# Any thoughts on my last sonogram?



## chopper (Mar 4, 2007)

Just curious if anyone's got any input regarding my latest ultrasound:

ACC: 12122931 US THYROID/PARATHYROID/NECK
PROCEDURE: Thyroid ultrasound.

INDICATION: Follow-up thyroiditis.

COMPARISON: Thyroid ultrasound report dated 11/23/04. Images from that study are not available,

FINDINGS: The isthmus is enlarged measuring 0.8 cm. The right thyroid lobe measures 5.0 x 1.6 x 2.0 cm and the left lobe 4.6 x 1.7 x 2.2 cm.

There is diffuse heterogeneity of the thyroid gland. Measurements are not significantly different when compared to those given on 03/12/04 report.

The color flow is slightly prominent throughout. Nonetheless, there is not typical hyperemia as expected with thyroiditis.

IMPRESSION: Heterogeneous enlarged thyroid gland without discrete lesion.


----------



## Andros (Aug 26, 2009)

nasdaqphil said:


> Just curious if anyone's got any input regarding my latest ultrasound:
> 
> ACC: 12122931 US THYROID/PARATHYROID/NECK
> PROCEDURE: Thyroid ultrasound.
> ...


Well, thank goodness there are no discrete lesions. That is wonderful news.

This may apply........

It has been said that Hashimoto thyroiditis and Graves' disease are the same autoimmune thyroid disease but at different ends of the spectrum. Transition between the two autoimmune thyroid diseases may occur, which adds to the difficulty in differentiating between the two (1). The ultrasonographic appearance of both Graves' disease and Hashimoto thyroiditis are similar as well, with both having a hypoechoic and heterogeneous echotexture. While Graves' disease typically shows marked hypervascularity with power Doppler analysis, the vascularity of Hashimoto thyroiditis is variable, ranging from avascular to hypervascular.

http://www.springerlink.com/content/t1j57j1p0k617773/

Also, the gland does not appear to be vascular/engorged (hyperemia) which is more good news. So, that makes one wonder because the Heterogeneous echotexture is "typical" with Hashimoto's Thyroiditis as is Hyperemia. But you don't have hyperemia. Nor would you want it but that makes this your not so typical case.

You just have a very ill behaved nasty thyroid which is making life miserable by all counts but thank God there is nothing there to be alarmed about.

Did the doctor comment on the ultrasound results yet? If so, I sure would be interested if you care to share.


----------



## chopper (Mar 4, 2007)

No, the doctor did not say much about the sono.

What do you think about these numbers below? I put all of my labs from 2003 through today into an Excel spreadsheet so I can sort and sift and keep accurate records.

Keep in mind I have never been on meds. At the end of each column I totalled it and then took an average. Note my Free T3 and Total T3 have been out of range HIGH several times in the past but that was closer towards 2003 when I felt really hyper. Any thoughts?

Test My Score Range
Ferritin, Serum 390 22 - 322
Ferritin, Serum 412 20 - 345
Ferritin, Serum 370 10 - 292
Cortisol 16.3 4.3 - 22.4
Cortisol 13.3 3.1 - 16.7
Cortisol 22.6 3.1 - 22.4
Cortisol 21.2 4.3 - 22.4
Cortisol 21.2 3.1 - 22.4
Cortisol 19.8 3.1 - 22.4
Cortisol 24-Hour 42 0 - 50
Cortisol 24-Hour 72 0 - 50
Cortisol 24-Hour 20 0 - 50
Prolactin 18.8 2.1 - 17.7
Prolactin 9.1 2.1 - 17.7
Prolactin 18.3 2.1 - 17.7
Prolactin 18.8 2.1 - 17.7
Prolactin 23.5 2.1 - 17.7
Prolactin 10.8 2.1 - 17.7 
How would you like to have these labs for the last 7 years? :sick0020:


