# Very long, but desperately seeking opinions on labs



## becky82 (Sep 19, 2013)

Hi everyone! This is my first time posting here. I apologize in advance for the length! I tried posting on another thyroid forum but haven't gotten a response so I'm hoping I will hear from somebody here. I'm pretty distressed over some of my health issues and don't know what to think. I would appreciate any thoughts, advice or even virtual hugs! I really need support from others right now and don't know where else to turn.

First of all, I have been suffering from hypo and hyper symptoms for years now, but not sure if my thyroid is the issue. I'm 31 years old and my labs have always been "normal". Well, things have been going increasingly downhill since the birth of my son 4 years ago (emergency c-section with uterine hemorrhage). I no longer work as I don't feel I can be a reliable employee. My short-term memory is absolutely terrible. I have bad brain fog and can't concentrate. I feel so dumb most of the time when I KNOW I am much smarter than this. My cognitive problems are awful.

In 2007, I rapidly lost 75 lbs (my TSH was .7 that year), which was fine because I had gained about 80 pounds in the previous two years. I got pregnant in 2008 and gained the 75 pounds back. I've gained an additional 40 pounds since earlier this year without any significant diet changes. Along with the weight symptoms, I have mood swings where I get very irritable and angry (this is *VERY* unlike me), my voice gets hoarse & often cracks like a prepubescent boy, lol! My skin is extremely dry, fatigue is just AWFUL, lots of muscle, joint and bone pain, vertigo, depression, anxiety, high pulse (in the 90's-100's when sitting) which jumps up to 140ish beats upon standing, very shaky in the morning, lightheadedness, high triglycerides (above 200) compared to 2 years ago, low body temperature (around 97.6), rashes, ridiculous sweating when standing upright, my always regular periods have started to become irregular and lighter...I could really go on and on!!

I recently went to a new doctor in the same practice that I usually go to, and he looked at my previous lab work and was alarmed that none of the other doctors have helped me out. My ferritin is low (15), iron is around 66, my RBC, hemoglobin & hematocrit are consistently low, electrolytes are low, and my sed rate is always slightly elevated (in the 30's) but, as usual, I have negative ANA and negative RF. My thyroid labs appear normal. My new doctor is much more of an out of the box thinker than his colleagues. He thinks I have POTS based on my fast heart rate upon standing, and also thinks I have an autoimmune disease but isn't sure which one(s) yet. He also thinks I have secondary hypothyroidism and/or a pituitary problem as well. Upon looking at my thyroid labs over the years, he remarked that he thinks my thyroid is about to burn out. He also said he could see my thyroid from across the room! He ordered a thyroid ultrasound and I just received the results yesterday:

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*Report*
Impression: Thyroid enlargement with a 1.7 cm nodule in the right thyroid lobe and a 1.6 cm nodule in the left thyroid lobe.

COMMENT: Biplanar images were obtained. The right lobe measures 6.6 cm. The left lobe measures 7.0 cm. The isthmus measures 0.3 cm. The thyroid gland is enlarged. In the right thyroid lobe there is a 1.7 cm hypoechoic nodule without a well demarcated to surrounding halo. Some nonspecific vascularity present within this lesion. There is a second smaller 7.0 mm hypoechoic nodule in the right upper pole.

In the left thyroid lobe there is a 1.6 cm hypoechoic nodule inferiorly.

Tiny bilateral 3.0 mm nodules also noted.

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I went and picked up the report yesterday before I talked to my doctor and did a bunch of googling and scared myself straight! These nodules don't necessarily sound benign. I did read that nodules that are "markedly hypoechoic" or have calcification tend to be malignant. Would the radiologist have noted that in the report?? The office staff called me this morning and told me that they were going to setup an appointment with an ENT for a consultation and biopsy, but I don't go until September 30th. I told them I am absolutely terrified based on my symptoms (really bad pain in my left tibia lately) and the results of the ultrasound. I'm scared that I have thyroid cancer that has spread to my bones or something (ahhh! I do tend to have pretty bad health anxiety). He told me not to worry and he thinks the nodules are benign, but we have to go through this as standard procedure. He currently doesn't know much about this leg pain issue yet but I have an appointment with him next week and will bring it up again then.

Anyway! Here's a list of my thyroid labs (and a few others) for the last year. Before these latest labs, my TSH has always been below 1, usually in the .5 range (since at least '07).

