# Latest Uptake/Scan Lab Results



## carreg (Aug 10, 2011)

I was diagnosed with Hashitoxicosis last summer. Believe me, it has been a roller coaster experience cycling between hypo and hyper symptoms. Currently, I feel like I am cycling toward hypo. My endocrinologist recently ordered another thyroid uptake and scan with the following results listed under Impression. The scan I had done last summer was normal (homogeneous) with no mention of nodules and only elevated uptake at 4 hours. The current scan seems to indicate a nodule was actually present last year.

Any thoughts on what the results indicate would be very helpful. Thanks!!

Normal values at 4 hours: 6 - 18%
Normal values at 24 hours: 10 - 35%

Impression: Uptake/Scan done June 5th & 6th
"The 4 hour uptake is 14.2% which is at the upper limits of normal. Previously the 4 hour uptake was elevated at 20.1%. The 24-hour uptake value is elevated at 49.6% (upper normal is 35%). Previously the 24-hour uptake was 31.5%. There is heterogeneous tracer uptake on the thyroid images with a small cold nodule suggested in the lower pole of the left thyroid more prominent than seen previously. There was a minimal "cold" focus on the previous nuclear medicine scan also this appears much more prominent and convincing on the current study. Consider ultrasound evaluation as there is a small risk of neoplasm for cold nodules."

Latest Labs done 05/26/2012:

TSH: 0.59 (normal values 0.40 - 4.50)
T4, Free: 1.0 (normal values 0.8 - 1.8)
Thyroid Peroxidase AB: 549 (normal values less than 35)
TSI: 96% (baseline less than 140)


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## joplin1975 (Jul 21, 2011)

I would schedule a FNA of that nodule ASAP, assuming it is large enough. Cold is highly suspicious for cancer.


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## carreg (Aug 10, 2011)

Thanks Joplin1975,
I have a call into the endocrinologist. I have noticed some changes in the last several months; hoarseness, slight swelling of the left side of my neck, and a cough that comes and goes especially at night. 
I am a little upset that the nodule was apparently detected last year but no mention of it was on the report sent to the endo last year. . . .
Thanks again and I will post updates.


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## Andros (Aug 26, 2009)

carreg said:


> I was diagnosed with Hashitoxicosis last summer. Believe me, it has been a roller coaster experience cycling between hypo and hyper symptoms. Currently, I feel like I am cycling toward hypo. My endocrinologist recently ordered another thyroid uptake and scan with the following results listed under Impression. The scan I had done last summer was normal (homogeneous) with no mention of nodules and only elevated uptake at 4 hours. The current scan seems to indicate a nodule was actually present last year.
> 
> Any thoughts on what the results indicate would be very helpful. Thanks!!
> 
> ...


Cold suggests that cancer is present. Are you scheduled for an FNA?

Your TSI is very high; too bad they did not run the FREE T3. Also, Thyroglobulin and Thyroglobulin Ab would be a good idea.

I believe you are hyper; symptoms can and do cross over.

Follow up on that nodule.

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

Thyroid cancer in patients with hyperthyroidism.
http://www.ncbi.nlm.nih.gov/pubmed/12876418

If nothing else, you need a baseline on the Thyroglobulin and Thyroglobulin Ab.

cancer TPO and thyroglobulin
http://onlinelibrary.wiley.com/doi/10.1111/j.1699-0463.1994.tb04888.x/abstract
http://www.wikigenes.org/e/gene/e/7173.html

Understanding Thyroglobulin Ab.
http://www.labtestsonline.org/understanding/analytes/thyroglobulin/test.html

Thyroglobulin Ab and cancer
http://qjmed.oxfordjournals.org/content/59/2/429.full.pdf


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## carreg (Aug 10, 2011)

Andros,
I am waiting on the endo to call me to set up an ultrasound/FNA. Is there any other test you think I should request? Thanks so much for the information. This forum has been so helpful!!


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## webster2 (May 19, 2011)

I agree! I hope they'll get you in soon!  Best wishes to you!


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## Andros (Aug 26, 2009)

carreg said:


> Andros,
> I am waiting on the endo to call me to set up an ultrasound/FNA. Is there any other test you think I should request? Thanks so much for the information. This forum has been so helpful!!


At this time, just that and most importantly that FNA. Please let us know when it is scheduled.

You are in my thoughts and prayers for all of this.


