# New! Ultrasound and new labs



## usmc4myson (Sep 26, 2010)

Hello everyone,
I got a call from my dr this morning that they wanted me to make an appt to go over results of my ultrasound and recent bloodwork. First available? Tuesday. I asked them for a copy of reports...because there is no way I want to wait 5 days for my appt!

Let me also preface this by saying that I have VERY little respect for the radiology dept at our hospital. They seem to report the bare minimum...almost as if they scan the CT or ultrasound or xray as if they were scanning through an old magazine...and I wonder if their eyes are actually making synapses with their brain as they make their reports. My 15 yo son hurt his lower back acutely in wrestling this past Jan. He had xrays and then an MRI. They were "normal." Yeah. He can barely walk. We then took these results to an spine surgeon. Here are the words of her report. "I disagree with the reading from the radiologist and think that there is a change in marrow signal at the L5 pedicles. There is also no thin cuts, and most of the pars at the lower levels were not scanned."
He had a CT scan done to get more info, and this past July he had surgery to repair bilateral fractures of the L5S1 pedicles. So there you go. And this was not the only time this has happened.

Ok...now onto my ultrasound report. "Right thyroid lobe measures 3.5 x 1.6 x 1.6 cm. A 1.4 cm. solid nodule is present in the midpole of the right lobe. Left thyroid lobe measures 3.5 x .7 x 1.3 cm. Normal flow bilaterally. Isthmus measures .29cm Impression: 1. solid nodule in the mid pole of the right lobe. Consider correlation with thyroid scan.

Thaaaat's all folks...nothing about heterogeneous or homogeneous. They didn't scan any of the area where lymph nodes are...just to check them. It just seems shoddy to me.

Also, labs came back.

TSH 2.90 (.40- 4.50)
T-3 uptake 29 (22-35)
T-4 total 7.6 (4.5-12.5)
Free T-4 index (T-7) 2.2 (1.4-3.8)
Thyroid peroxidase antibodies 203 H (<35)
Thyroglobulin antibodies 35 H (<20)

The last time my antibodies were checked was back in 2001. Back then, my Thyroglobulin ab was 6. Anything more than 2 was flagged as high.
My Peroxidase ab were 20 H. and again, anything above 2 is high. Why did the reference values change so drastically from 2001 till now?? They are both listed as IU/mL.

I know a solid nodule is not good. I guess I will know on Tuesday what my doctor thinks about it. Until then, what do you suggest that I ask for at my appt? Remember, my body reacted voilently to the CT scan from 9/17. Will they skip the RAIU on me given that information, and go straight to biopsy? Should I ask for my free T3 and 4 and all the tests that Andros told me about? The TBII, the TPO, and the TSI?

Thanks for any and all replies. I am remaining calm and optimistic.


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## Andros (Aug 26, 2009)

usmc4myson said:


> Hello everyone,
> I got a call from my dr this morning that they wanted me to make an appt to go over results of my ultrasound and recent bloodwork. First available? Tuesday. I asked them for a copy of reports...because there is no way I want to wait 5 days for my appt!
> 
> Let me also preface this by saying that I have VERY little respect for the radiology dept at our hospital. They seem to report the bare minimum...almost as if they scan the CT or ultrasound or xray as if they were scanning through an old magazine...and I wonder if their eyes are actually making synapses with their brain as they make their reports. My 15 yo son hurt his lower back acutely in wrestling this past Jan. He had xrays and then an MRI. They were "normal." Yeah. He can barely walk. We then took these results to an spine surgeon. Here are the words of her report. "I disagree with the reading from the radiologist and think that there is a change in marrow signal at the L5 pedicles. There is also no thin cuts, and most of the pars at the lower levels were not scanned."
> ...


Well, we never like to hear about a solid nodule so I advise you to insist on FNA. Given the report, you should not even have to ask.

Please let us know.

Antibodies are creeping up on you.


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## usmc4myson (Sep 26, 2010)

Thanks Andros.

Ya know, I just thought of something. For about the past year, I have been taking 2 guifenesin per day because whenever I swallowed, it felt like a lump of mucus in my throat! I never put two and two together, and I never told my doctor because I have seasonal and environmental allergies all year long, and subconsciously, I must have just attributed it to my allergies.
When I had the CT scan with the contrast dye on the 17th of Sept., it whacked out my thyroid big time, and the throat fullness got much more pronounced. Does this sound plausible? Looking back, I should have told my doctor about my "post nasal drip"...but hindsight is 20/20...


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## Hope57 (Sep 16, 2010)

Andros is spot on, you should have FNA. Im seeing thyroid/oncologist Monday as i have solitary papillary cancer on lower right pole of thyroid and spread to at least one clevical
lymph node.

