPage=online&aid=1066424

Thyroid tissue does travel. 
An analogy would be somewhat like endometriosis. It is called ectopic thyroid tissue.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1468401/

You can Google more info. I put this in my search engine...

lymph nodes, neck, brown fluid aspirated

Thank you for caring about me. Hysterical was not the word and naturally these things come at a bad time as well. But I am fine and I am more worried about you. I would live my life w/o a PC as long as you are fine.

Let me know what you think and what you decide. You are not the first I have urged to get a second opinion and even a third. Something is not right here. The fluid should be clear or at worst a very light yellow.

Vasculitis? I always thought it was inflamation of the veins and/or arteries. Here is the definition............
http://www.nhlbi.nih.gov/health/dci/Diseases/vas/vas_whatis.html

What's up w/ that? Please don't tell me the doc said you have vasculitis of the lymph nodes? I beg you not!!! LHM!

Excerpt from the link to vasculitis.................

Vasculitis can affect any of the body's blood vessels. These include arteries, veins, and capillaries. Arteries carry blood from your heart to your body's organs. Veins carry blood from your organs and limbs back to your heart. Capillaries connect the small arteries and veins.


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## ann.olscv (Dec 29, 2009)

Hi Andros,
Sorry for delay in responding. I have been in Arizona. I made a mistake. I meant to say vascular not vasculitis. Sorry about that. When the Dr was doing the ultrasound he showed me the blood flow and one was filled with blood and the other was not. It hardly had any blood flow. It was quite interesting. 
I'm a bit confused with the brown fluid and the lymph node 'smear' coming back normal. That didn't make sense to me. My husband is going to call the Dr on my behalf with the information you sent me and ask for clarification. 
I tried to ask the nurse about it and she said "don't even go there". Whatever that means. Haha. I don't want to be an alarmist however we have had several incidents of misdiagnosis with myself and my children that were life threatening so my confidence in DR's has diminished quite a bit. 
Do you know what else could cause a vascular nodule if it's not cancer?
Thank you very much for your help and guidance.
Ann


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## Andros (Aug 26, 2009)

ann.olscv said:


> Hi Andros,
> Sorry for delay in responding. I have been in Arizona. I made a mistake. I meant to say vascular not vasculitis. Sorry about that. When the Dr was doing the ultrasound he showed me the blood flow and one was filled with blood and the other was not. It hardly had any blood flow. It was quite interesting.
> I'm a bit confused with the brown fluid and the lymph node 'smear' coming back normal. That didn't make sense to me. My husband is going to call the Dr on my behalf with the information you sent me and ask for clarification.
> I tried to ask the nurse about it and she said "don't even go there". Whatever that means. Haha. I don't want to be an alarmist however we have had several incidents of misdiagnosis with myself and my children that were life threatening so my confidence in DR's has diminished quite a bit.
> ...


Ann, hey there!! Hang tough,GF!! Okay.....

hemorrhagic areas means vascular (High blood flow) and you must read this...........

http://emedicine.medscape.com/article/127491*overview

Very very good and concise article.

Here is more............... If capsular or vascular invasion is seen, the contralateral lobe should be resected, and the patient should undergo postoperative thyroid cancer management with an endocrinologist.

http://mediwire.healingwell.com/main/Default.aspx?P=Content&ArticleID=142949

You know I don't want you or anyone to have cancer but I do want to be sure you don't; bottom line here.

Hugs,


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## ann.olscv (Dec 29, 2009)

Hi
Thanks for the information. We have a call into the Dr. I hope to hear from him tomorrow.
The fist link you have listed is not found. I'm really interested in finding that article. (http://emedicine.medscape.com/article/127491*overview) When I get to emedicine.medscape.com what can I type in to find this article?
Thanks!
Ann


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## ann.olscv (Dec 29, 2009)

My newest labs as of 2/15/10. I am now on 100 mcg synthroid as of end Feb.

FT4 = .64 (Range 0.8*2.0)
FT3 = 1.4 (Range 1.9*5.1)
TSH 3rd Gen = 1.6 (Range 0.3*3.0)
TPO Ab = 227 (Range <10.1)
Tg = .17 (no range listed)
Tg Ab = L0.4 (Range <0.7)
Calcitonin = L2 (no range listed)

Any thoughts anyone?


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## Andros (Aug 26, 2009)

Andros said:


> Ann, hey there!! Hang tough,GF!! Okay.....
> 
> hemorrhagic areas means vascular (High blood flow) and you must read this...........
> 
> ...


I don't know how Google takes me to a link and then it won't work when I share it. Sigh. It won't work; you are correct.

Here are some others....

http://emedicine.medscape.com/article/385301*overview

This one is really good.....

http://www.springerlink.com/content/a26943237x275157/

and this........

http://ijs.sagepub.com/cgi/content/abstract/3/1/29

Here is what I put in my search engine; you can find lots and lots.....

thyroid hemorrhagic areas, vascular


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## ann.olscv (Dec 29, 2009)

Thanks...will look those up now!


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## Andros (Aug 26, 2009)

ann.olscv said:


> My newest labs as of 2/15/10. I am now on 100 mcg synthroid as of end Feb.
> 
> FT4 = .64 (Range 0.8*2.0)
> FT3 = 1.4 (Range 1.9*5.1)
> ...


You must be exhausted. Frees are in the basement and FT3 below range. FT3 is your active hormone as I am sure you know. Goodness, goodness!

And it is interesting to note that while below range,you do have antibodies to the thyroglobulin which could cause a false reading of the thyroglobulin as per......................

If a person develops thyroglobulin antibodies, then the thyroglobulin test results may be falsely elevated or decreased, depending on the testing method used. Results must be interpreted with caution. The presence of the antibodies lessens or eliminates the usefulness of the thyroglobulin test as a tumor marker.

Here is the entire article which I recommend you read........
http://www.labtestsonline.org/understanding/analytes/thyroglobulin/test.html


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