# Would you remove it?



## beatsRN (Jan 10, 2013)

Looking to get a bit of insight in regards to proceeding with thyroidectomy or other testing/options.

Short History (I'll try):

31 year old female, diagnosed Hashimoto's (and hypo) December 2012, 8 months after the birth of my second child. At the time of diagnosis anti TPO was >13,000, TSH 14.0. Was placed on Synthroid for a period of 6 months, switched to NatureThroid per my request in May of this year. Have been doing well until approximately 2 months ago when I started having compression type symptoms (difficulty breathing especially while laying down, feeling as though something is caught in my throat, lowered voice, hoarseness x a few weeks). Saw my PCP who ordered follow up u/s.

Previously my u/s showed multinodular goiter with two sub-centimeter nodules. Follow up u/s was suggested in 6-12 months. Recent u/s (9 months after first), showed nodules were no longer present but 1.8 cm cyst was seen. PCP referred to ENT, who ordered FNA, but suggested symptoms were due to reflux not the cyst or enlarged thyroid.

During FNA, the "cyst" was discovered to actually be a lymph node. FNA results are as follows:

Diagnosis: Negative/benign, Abundant lymphocytes. No immunophenotypic evidence for non-Hodgkin lymphoma. Favor benign node.

Immunophenotypic analysis on the lymphoid gated population shows 93% of the lymphocytes are T-cells with normal CD4:CD8 ratio. 5% are polyclonal B-cells.

My questions really deal with if you'd just leave it at that, or request to pursue thyroidectomy/further testing. I'm quite aware that lymphocytes will be present in a Hashimoto's thyroid, I'm just unsure about the lymph node and what that means for the future. I've read that Hashimoto's increases the risk of non-Hodgkin's Lymphoma quite a bit. While I know it is quite rare, I'm not sure I'm willing to take that risk. That coupled with the compression symptoms (that I don't believe are caused by reflux...I'm not having typical symptoms that I had several years ago of reflux).

I have a follow up with my ENT tomorrow and want to be prepared to discuss fully. I'm am not opposed to a second opinion if it requires that.

Thanks for any insight you might be able to provide.


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## joplin1975 (Jul 21, 2011)

Well...

I'll say upfront that I'm heavily biased toward surgical removal -- it has improved my quality of life significantly.

And, secondly, compression issues are a very common and solid reason to get a TT. I keep hearing about people having the kinds of symptoms you mention and it's blown off as reflux.

Mostly, I'm curious if your antibodies dropped at all? I've never heard of a number that high. Have you had any other antibody test? If that TPO number was accurate, I have a feeling it will be very difficult to stabilize on medication and surgical removal might be the quickest & easiest way to euthyroid.


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## beatsRN (Jan 10, 2013)

joplin1975 said:


> Mostly, I'm curious if your antibodies dropped at all? I've never heard of a number that high. Have you had any other antibody test? If that TPO number was accurate, I have a feeling it will be very difficult to stabilize on medication and surgical removal might be the quickest & easiest way to euthyroid.


Antibodies were rechecked in July 2013 I believe (original December 2012) and they had dropped significantly. Though still quite elevated at 1200 something. They were checked approximately 8 weeks after starting NatureThroid and starting a gluten free diet.

I had a terrible time feeling well, as well as getting euthyroid while on Synthroid. I have felt much better since the switch and have been stable with labs and symptoms since August. While on Synthroid I was fluctuating wildly.


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## Andros (Aug 26, 2009)

beatsRN said:


> Looking to get a bit of insight in regards to proceeding with thyroidectomy or other testing/options.
> 
> Short History (I'll try):
> 
> ...


With your TPO at 13,000; you may be very wise to have surgical removal (ablation) as this suggests cancer amongst other things.

TPO Ab
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 thyroiditis and Graves disease.
http://labtestsonline.org/understanding/analytes/thyroid-antibodies/tab/test

Substances not found in normal serum (scroll down to autoantibodies)
http://www.thyroidmanager.org/chapter/evaluation-of-thyroid-function-in-health-and-disease/

Of course the above is only one person's opinion. No medical background here.


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