*9/4/13* (after 12 hours of fasting)
TSH: 1.21 (Range: 0.34-5.60 mcIU/mL)
T4 Free: 0.74 (Range: 0.58-1.64 ng/dL)
TPO Antibodies: 13 (0-34 iu/mL)
DHEA-S: 231.2 (Range: 98.8-340 ug/dL)
Cortisol: 19.3 (Range: 2.3-19.4 ug/dL)

*6/10/13*
TSH: 1.17 (Range: 0.34-5.60 mcIU/mL)
T4: 9.2 High (Range: 4.6-9.1 mcg/dL)
FTI: 8.46 (Range: 5.9-13.10 ng/dL)
T3 Uptake: 36.8 (Range: 32-48.4%)

*1/13/13*
TSH: 0.57 (Range: 0.34-5.60 mcIU/mL)

*6/5/12*
TSH: 0.51 (Range: 0.4-4.5)
T4, Total: 8 (Range: 4.5-12 mcg/dL)
T3, Free: 3.2 (Range: 2.3-4.2 pg/mL)
T3, Total: 112 (Range: 76-181 ng/dL)
T3, Reverse: 17 (Range: 11-32 ng/dL)
Thyroglobulin Antibodies: <20
Thyroid Peroxidase AB: <10

Based on this information, what do you guys think? Is it possible these nodules are benign? Do you think this sounds like hypothyroidism or something else? Why would my thyroid be enlarged and why would I have an elevated T4? Should I ask my doctor for a trial of a thyroid med?? I'm wondering if it's not even a thyroid issue since I don't have elevated antibodies.

If it helps any, my mom was just diagnosed with Hashi's (normal TSH & other labs aside from extremely high antibodies) and my 27 year old brother was just diagnosed with Type 1 diabetes. The autoimmune diseases are starting to come out of the woodwork in my family!

Sorry again for such a long post. I would be so grateful for a response. I really need some support right now because I'm so scared. I don't know who else to talk to. Thank you in advance to anyone who is willing to talk with me! :hugs:


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## jenny v (May 6, 2012)

First of all, deep breaths! Everything is going to be okay. It's very easy to fall down the rabbit hole of panic when you first discover health issues, but it sounds like you've finally found a good doctor and that is oftentimes very hard to do. So, you've got one thing crossed off your list.

Next, it's good that you're seeing an ENT for those nodules. They are big enough to be biopsied and it would be a good idea to do that based on the ultrasound report. Try not to worry about the results just yet. Even if it happens to be malignant, thyroid cancer is typically very slow growing and rarely spreads. My thyroid is covered in hyperechoic nodules, but none are large enough to be biopsied (although it doesn't matter at this point because my thyroid is being removed in a few weeks due to uncontrollable Hashi's).

I would also ignore the T4 results for now, those can be artificially high sometimes if you're taking birth control pills or antibiotics. Concentrate on the Free T4 result, which is a little low and could be causing some of your symptoms. Hopefully, the doctor is also addressing your low ferritin and iron because both of those can cause symptoms like fatigue, aches and pains, and other issues.

You've got a good doctor, a good plan and you're on your way now, where you weren't before. This is a very good start for you. hugs3


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## Andros (Aug 26, 2009)

becky82 said:


> Hi everyone! This is my first time posting here. I apologize in advance for the length! I tried posting on another thyroid forum but haven't gotten a response so I'm hoping I will hear from somebody here. I'm pretty distressed over some of my health issues and don't know what to think. I would appreciate any thoughts, advice or even virtual hugs! I really need support from others right now and don't know where else to turn.
> 
> First of all, I have been suffering from hypo and hyper symptoms for years now, but not sure if my thyroid is the issue. I'm 31 years old and my labs have always been "normal". Well, things have been going increasingly downhill since the birth of my son 4 years ago (emergency c-section with uterine hemorrhage). I no longer work as I don't feel I can be a reliable employee. My short-term memory is absolutely terrible. I have bad brain fog and can't concentrate. I feel so dumb most of the time when I KNOW I am much smarter than this. My cognitive problems are awful.
> 
> ...


You do have a very good doc to have ordered the FNA based on this ultra-sound. It is wise to do so.

That said; you might want to have these 2 tests to absolutely rule out hyperthyroid because there are antibodies that are binding, blocking and stimulating and the cancel each other out thus producing lab results which are in normal range.

Welcome to the group leaves


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## becky82 (Sep 19, 2013)

Thank you so much for replying, Jenny and Andros! hugs1 I'm really trying to stay positive and keep my mind off of it until my appointment, but it's not working out very well. I tend to ruminate about things which makes me quite miserable.