----------



## chopper (Mar 4, 2007)

Here's some more...FT3, FT4, TSH

Test Score Range
Free T3 2.6 (2.3 - 4.2)
Free T3 2.9 (2.3 - 4.2)
Free T3 3.2 (2.3 - 4.2)
Free T3 3 (2.3 - 4.2)
Free T3 3.02 (2.3 - 4.2)
Free T3 3.41 (2.3 - 4.2)
Free T3 3.59 (2.3 - 4.2)
Free T3 4.51 (2.3 - 4.2)
Free T3 3.8 (2.3 - 4.2)
Free T3 3.66 (2.3 - 4.2)
Free T3 3.43 (2.3 - 4.2)
Free T3 3.87 (2.3 - 4.2)
Free T3 3.43 (2.3 - 4.2)
Free T3 3.94 (2.3 - 4.2)
Free T3 3.56 (2.3 - 4.2)

*Avg. 3.461 (2.3 - 4.2)*

**********************************
Test Score Range
Free T4 0.65 (0.8 - 1.8)
Free T4 0.76 (0.8 - 1.8)
Free T4 1.02 (0.8 - 1.8)
Free T4 0.92 (0.8 - 1.8)
Free T4 0.8 (0.8 - 1.8)
Free T4 0.82 (0.8 - 1.8)
Free T4 0.7 (0.8 - 1.8)
Free T4 0.9 (0.8 - 1.8)
Free T4 0.9 (0.8 - 1.8)
Free T4 1.2 (0.8 - 1.8)
Free T4 1 (0.8 - 1.8)
Free T4 0.9 (0.8 - 1.8)
Free T4 0.9 (0.8 - 1.8)
Free T4 1.1 (0.8 - 1.8)
Free T4 0.9 (0.8 - 1.8)

*Avg. 0.898 (0.8 - 1.8)*

***********************************

Test Score Range
Total T3 1.42 (0.70 - 1.79)
Total T3 1.3 (0.70 - 1.79)
Total T3 1.84 (0.70 - 1.79)
Total T3 1.92 (0.70 - 1.79)
Total T3 1.96 (0.70 - 1.79)
Total T3 1.31 (0.70 - 1.79)
Total T3 1.8 (0.70 - 1.79)
Total T3 1.41 (0.70 - 1.79)
Total T3 1.72 (0.70 - 1.79)

*Avg. 1.631 (0.70 - 1.79)*

***********************************

Test Score Range
Total T4 6 (4.5 - 12.0)
Total T4 5.4 (4.5 - 12.0)
Total T4 7.4 (4.5 - 12.0)
Total T4 9 (4.5 - 12.0)
Total T4 9.8 (4.5 - 12.0)
Total T4 6.9 (4.5 - 12.0)
Total T4 6.8 (4.5 - 12.0)
Total T4 8.5 (4.5 - 12.0)
Total T4 5.3 (4.5 - 12.0)
Total T4 7.4 (4.5 - 12.0)

*Avg. 7.25 (4.5 - 12.0)*

******************************

Test Score Range
TSH 14.07 (0.45 - 4.5)
TSH 9.17 (0.45 - 4.5)
TSH 7.463 (0.45 - 4.5)
TSH 10.945 (0.45 - 4.5)
TSH 17.084 (0.45 - 4.5)
TSH 19.561 (0.45 - 4.5)
TSH 14.202 (0.45 - 4.5)
TSH 6.197 (0.45 - 4.5)
TSH 15.352 (0.45 - 4.5)
TSH 6.89 (0.45 - 4.5)
TSH 14.64 (0.45 - 4.5)
TSH 13.206 (0.45 - 4.5)
TSH 9.84 (0.45 - 4.5)
TSH 8.86 (0.45 - 4.5)
TSH 9.119 (0.45 - 4.5)
TSH 8.15 (0.45 - 4.5)
TSH 14.659 (0.45 - 4.5)
TSH 15.233 (0.45 - 4.5)
TSH 7.729 (0.45 - 4.5)
TSH 9.008 (0.45 - 4.5)
TSH 8.38 (0.45 - 4.5)
TSH 9.84 (0.45 - 4.5)

*Avg. 11.345 (0.45 - 4.5)*

**********************************
*...and then of course we have all those lovely antibodies....I think I broke the machine for TPO at greater than 2700!*