My usual g,.p, was away and i saw a locum g.p. who ordered ultra sound on swollen lymph node and thyroid as i have hashimoto's. Swollen lymph was all that i noticed because throid nodule is low down the pole i can only feel it if i put my hand there, and swollow. When report came back as irregular lymph and nodule request FNA to rule out malignatcy, locum gp said, don't worry these things are usually nothing and don't rush to have FNA, i will get appointment with specialist in a few weeks for you and he can do FNA. That was not good enough for me, i waited 2 day's when my regular gp was back, who i have know for over 20yrs, he took one look at ultrasound report, rang hospital for FNA under unltrsound and the results were back in 24hrs. Papillary carcinoma with lymph gland spread, both measure 1.8cm.
Sometimes, i think we must follow our own intuition, and take control of our own health. Good luck, but do get it done.


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## Andros (Aug 26, 2009)

usmc4myson said:


> Thanks Andros.
> 
> Ya know, I just thought of something. For about the past year, I have been taking 2 guifenesin per day because whenever I swallowed, it felt like a lump of mucus in my throat! I never put two and two together, and I never told my doctor because I have seasonal and environmental allergies all year long, and subconsciously, I must have just attributed it to my allergies.
> When I had the CT scan with the contrast dye on the 17th of Sept., it whacked out my thyroid big time, and the throat fullness got much more pronounced. Does this sound plausible? Looking back, I should have told my doctor about my "post nasal drip"...but hindsight is 20/20...


Yes; if it was iodine which it may have been. Guifenisen is the only thing I can safely take if there is nothing else added. It is non-adrenergic. I can't take things like Nyquil. Very dangerous for me.

Everyone is different but read all labels before taking anything.


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## usmc4myson (Sep 26, 2010)

Hope, 
I will insist on FNA right away. However, they didn't even do an ultrasound of any of my lymph glands...so how do I know if there is any spread? Will I also need another ultrasound of the lymph glands on my clavicle and neck? My Dad's Hodgkins started first in his groin, and then to his armpit...so I want to make sure none of my lymph glands are swollen. My entire clavicle is very very tender to touch...especially right near the thyroid. I am also about 30 lbs overweight, so that makes things more difficult to palpate.

Andros,
I had no idea that there were certain medications to stay away from with Hashimotos. The reason I took the plain guifenesin was because of the feeling in my throat that I had, which may have been my thyroid enlarging instead of post nasal drip. I don't know, and I guess there's no point in trying to figure backwards now, is there? 
Yes, the contrast contained iodine. Supposedly, the prednisone kept me from having anaphylactic shock, but it didn't stop my thyroid from sucking up all that iodine and sending me in a tailspin...
I visit my dr on Tuesday. Do you think that there is still a need to do all the other bloodwork? I'd like to also check my calcitonin levels... and repeat the cbc and liver function tests.

Thanks for your support guys...it means a lot to me.


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## Andros (Aug 26, 2009)

usmc4myson said:


> Hope,
> I will insist on FNA right away. However, they didn't even do an ultrasound of any of my lymph glands...so how do I know if there is any spread? Will I also need another ultrasound of the lymph glands on my clavicle and neck? My Dad's Hodgkins started first in his groin, and then to his armpit...so I want to make sure none of my lymph glands are swollen. My entire clavicle is very very tender to touch...especially right near the thyroid. I am also about 30 lbs overweight, so that makes things more difficult to palpate.
> 
> Andros,
> ...


There is a need for that bloodwork. One of the main reasons is so that you rule in or rule out certain things and another reason is "if" you have any of these antibodies, you will have a "baseline" to monitor improvement or not.


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## usmc4myson (Sep 26, 2010)

Ok. Saw my doctor on Monday. He wanted me to get an appt with either an ENT or an Endo within two weeks. He will let them order any other tests. I was trying to do research to see where to go, and came across the Jefferson Thyroid Treatment Program. On Tuesday Oct. 12, I was able to get an appt to see a well known endocrinologist named Dr. Jeffrey Miller...and the neat thing about their program is that they take a team approach. They have pathologists, surgeons, and radiologists consulting together, so that there is not a gap of weeks in between testing and getting the results. 
I like the idea of that!!! 
The two surgeons I am considering (if it comes to that) are Drs. Pribitkin and Rosen. They both specialize in thyroid surgery.

I am FINALLY starting to feel a little bit better tho...and taking my Synthroid no longer causes palpitations and shakiness. I think the iodine is mostly out of my system from that dagnabit CT scan!!

We just picked up our Marine at the airport last night, and we are hosting a big party for him on Saturday, so I have been running on pure adrenaline the past couple of days...but it's all good!!! We are so thankful that he is home...in one piece. Many Moms can't say that...

