# Interpreting Uptake and Scan Results



## xroswellx (Aug 25, 2016)

Hello! I was able to get a copy of the summary of my uptake and scan that was done in May but I don't quite understand what some of it is meaning. Anyone that can shed some light would be much appreciated! It won't let me upload the actual summary so I am typing it out below.

"*Indication*: Suspected or known hyperthyroidism. No thyroid sonogram is presently available. Reportedly a sonogram on 1/12/16, apparently done elsewhere, revealed a 3.6 cm complex nodule on the right lobe, and two nodules on the isthmus. A TSH on 4/11/16 was normal at 0.57 (0.3-4.0 uIU/mL)."

"*Radeioactive Ioding Uptake* 24 hour uptake = 30% (normal 10 to 35)"

"*Technetium Scan*

There is quite a heterogeneous isotope distribution throughout both lobes. There is a spheroid area of relatively intense isotope distribution in the lower portion of the right lobe and another in the upper portion of the left lobe."

"*Impression:* In the context of confirmed hyperthyroidism, the radioisotope uptake value and the radioisotope scan findings together would be consistent with one of the heterogeneous, non-suppressed forms of hyperthyroidism, most likely either toxic nodular thyroid or two toxic adenomas. Unfortunately the previous sonogram images are not presently available for comparison."

For reference, here is the summary of my ultrasound from 1/12/16.

"*Indication*: Lump in throat, lump in right side throat since 26 December 2015
Comparison: None
*Findings*:
The right thyroid lobe measured 4.7 x 3.1 x 2.9 cm. The left thyroid lobe measures 3.7 x 1.4 x 1.4 cm. Large cystic focus with intraluminal debris and septations occupying the right thyroid lobe measuring 3.6 x 2.6 x 2.7 cm. No vascular flow. Within the right aspect of the thyroid isthmus a small hypoechoic nodule was identified measuring 6 x 9 x 6 mm. Within the left aspect of thyroid isthmus a 1.6x 0.8 x 1.6 cm solid nodule is identified. It is slightly hypoechoic. No abnormality identified in the left thyroid lobe
*Impression*:
1. 3.6 x 2.6 x 2.7 cm complex cystic structure with septations in intraluminal debris within the right thyroid lobe
2. 2 solid nodules the thyroid isthmus. The larger of the 2 nodules measures 1.6 x 0.8 x 1.6 cm. Consider FNA of this larger solid nodule .. Otherwise recommend ultrasound follow-up in 6 months."

*My main question* - what does heterogeneous mean in relation to this test? Other information or insights are appreciated too. I am scheduled for a Total Thyroidectomy in about 5 weeks and I keep going back and forth on whether or not I want to go through with it, as I have been asymptomatic for almost a year. Is this test result enough of a reason to have my thyroid removed? The nodule is still there and very palpable, but other than that, I have had no hyper symptoms that I am aware of since last October.


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## jenny v (May 6, 2012)

So your surgery is in October? Do they plan to do another ultrasound before then?


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## joplin1975 (Jul 21, 2011)

I think heterogeneous, in this case, means that your thyroid isn't absorbing the radiodione at a consistent, normal rate. So some of your thyroid is acting normal, some might be acting slowly, and some might be acting in a more hyper manner.

If you look up heterogeneous and radioiodine uptake scans, the thing that always seems to come up is thyroidtoxicosis. I think the take home message is really that you don't have a healthy thyroid and a TT is probably your best bet.


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## xroswellx (Aug 25, 2016)

As far as I have been told there is no plan for a second ultrasound.

My understanding of the current plan (laid out by the ENT Surgeon in June) is to suppress my thyroid so that I am euthyroid going into surgery, to prevent thyroid storm. I reached out a few days ago to see how he plans to do that (from what I understand my levels from April would be euthyroid already, wouldn't they?). I would hope that he at least plans to do bloodwork before medicating me, but if not I am going to ask my PCP to run a thyroid panel to see where I am now.


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## joplin1975 (Jul 21, 2011)

xroswellx said:


> (from what I understand my levels from April would be euthyroid already, wouldn't they?)


That's hard to say without seeing the ranges...but it almost looks like he's relying on TSH? Which is never good...

If you have an inclination toward hyperthyroidism, as noted by the uptake scan, I don't think medicating is a good idea.


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## xroswellx (Aug 25, 2016)

The tests run in April were: TSH, Free T4, Thryroglobulin, and Thyrogobulin Antibodies.

TSH: 0.57 (0.4-4.5)

FT4: 1.1 (0.8-1.8)

Antibodies: <1 (<1 or 1)

Thyroglobulin: 98.5 (2.8 - 40.9 ng/mL) - insight on this one would be appreciated as I have never understood what this means or been able to find anything to explain it well as it generally is in reference to cancer treatment.

I think the plan for medicating is only for the week or two prior to surgery.


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## joplin1975 (Jul 21, 2011)

Too bad you didn't have free t3 or TSI run...

I'd still be hesitant to medicate before surgery. I was fully hypo and the thyroid dump post-surgery was the most unpleasant part of it all.

Thyroglobulin is a protein produced by the thyroid. Its present in normal thyroids, but you find elevated levels in thyroids with cancer. Elevated levels can also be found in thyroids with autoimmune issues.


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## xroswellx (Aug 25, 2016)

I will add those to the list to ask my PCP to order - are there any others that I should request?


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## joplin1975 (Jul 21, 2011)

Nope -- I think if you get those, you should be in as good of a place as possible to figure out what to do.


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## xroswellx (Aug 25, 2016)

Wonderful! My PCP sent the lab order this morning.

The lab it was sent to is a 24/7 lab so I can go in any time - is there a time that is best for testing thyroid function? Does fasting matter?

I can go after work today or before work tomorrow, so I'm just curious which will provide the most accurate results?


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## joplin1975 (Jul 21, 2011)

If you are not on any medication, just about any time should be fine.

If you are on thyroid meds, go first thing in the morning and then take your meds after.

You may want to get the blood drawn at the same time as you had them drawn last time.


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## xroswellx (Aug 25, 2016)

The tests I *think* she ordered are TPO, TSI, TSH, FT4, and T3 Uptake (not what I asked for...). I say "think" because I have yet to get the results and I tried to read the order sheet while my blood was being drawn so I am not entirely sure what was ordered (just that they took FIVE vials of blood). Are any of those ones that take awhile to process? I had the blood drawn Tuesday morning (9/20) and the lab my insurance uses (Quest Diagnostics) was supposed to pick it up that afternoon. The last two times that lab has done my blood work, I've had the results within 48 hours.


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## joplin1975 (Jul 21, 2011)

Quest is usually pretty quick, but they won't release the results to you until they are first delivered to your doctor.

Sometimes the antibodies and free t4 test can take a little longer than the TSH.


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