Thyroglobulin Antibody 75 (00 - 74)
Thyroglobulin Antibody 82 (00 - 74)
Thyroglobulin Antibody 326 (00 - 74)
Thyroglobulin Antibody 943 (00 - 74)
Thyroglobulin Antibody 1244 (00 - 74)
Thyroglobulin Antibody 768 (00 - 74)

Thyroid Peroxidase Antibody >1000 (00 - 39)
Thyroid Peroxidase Antibody 1014 (00 - 39)
Thyroid Peroxidase Antibody 1605 (00 - 39)
Thyroid Peroxidase Antibody >2,700 (00 - 39)
Thyroid Peroxidase Antibody 2,064 (00 - 39)

Thyroid Stimulating Immunoglobulin (TSI) 179 (less than 125)
Thyroid Stimulating Immunoglobulin (TSI) 130 (less than 125)
Thyroid Stimulating Immunoglobulin (TSI) 170 (less than 125)
Thyrotropin Binding Inhibitory Immunoglob. (TBII) 9.9 <= 16%
Thyroxine Binding Globulin (TBG) 25 13 - 39

Keep in mind this is like 7 years of labs I had saved on my computer...


----------



## Andros (Aug 26, 2009)

nasdaqphil said:


> No, the doctor did not say much about the sono.
> 
> What do you think about these numbers below? I put all of my labs from 2003 through today into an Excel spreadsheet so I can sort and sift and keep accurate records.
> 
> ...


I certainly find it interesting that your ferritin is consistantly above the range. Have you ever been tested for hemochromatosis?

You sure can see a pattern w/ the 24 hour cortisol tests. Cortisol levels may also increase as a result of hyperthyroidism and conversely, they decrease w/ hypothyroidism. You do sort of flit back and forth between hyper and hypo, is this not correct?

Now the prolactin blows me out of the water! Oh, my goodness. Well, what "is" going on there? I presume you take no meds that could cause this such as hypertension med or Tricyclic anti-d's???

Have you had an MRI of the pituitary? 
And your doc says what about the prolactin?

If one is hypothyroid, it is not unusual to see increased levels of prolactin so that must be considered as well.

And to answer your question, no.....................I would not like to have labs like yours and I sincerely wish I could help pinpoint the medical issue which seems to be a bit more than just thyroid.

As we both know though, all this forms a cascade effect. If one system goes kaplooey, sometimes the others follow suit. It is often very hard to figure out which came first, the cart or the horse.


----------



## chopper (Mar 4, 2007)

I don't even take aspirin. No meds whatsoever. Now you can see why I haven't been "fixed". High prolactin, high TSH, lower FT4 indicate hypo. TSI, high Cortisol, nervousness, heat intolerance indicate hyper.

This has been my 7 year battle. Do I take the Synthroid and risk a really bad hyper episode or do I continue toggling back and forth while feeling like crud all the time?

By the way, I "look" classic hypo - puffy, dry skin, way overweight. My labs seem contradict each other in every way. High Total T3 and High TSH with High Ferritin but normal Iron loads. None of it makes sense.

High prolactin is pretty common with hypo alongside my really low testosterone. I had a non-contrast pit MRI and from what they could see, it was unremarkable. I should go for one with contrast though.

I should note, Im a 39 year old man and my mother had thyroidectomy for nodules/hashi's but she never let it progress before undergoing surgery and more recently - just 3 weeks ago, my mother's brother (my first uncle) was diagnosed with classic Graves' hyper. I've been telling my mother for about 5 years he had Graves but no one listened to me. He had TED and everything.

Now, if you were me, would you just pop some Synthroid and see what happens? I have the script and the pills but have been nervous about taking them since the last time I tried about 4 years ago they made me very nervous feeling.


----------



## Andros (Aug 26, 2009)

nasdaqphil said:


> Here's some more...FT3, FT4, TSH
> 
> Test Score Range
> Free T3 2.6 (2.3 - 4.2)
> ...