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## crimebuff (May 25, 2012)

If the FNA is indeterminate, request the Affirma gene expression test which will give you more info-my FNA was indeterminate, Affirma said 50% cancer chance and after surgery the diagnosis was cancer


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## carreg (Aug 10, 2011)

Finally heard back from the endocrinologist's office. I have an appointment this Tuesday, the 19th. I'll let you know how it goes. Thanks again for all the helpful information. I feel I can go into the appointment much better informed and ready to ask the right questions about my health.


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## Andros (Aug 26, 2009)

carreg said:


> Finally heard back from the endocrinologist's office. I have an appointment this Tuesday, the 19th. I'll let you know how it goes. Thanks again for all the helpful information. I feel I can go into the appointment much better informed and ready to ask the right questions about my health.


Good luck on the 19th.. We will be waiting to find out.

You are welcome. It is good to be able to be proactive and "involved" in your health care.


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## carreg (Aug 10, 2011)

Well, I had my appointment with the endo yesterday. He spent about 30 minutes going over my scans and comparing last years with the most recent. He was able to pull up the scan on the computer and went over it screen by screen with my husband and I. The endo was actually upset that last year's scan listed my thyroid as homogeneous. He did not have the technology to pull up the pictures last year and had gone solely by the written report. The endo was upset that last year's scan report stated my thyroid was homogeneous. He stated this was clearly not the case and if he had seen the pictures last year, he would have immediately recommended RAI therapy. He also went on to say that the most recent scan showed my thyroid to be multinodular and in his words, very "heterogeneous". He said we could either go with RAI therapy or surgery. After much thought and talking this over with my husband, I've elected to go with the RAI therapy. I know some may disagree with my decision but, for me, I feel it is the way to go. I may come back later on and say, "What was I thinking!" :-0
As far as the cold nodule, the endo wants me to have an ultrasound because when he looked at the scan, he stated it appeared to be more multinodular than one nodule. 
If I said I wasn't apprehensive about all this, I would be lying. I did feel better, however, when the endo validated my feelings and said this is something I have apparently had for many years and I have suffered because the previous doctors were only looking at the TSH and not ordering more extensive lab work/testing.


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## Andros (Aug 26, 2009)

carreg said:


> Well, I had my appointment with the endo yesterday. He spent about 30 minutes going over my scans and comparing last years with the most recent. He was able to pull up the scan on the computer and went over it screen by screen with my husband and I. The endo was actually upset that last year's scan listed my thyroid as homogeneous. He did not have the technology to pull up the pictures last year and had gone solely by the written report. The endo was upset that last year's scan report stated my thyroid was homogeneous. He stated this was clearly not the case and if he had seen the pictures last year, he would have immediately recommended RAI therapy. He also went on to say that the most recent scan showed my thyroid to be multinodular and in his words, very "heterogeneous". He said we could either go with RAI therapy or surgery. After much thought and talking this over with my husband, I've elected to go with the RAI therapy. I know some may disagree with my decision but, for me, I feel it is the way to go. I may come back later on and say, "What was I thinking!" :-0
> As far as the cold nodule, the endo wants me to have an ultrasound because when he looked at the scan, he stated it appeared to be more multinodular than one nodule.
> If I said I wasn't apprehensive about all this, I would be lying. I did feel better, however, when the endo validated my feelings and said this is something I have apparently had for many years and I have suffered because the previous doctors were only looking at the TSH and not ordering more extensive lab work/testing.


Sounds like you have a doc that is leaving no stone unturned. When are you having the ultra-sound? Could turn out that you may have to have surgery. I hope not but be emotionally prepared.

A cold nodule is unlikely to uptake. That would be my personal concern.


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## carreg (Aug 10, 2011)

I met with the radiologist Monday afternoon. He was very informative about the RAI therapy and also discussed the nodule. He was the radiologist who read the uptake/scan and reported on the nodule. He felt comfortable going ahead with the therapy and was going to talk with my endocrinologist about scheduling another ultrasound. 
I had the RAI therapy this morning with 15.2 mCi of iodine. I was given directives to take "isolatation" precautions for four days with the general public/ five days with pregnant woment and children. I was also given a card to carry because the radiologist said some sensors are so sensitive, they can detect the iodine for several weeks. 
I am praying this will work and I won't have to have surgery . . . . .


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