Hope everyone is doing well...it's going to be a beautiful weekend in our area...

~Amy


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## Andros (Aug 26, 2009)

usmc4myson said:


> Ok. Saw my doctor on Monday. He wanted me to get an appt with either an ENT or an Endo within two weeks. He will let them order any other tests. I was trying to do research to see where to go, and came across the Jefferson Thyroid Treatment Program. On Tuesday Oct. 12, I was able to get an appt to see a well known endocrinologist named Dr. Jeffrey Miller...and the neat thing about their program is that they take a team approach. They have pathologists, surgeons, and radiologists consulting together, so that there is not a gap of weeks in between testing and getting the results.
> I like the idea of that!!!
> The two surgeons I am considering (if it comes to that) are Drs. Pribitkin and Rosen. They both specialize in thyroid surgery.
> 
> ...


This is very good news; that you have and appt. and that your son is home (for a visit?)

God bless you and your family!


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## usmc4myson (Sep 26, 2010)

Ok, it has been a couple of weeks, but I had a visit with the endo in Philly. He basically took 5 minutes to chat with me, and then ordered a FNA with a specific woman doctor, and wrote on the script to check suspicious lymph nodes as well.
That was the whole of it. However, he was able to call over to the ENT surgeon's office, and the ENT was able to see me less than an hour after I left the endo's office! The ENT numbed my throat and did a nasopharyngeal scope. This took all of five minutes. He said that my vocal cords are perfect, with no polyps. He also said that my esophagus was fairly swollen, and he diagnosed me with GERD. I had no idea! I never get heartburn! GERD is a silent disease in many cases, and dangerous if left untreated. He seemed to think that this explains the lump in my throat feeling, as well as my hoarseness. This could be in addition to the pressure that the solid thyroid nodule might be placing.

Can I say that I dislike strongly a little word called CAPITATION? The ENT ordered an upper GI Barium Xray. I stupidly thought that since *he *ordered it, I could have it done at Jefferson. I made an appt. Called my primary for a referral, and two days later, drove two hours in rush hour traffic to the radiology dept at Jefferson. Got there to find no referral in the system!! Called my primary's office. They said I could not have any radiology done anywhere but this certain local hospital, which I loathe. They have no idea why I wasn't called and told that they couldn't do the referral. I was a basket of tears. Needless to say, I am in the process of changing primary care doctors. What a pain...but now I will never have to subject myself to the dim witted radiology dept of our local hospital again. It's too bad too, because I really like my primary care docs. 
I think it is so stupid to go to a specialist for something, and not be able to get diagnostic testing done in the same hospital that the specialist is in! Who thought of that one????

My primary doc did order a redo of some of my labs, and I am waiting on the results.

FNA/ultrasound is scheduled for Nov. 15.

Need to wait till November 1st to possibly reschedule the Barium study. My new primary care doc doesn't seem to think that I even need the Barium study. I called her office to see how to get in as a new patient, and she answered the phone!! I spoke with her for about 20 minutes! How unusual is that??!! Anyway, she thinks that since I had the nasopharyngeal scope, and he saw swollen esophagus, that I should start the omeprazole and see if it helps before getting the barium study done. Does this sound right, or do I listen to the ENT specialist who ordered the test? I think that maybe she is the type of doc who is very very careful about the tests she orders. Is this a good thing?! I was a little surprised that she would so quickly dismiss the specialists orders. Any thoughts?

Thanks, and it is good to be back on the boards!


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## Andros (Aug 26, 2009)

usmc4myson said:


> Ok, it has been a couple of weeks, but I had a visit with the endo in Philly. He basically took 5 minutes to chat with me, and then ordered a FNA with a specific woman doctor, and wrote on the script to check suspicious lymph nodes as well.
> That was the whole of it. However, he was able to call over to the ENT surgeon's office, and the ENT was able to see me less than an hour after I left the endo's office! The ENT numbed my throat and did a nasopharyngeal scope. This took all of five minutes. He said that my vocal cords are perfect, with no polyps. He also said that my esophagus was fairly swollen, and he diagnosed me with GERD. I had no idea! I never get heartburn! GERD is a silent disease in many cases, and dangerous if left untreated. He seemed to think that this explains the lump in my throat feeling, as well as my hoarseness. This could be in addition to the pressure that the solid thyroid nodule might be placing.
> 
> Can I say that I dislike strongly a little word called CAPITATION? The ENT ordered an upper GI Barium Xray. I stupidly thought that since *he *ordered it, I could have it done at Jefferson. I made an appt. Called my primary for a referral, and two days later, drove two hours in rush hour traffic to the radiology dept at Jefferson. Got there to find no referral in the system!! Called my primary's office. They said I could not have any radiology done anywhere but this certain local hospital, which I loathe. They have no idea why I wasn't called and told that they couldn't do the referral. I was a basket of tears. Needless to say, I am in the process of changing primary care doctors. What a pain...but now I will never have to subject myself to the dim witted radiology dept of our local hospital again. It's too bad too, because I really like my primary care docs.
> ...