You have some very scary FT4's and T4's going on. Very very low at various times.

And the TSH; oh my gosh! You have never been in normal range; not one time if I am viewing correctly. (going slightly cross-eyed here)

TBII, thyroid binding inhibitory immunoglobulin is often seen in Graves' Disease. Do you have any clinical signs of Graves' Disease such as your eyes, goiter, pretibial myxedema?

It is awesome what you have done with your Excel Sheet. Very very impressive and there are patterns. I am going to review these stats again tomorrow when my eyes aren't falling out of my head.

You have done a lot of hard work keeping track of your labs like this.


----------



## Andros (Aug 26, 2009)

nasdaqphil said:


> I don't even take aspirin. No meds whatsoever. Now you can see why I haven't been "fixed". High prolactin, high TSH, lower FT4 indicate hypo. TSI, high Cortisol, nervousness, heat intolerance indicate hyper.
> 
> This has been my 7 year battle. Do I take the Synthroid and risk a really bad hyper episode or do I continue toggling back and forth while feeling like crud all the time?
> 
> ...


If I were in your shoes and boy, you have some hard footsteps to follow, let me tell you...............

I would have my thyroid either nuked or ablated. There would be no question in my mind about that. You have suffered enough.

Or, you could try "Block and Replace" but finding a doctor to understand how to do this could be a giant problem.

And, quite frankly, I still would opt for yanking it out one way or the other. You need to recapture quality of life. This is my most humble opinion.

Will talk more...............; going off-line now.


----------



## chopper (Mar 4, 2007)

Ultimately I think ablation or surgery is the only way to be fixed. But even with that, there are questions. Why was and is my TSH so high given my high and high normal Total and Free T3? Do I nuke my thyroid only to find out after more hell that I've got a tiny tumor in my head causing all this trouble and am ultimately not fixed at all? Is there another problem entirely?

Taking Synthroid is the easiest of choices. If I am truly hypo then it will help. My personal feeling is that my resilient thyroid is finally starting to die off. Panic attacks used to consume me about 6 years ago when I first started having trouble. I was always "jumpy" feeling. Lately, I've seen my numbers come down pretty consistently with lower lows and higher highs but my TSH is still all over the place.

You don't think I should risk the Synthroid? I think I need to just check into the Mayo Clinic for a month a have them fix whatever's wrong. I wouldn't be surprised if it was Cushing's with a mix of Hashi's after all this time.

I'll also note when what ever this is "turns on" I can literally feel it going on and off and my left eye will droop - just my left. Myastenia Gravis was also considered but again, conflicting tests. This Saturday I had a break. I told my wife how great it felt to feel good. The change is completely noticable. My lungs felt like they opened wide. I was awake, alert and not spacey feeling. I was able to do some things around the house without my heart ripping out of my chest like it normally does. It's like the difference between night and day, really. Like someone's got a switch inside and they're playing around with the lights. 7 years of this - my best years. Doing nothing has not worked. I need to make a plan and follow it through even if it requires a lot of trouble in between. I'm just not sure which path is the best path to take.


----------



## Andros (Aug 26, 2009)

nasdaqphil said:


> Ultimately I think ablation or surgery is the only way to be fixed. But even with that, there are questions. Why was and is my TSH so high given my high and high normal Total and Free T3? Do I nuke my thyroid only to find out after more hell that I've got a tiny tumor in my head causing all this trouble and am ultimately not fixed at all? Is there another problem entirely?
> 
> Taking Synthroid is the easiest of choices. If I am truly hypo then it will help. My personal feeling is that my resilient thyroid is finally starting to die off. Panic attacks used to consume me about 6 years ago when I first started having trouble. I was always "jumpy" feeling. Lately, I've seen my numbers come down pretty consistently with lower lows and higher highs but my TSH is still all over the place.
> 
> ...


If your thyroid was consistantly hypo, I certainly would agree that taking thyroxine would be the obvious choice but you even pointed out to another poster that w/ fluctuating thyroid, it is impossible to titrate the thyroxine and how right you are about that.