Andros - what 2 tests were you referring to? Not sure that you mentioned that in your post!

Jenny - thank you so much for the encouragement. I really hope it is nothing but I am glad this doctor is way more on top of things than other doctors I have been to that have brushed me off. I have an appointment with my doctor on Thursday and plan to ask him about the low ferritin and iron issues. Regarding the T4, I haven't been on antibiotics or birth control, so I wonder what else could be elevating it. Is it possible that the nodules could be?

I wish I could get into the ENT this week. It's going to be a long road. If it's cancer, I am not too thrilled about having my entire thyroid taken out. Hopefully it's something I won't have to think about, but I have a feeling it is. :sad0049:


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## becky82 (Sep 19, 2013)

Hi guys! I just thought I'd update with the results of my FNA. My doctor and the ENT were very confident that I didn't have thyroid cancer, and their predictions appear to be correct after receiving the pathology report today. My ENT talked to me about the benign results and basically told me to go live my life and stop worrying, ha. He didn't want to give me too much advice, however, because he wanted my primary physician to talk to me about the results. I am supposed to see him tomorrow, but it's looking like I'm going to have to reschedule due to not having a babysitter. Anyway, I thought I would post my results because I'd like to have opinions and also, maybe they could somehow help someone else down the line. 
------------------------------------------------
*Final Pathologic Diagnosis*
A: Thyroid, Right Lobe, Fine Needle Aspirate - Benign Follicular Nodule
B: Thyroid, Left Lobe, Fine Needle Aspirate - Benign Follicular Nodule

*Note*
The two specimens are similar. The cytologic features are characteristics of benign colloid nodules.

*Microscopic Description*
A: Both the air dried and fixed smears demonstrate abundant colloid. There are several groups and sheets of follicular cells, most of which have regular small round nuclei. Occasional cells demonstrate Hurthle change. Also a rare follicular structure is identified. Cell block consists largely of red blood cells and colloid. The specimen is suitable for evaluation.

B: Air dried and fixed smears of this specimen also contain abundant colloid. There are scattered groups and small sheets of follicular cells along with several pigmented macrophages. Only a rare follicular structure is formed. The cell block consists largely of blood and colloid with a few scattered pigmented macrophages. The specimen is suitable for evaluation.
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(Note: I read on the medical assistant's report that they labeled my thyroid as a nontoxic multinodular goiter. Additionally, ENT said that the pathologist would normally write more if they felt it was suspicious or needed a follow up.)

I would also like to know if I should be concerned about the Hurthle change. I've read this could indicate cancer eventually and/or be a sign of Hashimoto's. Also, any thoughts on the "rare follicular structure"? No clue what to think about that. What do FNA results look like with someone with Hashi's? My TPO antibodies are in normal range.


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## Andros (Aug 26, 2009)

becky82 said:


> Hi guys! I just thought I'd update with the results of my FNA. My doctor and the ENT were very confident that I didn't have thyroid cancer, and their predictions appear to be correct after receiving the pathology report today. My ENT talked to me about the benign results and basically told me to go live my life and stop worrying, ha. He didn't want to give me too much advice, however, because he wanted my primary physician to talk to me about the results. I am supposed to see him tomorrow, but it's looking like I'm going to have to reschedule due to not having a babysitter. Anyway, I thought I would post my results because I'd like to have opinions and also, maybe they could somehow help someone else down the line.
> ------------------------------------------------
> *Final Pathologic Diagnosis*
> A: Thyroid, Right Lobe, Fine Needle Aspirate - Benign Follicular Nodule
> ...


That was the first thing that piqued my interest. I wondered if it was Hashi's Hurthle cell or Cancer. So, this is something to talk to your doc about and I will provide some good links.

Hashimoto's is diagnosed by FNA. If certain Hurthle Cells indigenous to Hashi's are present, then you have Hashi's.

Histologic diagnosis of Hashimoto's
http://emedicine.medscape.com/article/120937-diagnosis

Hashimoto's Hurthle cells
http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)71549-2

Histologic diagnosis of Hashimoto's
http://emedicine.medscape.com/article/120937-diagnosis

Hashimoto's Hurthle cells
http://www.pathconsultddx.com/pathCon/diagnosis?pii=S1559-8675(06)71549-2

http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/

http://www.mayoclinic.com/health/hurthle-cell-cancer/DS00660


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