# What does this mean?



## Stacey43 (Feb 27, 2014)

I went on my insurance website today (was recently updated to included in & outpatient data). I was scheduled to have TT last May which was cancelled, was surprised to see it listed and closed. It also said; Primary Diagnosis "THYROTOX W O GOITER W O CRISIS." What does the diagnosis mean to you?


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## Stacey43 (Feb 27, 2014)

Was trying to upload the file but couldn't get it to work for me.


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## Lovlkn (Dec 20, 2009)

I read a few of your posts from awhile back and wondered if you ever had the biopsy you cancelled due to being scheduled for surgery?



> 16 May 2014 - 08:23 PM
> 
> I was diagnosed this past February and the doctors said my thyroid is dead, fibrosed (scar tissue) had a large goiter and multiple nodules. The Endo said get it removed, so I said okay. When I talked to the surgeon he said "increased risk of cancer" he also said it is so badly fibrosed he can't see what's going on with the thyroid in the US. Basically my thyroid is scar tissue and nodules. I still don't understand it completely, never even knew about the thyroid until recently. Everyone keeps saying I don't need it removed and/or go gluten free and it will be fixed. I am so confused! I think I'm looking for an excuse to put it off since the thyroid is almost half the size it was and I want to enjoy my family's visit.


The increased risk of cancer is because of the destruction of your thyroid gland - you mentioned it is 1/2 the size it used to be and filled with nodules and scar tissue. I was in the same situation and nobody ever suggested I get a biopsy and when I finally had my thyroid removed it was a mess per the surgeon and filled with nodules and basically destroyed. I did not have cancer so it is possible to have this situation without having cancer. But since they have diagnosed it and suggested cancer could be a risk you absolutely need to have the biopsy or re-schedule the surgery to remove.

THYROTOX may be shortened for "thyrotoxicosis [thi″ro-tok″sĭ-ko´sis]

the condition caused by excessive quantities of thyroid hormones (see hyperthyroidism); it may be due to overproduction by the thyroid gland (as in Graves' disease), overproduction originating outside the thyroid, or loss of storage function and leakage from the gland."

http://medical-dictionary.thefreedictionary.com/thyrotoxicosis

What medications are you taking?

Have you ever had TPO or TSI antibodies tested?


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## Stacey43 (Feb 27, 2014)

My Endo closed his practice and moved on months ago. I never had a biopsy or my thyroid removed. I did just get a referral to a new Endo, that appointment is June 16. I had the TPO & TgAb, they were in the 1300 & 1400 range, never tested for Graves that's why I don't understand the Primary Diagnosis listed with my insurance company. One US stated high vascularity not typical of Hashimoto's and US Tech thought I had Graves. I don't know what that means. At diagnoses and when they said I would need TT my TSH was just under 28. I wish I could remember the exact numbers, water damage. 

My second appointment with the Endo he told me my diagnosis was Hashimoto's with goiter and hypothyroidism.

I don't understand why Primary Diagnosis is what it is, did the doctors not tell me something?

Also wondering if a 20.5 x 1 cm lymph node is something I should be concerned about?


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## Stacey43 (Feb 27, 2014)

Oh and my TT was cancelled because of an infection. Three months after cancelled surgery (Aug 1) I was told I wouldn't need it. Now I'm being told I will need it removed again but insurance company thinks it's already been removed.


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## Lovlkn (Dec 20, 2009)

Your insurance company approved it - you need to call them and explain that it was cancelled due to your infection. Better to get to work on that now - prior to your endo visit.

Another option for you might be to g to an ENT. You have medical history and the ENT could pull your old records and see what was happening.

As far as your diagnosis. 242.90 THYROTOX NOS W/O CRISIS

Doctors need a diagnosis and code to bill your insurance company for the visit. I found this by internet search.

Did you have an ultrasound? Are you taking medications? Has thyroglobulin been tested?

This link is even better at explaining it

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1476727/

It talks mostly about hyperthyroidism. When the thyroid gland is being destroyed it often puts excess thyroid hormone into your system. Depending on the extent of the damage your symptoms may be hyper or hypo.


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## Stacey43 (Feb 27, 2014)

I'm on Armour, Raised TSH 9.89 last draw, also low T4, .26, T3 total 94. I did google it but don't understand why the doctor used that as my primary diagnosis, I was not hyper. I was diagnosed with Hashimoto's. Yes I had the thyroglobulin tested a year ago. It came back in high range.

I have had 4 US since June of 2013. This is my most recent one, dictation is terrible.

Findings: High resolution ultrasound scanning and color flow doppler imaging of the thyroid gland shows the right lobe to measure 4.5 x 1.9 x 2,2 cm and left lobe 4.5 x 2 x 2,4 cm. Isthmus is thickened to 7 mm. Both lobes of the thyroid gland are heterogeneous. No suspicious lesions seen although there are some solid nodules noted bilaterally with a solid nodule in the right lobe of the thyroid gland measuring about 8 mm in maximum diameter and this could be followed.

The patient apparently has a problem not mass superior to the left lobe of the thyroid gland. This was assessed ultrasonically and appears to represent a lymph node measuring 20.5 x 1 cm."

Impression: Slightly enlarged multinodular goiter. The probable nodule superior to the thyroid gland on the left side appears to be a lymph node. A follow up study of the solid nodule in the right side be recommended. A short term followup study and 6 months would be suggested.


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## Lovlkn (Dec 20, 2009)

Your history is all you need a surgeon to see. I do not see why another visit to an endo is required. I asked my surgeon if she had ever had insurance refuse to cover a thyroid removal and she said never. You will want a surgeon who does 4-5 thyroid surgeries a week.

Start straightening out your insurance issue so you can move on with your life and get your thyroid removed. The high thyroglobulin would be enough of a reason as well as your doctors notes about the condition of your gland and the risk of cancer.

Start researching surgeons in your area who specialize in endocrine issues. If no referral is required call the office and see if you can get an appointment. Or you could have your primary try to refer you in. Last resort would be going to an ENT, only use them for your surgery if they specialize and do 4-5 thyroid surgeries a week. Experience counts here.

http://endocrinediseases.org/thyroid/surgery_surgeon.shtml


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## Stacey43 (Feb 27, 2014)

I can't get doctors notes, he left town. All I have is lab work and US reports. Endo also forgot to forward his notes and findings to my PCP. I have to get labs done on Monday, I'm going to ask nurse practitioner to run a complete thyroid panel including all antibodies.

I need an Endo because the nurse practitioner isn't sure what to do for me. I will need a doctor to verify I do in fact have a thyroid and I only see a nurse practitioner. I was going to the main thyroid surgeon in the area, he works in 4 hospitals in 3 counties and is the only one i know of. If I go to an ENT I am putting my throat in the hands of someone that rarely if ever does TT's. Also I can't refer myself for surgery, especially when insurance company thinks I had mine removed.


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## Lovlkn (Dec 20, 2009)

> All I have is lab work and US reports


That's all you need.

Your PCP can feel your neck and verify that you still have a thyroid and they should refer you into the surgeon.

Your PCP must have notes on your originally scheduled surgery?

All you are going to end up doing, waiting on this endo appt in June is to get a referral from them. Let your PCP contact the surgeon and explain your situation.


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## Andros (Aug 26, 2009)

If I were you, I would not wait until June. See if you can get on a cancellation list.

Hugs,


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