And, I certainly understand the dilemma re the pituitary possibly being the culprit here. You would want to rule that out before you go zapping anything. I totally agree w/ that.

Doing nothing does not work; how very true. Sad, but true.

On the flip side; I am thrilled you had one good day and I know your wife was as well. We wish for more of those.

Pseudo myasthenia gravis is common with hyperthyroid. I had that. There are no antibodies present for myasthenia gravis; it is just secondary to the primary diagnosis.


----------



## Andros (Aug 26, 2009)

nasdaqphil said:


> Here's some more...FT3, FT4, TSH
> 
> Test Score Range
> Free T3 2.6 (2.3 - 4.2)
> ...


Do you see the period where your cortisol was high and also when your T3 was high? Do you think that was in the same time period? It made me curious about rT3 so I looked it up....

Under stress conditions, the adrenal glands produce excess amounts of cortisol. Cortisol inhibits the conversion of T4 to T3, thus shunting T4 conversion from T3 towards rT3. Consequently, there is a widespread shutdown in T3 binding across the body. This condition is termed Reverse T3 Dominance.

http://en.wikipedia.org/wiki/Reverse_triiodothyronine

Did you ever have a rT3 test?


----------



## chopper (Mar 4, 2007)

Cortisol does not seem to be related to my T3. Cortisol is always high even though my T3 has come down quite a bit lately.

I found this on the internet to be very interesting, further solidifying my case for Graves:

"...body of *thy­roid patients have been sur­pri­sed to dis­co­ver that being hypothy­roid also results in having low Ferri­tin*, or sto­rage iron. Ferri­tin is an iron-storage pro­tein which keeps the iron in a dis­sol­va­ble state and also makes the iron non-toxic to cells around it. So when Ferri­tin is mea­su­red via a blood test, it is basi­cally mea­su­ring your sto­rage iron, or the iron you have tuc­ked away for future use. You can have "nor­mal" iron serum levels, yet a low Ferritin. 
*Why do we often have low Ferri­tin?* *Because being hypothy­roid can result in a lowe­red pro­duc­tion of hydroch­lo­ric acid which in turn leads to the malab­sorp­tion of iron. It can also lower your body tem­pe­ra­ture (com­mon for those on thy­ro­xine, as well) which cau­ses you to make less red blood cells.* Addi­tio­nally, being hypo can result in hea­vier periods, which cau­ses more iron loss.
In turn, having low iron levels dec­rea­ses deio­di­nase acti­vity, i.e. it slows down the con­ver­sion of T4 to T3
*Why is having low Ferri­tin a pro­blem?* First, though the slide into low Ferri­tin can be symp­tom­less, it even­tually beco­mes the pre­cur­sor to being ane­mic. And once the lat­ter occurs, you can then have symp­toms which mimic hypothy­roid - depres­sion, achi­ness, easy fati­gue, weak­ness, fas­ter hear­trate, pal­pi­ta­tions, loss of sex drive, and/or foggy thin­king, etc...."

*"...Elevated ferritin levels have been recently observed in patients with hyperthyroidism* [2, 3], but levels decreased after thyroid function returned to normal

The reported increase in ferritin during hyperthyroidism has been described [2] and has been attributed to the stimulatory effect of thyroid-stimulating hormone and thyroid hormone on ferritin synthesis and release [4]. Although this may explain the huge elevation in the ferritin level, it does not explain the elevation in serum iron and serum iron-binding capacity.

Usually, elevated ferritin levels are unaccompanied by modifications in serum and tissue iron (for example, as in malignancies or inflammatory disease). We hypothesize the synthesis of a ferritin rich in L24 subunits and heavily glycosylated, thus carrying low amounts of iron...."

Now to make my case, I am a complete contradiction to the statement above:

1. My ferritin is always almost dangerously high - over the range by nearly 50% - tested 4 times, years apart. 
2. My body temp is always high, not low, typically 99.2. 
3. I have more red blood cells than less. My red blood cell count is always at the top of the range, and sometimes above the high end of the range.

