# i am here for my 17 year-old daughter



## Penni4Molly (May 16, 2011)

hi, y'all --

just got back from endo's - i have hypothyroid and have been treated for a few years w/synthroid. my daughter, however, is hyperthyroid and we just got back her labs and ultrasound results. i need a bit of guidance as her doctor didn't feel further testing on her thyroid was necessary after reading her ultrasound report, but i am feeling like she may? any advice will be taken with a grain of salt and yes, i will re-consult with her physician if i feel led to.

ok, her lab results

Free T3 -- 18.8 HI Ref Range 2.0-4.4 pg/mL
Thyroxine, Free -- 4.94 HI 0.93-1.70 ng/dL
TSH 3rd Generation -- 0.005 LO 0.470-5.010 mIU/mL
TSI -- 440 HI 0-139 *1
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her Ultrasound, i will type out verbatim:

Indication: Hyperthyroidism

Technical Factors: Sonogram of the thyroid glad was performed.

Findings: The right thyroid lobe measures 4.9 x 1.7 x 1.7 cm. The left thyroid lobe measures 5.2 x 1.5 x 1.75. The thyroid isthmus measures 0.6 cm in maximal anterior and posterior dimensions.

The thyroid gland is heterogeneous in echotexture and diffusely increased in vasculatrity upon Doppler interrogation. There is a solitary hypoechoic nodule within the superior pole of the right thyroid lobe, which does not demonstrate internal flow upon Doppler interrogation measuring 7 x 5 x 5 mm. The nodule does appear to contain punctuate internal microcalcifications, a suspicious feature.

Impression:

Heterogenous, hypervascular thyroid gland suggesting underlying thyroiditis. A solitary 7 mm hypoechoic nodule within the superior pole of the right thyroid lob for which tissue sampling is advised to exclude the possibility of thyroid neoplasia.

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ok, now i have to run out for a meeting, but would appreciate knowing whether the seasoned folks in this room would call the doctor back in light of the ultrasound findings and say anything, like why are we not doing a FNA?

i don't want to be an alarmist, but i am her advocate. i want to do right by her.

thanks for your help.

penni


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## Andros (Aug 26, 2009)

Penni4Molly said:


> hi, y'all --
> 
> just got back from endo's - i have hypothyroid and have been treated for a few years w/synthroid. my daughter, however, is hyperthyroid and we just got back her labs and ultrasound results. i need a bit of guidance as her doctor didn't feel further testing on her thyroid was necessary after reading her ultrasound report, but i am feeling like she may? any advice will be taken with a grain of salt and yes, i will re-consult with her physician if i feel led to.
> 
> ...


Hi penni and welcome. Oh, sugars!! I hate this for your youngster.

Here is the deal. #1., the radiologist recommends FNA (fine needle aspiration) and I do also.

#2. I personally think that that should be done plus RAIU (radioactive uptake scan)as sonograms do have their limitations.

The key words in the report are vascularity,heterogeneous, solitary nodule and microcalcifications. All of these suggest cancer needs to be a consideration by way of further testing.

Also, Hyper/Graves' are prone to cancer.
http://www.thyroidmanager.org/Chapter18/18-cancothr.htm

If it were me,I would get right on top of this. I wonder if your daughter has swollen lymph nodes in the clavicle/neck area?

Here is a symptoms check list which you may find handy.

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

Your daughter's TSI "is" high; as you know, the healthy person should have no TSI.

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://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

Did the doctor run Thyroglobulin Ab?

Thyroglobulin Ab http://www.nlm.nih.gov/medlineplus/ency/article/003557.htm

Will be keeping you and your daughter in my prayers and please get back to us on this.


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## lainey (Aug 26, 2010)

Keep in mind that the preferred minimum size for a FNA of a nodule is greater than 10mm (1 cm) as when the nodule is smaller than that, the chances of getting an indeterminate or inadequate sample is very high. Such results would leave you not much further ahead than you are now--watch and wait on the nodule likely first, with surgery also a possibility.

Your daughter is very hyperthyroid. You don't mention a medication schedule, however. If it were me, bringing her levels under control would be the priority at this point.


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## Penni4Molly (May 16, 2011)

oh, sorry -- she was put on 50mg of PTU - 5 tabs, bid. she goes back for bloodwork in about 6 weeks and has a follow-up visit on July 13th (same day as her mama).

she has been so sick for so long -- what spurs something like this? we both started attending weight watchers in march of this year and her weight was falling off at a rapid clip (she's now down 26 or 29 pounds, i've lost count). also, she had spinal fusion surgery with post-surgicial infection 2 years ago, so she's been through it, i'm not gonna lie. i don't want to put her through anything else if i don't have to.

penni


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## Andros (Aug 26, 2009)

Penni4Molly said:


> oh, sorry -- she was put on 50mg of PTU - 5 tabs, bid. she goes back for bloodwork in about 6 weeks and has a follow-up visit on July 13th (same day as her mama).
> 
> she has been so sick for so long -- what spurs something like this? we both started attending weight watchers in march of this year and her weight was falling off at a rapid clip (she's now down 26 or 29 pounds, i've lost count). also, she had spinal fusion surgery with post-surgicial infection 2 years ago, so she's been through it, i'm not gonna lie. i don't want to put her through anything else if i don't have to.
> 
> penni


I hear ya',Momma penni! Poor child. However, to know is better so something can be done. If your daughter is on PTU,they can't do the RAIU while she is on it but I am glad.

Wonder if she should be on a betablocker as well? Please ask the doctor; a lot of us have permanent heart damage from not receiving the proper medical diagnosis and intervention.

Sadly, any trauma can trigger what is already lying dormant. The surgery could have been the clincher w/the subsequent infection.


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## lainey (Aug 26, 2010)

I'm glad to hear she is on meds. Hopefully she will be feeling better soon.

Re: the ultrasound--because the nodule is solitary and "suspicious" I wouldn't leave go without followup--while the FNA is your choice to ask for, the likely recommendation would be repeat ultrasound in 6 months (your doctor may even say a year). I might be inclined to do it sooner--say 3 months--it's painless, and you can monitor the nodule for changes.

The usual course is to take antithyroid medication for a period of 12-18 months and then wean off to see if the thyroid goes into remission. Each person's response to medications is different, so be prepared for the idea that this problem may not be solved quickly. There are several directions it can take, so my advice would be to research, read other people's experience on the forums, and learn as much as you can about the outcomes. I only say this in caution, because your daughter has been through so much so recently, and she likely wants to feel well soon.


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