Good to hear from you and I know we will all be anxious for Nov. 15, 10 to get here!!

I actually think all of this is jumping the guns in every direction. My humble opinion is to get the FNA and take it one day at a time here.

How are you feeling?


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## Debbie from Milwaukee (Apr 18, 2010)

GERD is something I have been living with for almost 25 years (ever since my first daughter was born, sphinctor muscle went goofy from hormones or something). I have taken all of the meds up to omeprazole and continue to take 2 Prilozec a day. I was always seen by a GI, not an ENT doc. The docs have ordered 2 or 3 endoscopies over the years to check to see if I had any damage from times that some of the previous meds quit being effective. My esophogus is fine, and as long as I continue with 2 Prilosec a day (or mortgage my house and buy Nexium), it prevents any heartburn symptoms or damage.

I think the fact that this new primary doc took the time to speak with you is a very rare thing, and you might want to stay with her as long as you are comfortable and feel she is giving you good advice. My hunch is that this ENT doc is over-reacting with the swollen esophogus thing. I can tell you that after all of my years with GERD, I never was given a GI barium x-ray--only endoscopies. Also, there is no reason why you can't just start prilosec to try to relieve the swelling, then perhaps have a GI doc decide if you need any sort of test just to check your esophogus. On a side note, there is a way you can achieve the same effect of fighting GERD with something like apple vinegar (like using it as salad dressing) if you dislke the idea of taking prilosec.

Hope this helps. I also hope you are able to get to the bottom of what is wrong with your thyroid with the FNA.


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## usmc4myson (Sep 26, 2010)

Debbie and Andros,
Thanks for your help and encouragement. I think the reason the ENT ordered the Barium xray was to see my actual swallowing. I am still feeling like there is a big lump of oatmeal lodged at the base of my throat when I swallow. Some days it is worse than others, and on those days, my voice is affected as well. It is weird. I have a hunch that most of my issues are being caused by my thyroid--swelling for God knows why one day, and going back down the next. Sometimes I can feel and see the nodule, and other days it is less visible, but still palpable. 
I agree, Andros, that the one test I absolutely need to get done is the FNA. Everything else is secondary.
Taking it one day at a time...thank you so much.


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## Andros (Aug 26, 2009)

usmc4myson said:


> Debbie and Andros,
> Thanks for your help and encouragement. I think the reason the ENT ordered the Barium xray was to see my actual swallowing. I am still feeling like there is a big lump of oatmeal lodged at the base of my throat when I swallow. Some days it is worse than others, and on those days, my voice is affected as well. It is weird. I have a hunch that most of my issues are being caused by my thyroid--swelling for God knows why one day, and going back down the next. Sometimes I can feel and see the nodule, and other days it is less visible, but still palpable.
> I agree, Andros, that the one test I absolutely need to get done is the FNA. Everything else is secondary.
> Taking it one day at a time...thank you so much.


You are most welcome! And I am including a list of symptoms that will reinforce the idea of FNA, first and foremost.
Thyroid Cancer Symptoms

Often, thyroid cancer in its early stages does not exhibit symptoms. Many cases are found on routine examination as part of a physical. Your doctor may palpate, or feel, the area around the front of your neck, and may ask you to swallow some water as he or she is doing this. This allows for detection of any enlargement or mass in the thyroid.

The following represent symptoms typical of thyroid cancer.

■A lump in the front of the neck
■Hoarseness or voice changes
■Swollen lymph nodes in the neck
■Trouble swallowing or breathing
■Pain in the throat or neck that does not go away
■Persistent cough; coughing up blood

Patients with medullary thyroid cancer may also experience (in addition to the foregoing):

■Diarrhea
■Facial flushing/redness
These symptoms are due to increased levels of calcitonin common in this form of thyroid cancer

http://www.cityofhope.org/patient_care/treatments/thyroid-cancer/Pages/symptoms.aspx


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## mememe (Mar 18, 2010)

I had very similar symptoms to you with the "clogged" throat & post nasal drip with the allergies and sinuses. I went to my ENT and he diagnosed me, not with GERD, but with LPRD, they are similar but yet different. With treatment for the LPRD, I no longer have any "clogging" in my throat, although I still do have some post nasal drip, which I'm about to start some allergy meds to hopefully stop that. Anyway, you may want to look up LPRD and GERD both and compare the two.


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