This drives me NUTS. Im a complete contradiction. My TSH is high and my T4 low and Im fat. you would think clear cut Hypo. Then my TSI is High as well as my Ferritin, cortisol and ACTH and Im nervous and hot all the time. You would think clear cut Graves. I am literally split straight down the middle of having both hyper and hypo symptoms like two opposite people poured into one very overworked body.


----------



## Andros (Aug 26, 2009)

nasdaqphil said:


> Cortisol does not seem to be related to my T3. Cortisol is always high even though my T3 has come down quite a bit lately.
> 
> I found this on the internet to be very interesting, further solidifying my case for Graves:
> 
> ...


That is a wonderful find about ferritin.

And so right you are. I am big on pushing the ferritin issue w/ those who are hypo and even hyper because circumstances and the way our bodies react do vary from individual to individual.

Have you ruled out the possibility of hemochromatosis as per a previous post's discussion?

And, once again............there are antibodies/autoantibodies that cause rT3. So, you may wish to have an rT3 (reverse T3) run one day when you are in the mood.

Not all symptoms hold true when it comes to hypo vs hyper I have come to realize over the years. I prefer to refer to "Symptoms" lists as only guidelines.

You can flit back and forth for years and years (7 years for you, yes?) and never really get a clear cut diagnosis.

Are you nearer to making a decision about what course to follow? What is your wife's input since she knows you best? What is your doctor suggesting?


----------



## Andros (Aug 26, 2009)

nasdaqphil said:


> Just curious if anyone's got any input regarding my latest ultrasound:
> 
> ACC: 12122931 US THYROID/PARATHYROID/NECK
> PROCEDURE: Thyroid ultrasound.
> ...


Would you please read this? http://www.irondisorders.org/Disorders/toomuchiron.asp


----------



## chopper (Mar 4, 2007)

Hi,

The doctors sort of dismissed iron overload due to the fact that my iron was perfect in range and my Total Iron Binding Capacity (TIBC) was also well within range. Im told ferriritn is not the end-all be-all of iron overload. TIBC is supposedley just as important and mine was perfectly normal. With iron overload, I am told, you will see Ferritin levels in the 1200 range, not 300's typically. But again, a man of contradictions. I do have many symptoms associated with iron overload.

Do you happen to have and know how to use Excel? If you would like to take a look at my comprehensive lab excel file, I would be happy to show it to you if you private message me your email address. Perhaps a fresh set of eyes might find something striking. I've been over them a thousand times along with doctors and no one seems to know what's best.

My current endo really wants me to at least give the Synthroid a try but again, Im really nervous about taking it if I am in fact hyper and she wasn't exactly optimistic that Synthroid would be my answer. She essentially wanted me to try it and see what happens. I prefer to know I am taking the proper meds for my condition however, instead of experimenting like some sort of lab rat.


----------



## Andros (Aug 26, 2009)

nasdaqphil said:


> Hi,
> 
> The doctors sort of dismissed iron overload due to the fact that my iron was perfect in range and my Total Iron Binding Capacity (TIBC) was also well within range. Im told ferriritn is not the end-all be-all of iron overload. TIBC is supposedley just as important and mine was perfectly normal. With iron overload, I am told, you will see Ferritin levels in the 1200 range, not 300's typically. But again, a man of contradictions. I do have many symptoms associated with iron overload.
> 
> ...


You sure are keeping me on my toes here.:anim_63:

In iron overload states such as hemochromatosis, iron will be high and TIBC will be low or normal, causing the transferrin saturation to increase.

Reference for the above.........
http://www.labtestsonline.org/understanding/analytes/tibc/test.html

And, I would like to add that yes; you could see ferritin in the thousands if the patient consumes a "lot" of iron loaded foods and uses cast iron cookware. That would increase the asorption percentage and rate.

Anyway, sadly I know nothing about the Excel software except for the fact that it is widely used and an excellent software program; especially if you like charts. I don't have that software so I probably could not open it.

No...............being a lab rat is not good. It's too bad the doctor has such little confidence for that does not impart much confidence to you.


----------

