# Multinodular Goiter



## ruby (Aug 30, 2009)

In May, a sonogram revealed that I have a multinodular goiter. My FT4 then was .72; TSH is 2.8 and FT3 is 2.9. THe conclusion of my sonogram reads, "Mildly enlarged right lobe of thyroid. Diffusely nodular thryoid gland with an isoechoic nodule in left lower pole. Vague nodule is visualized in right lower pole."

My internist told me I had an "auto-immune thyroid disease," and put me on 50mg of synthroid. I asked about seeing an endocrinologist and having and FNA done, he said not right now. I had a number of other health problems going on (that is to say I was working up to having a kidney removed, which happend 3 1/2 weeks ago).

So my questions: 
-->When my internist said I had an "auto-immune thyroid disease" did he mean I have Hashimoto's? Are they the same thing?
-->I haven't "bounced back" from the kidney removal as expected, and I'm wondering if that could have anything to do with being hypothyroid. 
-->Is Hashimoto's connected to depression?
-->Wondering if it is time to see an endocrinologist...

Thanks for any help or thoughts you can offer. I'm just confused and trying to get my life back...


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## chopper (Mar 4, 2007)

Yes, yes, yes and yes.

Auto immune thyroid is usually referred to as Hashimoto's and vice versa. Rarely does "auto immune thyroid" refer to anything but Hashimoto's but it can. Hashi's is by far the most popular auto immune thyroid problem.

Hashi's can be linked to depression which will become quite visible if the "fog" lifts once you begin meds. If you feel happy again after meds, you know at least part of it was due to your thyroid trouble.

Yes, you should see an endo. An endo will probably FNA those nodules just to make sure what they are. My wife's got a small grape-sized nodule and they FNA her once a year and sono her twice a year.

I find your numbers a bit odd compared to mine since they are almost identical, except TSH. My endo has always thought my TSH was awfully high considering my Free T numbers. Your TSH appears to be more inline.

Check out the comparison:

Free T4: Me: 0.65 You: 0.72
Free T3: Me: 2.60 You: 2.90
TSH: Me: 14.07 You: 2.80

I'm wondering if I have a TSH producing pituitary tumor running around somewhere in my head. My TSH is typically very high, even when my numbers were more in the center of the range and also, I'm a bit surprised your TSH is not higher. I've already had a pituitary MRI and they didn't find anything. I do have a script for Synthroid that I have to start taking too. Maybe my TSH will drop quickly once my Free T4 comes up a little. This is the first set of labs I've had where my FT4 was actually below the range. I can tell you I feel foggy. Not so much depressed. More like a hangover. I tend to take a nap each afternoon.


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## ruby (Aug 30, 2009)

Thank you so much for your reply. I've felt like crap for such a long time and this spring pursued the heck out of why I just don't feel good. Ever. We found severe esophagitis. We found out that the doctor who did my hysterctomy 3 years ago tied off my right ureter and thus essentially killed my kidney (which is why it was removed). And we found the multi-nodular goiter. I think my internist felt it important to first treat the kidney and then we'll get to the other things. Well that kidney treatment turned out to be more a doozy than anyone anticipated...

First they tried to revive the kidney with a nephrostomy bag and while I had the bag I came down with an incredibly severe case of poison ivy, was on steroids for 27 days, and had two biopsies. One biopsy indicated a medication allergy, which turned out to be my major anti-depressant. Had to come off that and as I'm trying a new med, my psych is on vacation until after Labor Day. Meanwhile I am feeling worse and worse--tired, very depressed, achy all over, dizzy. I am healing welll (though slowly) from the kidney surgery...but on every other account I'm taking a nose dive.

I'm going to call my internist tomorrow and get a referral to an endo. Really, I just want to feel better. That is all.

FYI: I know almost nothing about thyroid numbers and what they mean; and very little about hashimoto's. I guess I just haven't wanted to "go there" yet. But I will do now. Any sites you can recommend for info?

Thanks for yoru help.


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## Andros (Aug 26, 2009)

ruby said:


> In May, a sonogram revealed that I have a multinodular goiter. My FT4 then was .72; TSH is 2.8 and FT3 is 2.9. THe conclusion of my sonogram reads, "Mildly enlarged right lobe of thyroid. Diffusely nodular thryoid gland with an isoechoic nodule in left lower pole. Vague nodule is visualized in right lower pole."
> 
> My internist told me I had an "auto-immune thyroid disease," and put me on 50mg of synthroid. I asked about seeing an endocrinologist and having and FNA done, he said not right now. I had a number of other health problems going on (that is to say I was working up to having a kidney removed, which happend 3 1/2 weeks ago).
> 
> ...


Hi, Ruby. I am concerned. For one thing, if your doctor did not run any antibodies' tests indigenous to the thyroid, that is a very vague statement indeed to say it's autoimmune. It probably is but I would want a more definitive answer than that.

The "usual" initial tests would be TPO (antimicrosomal antibodies), Thryoglobulin ab, TSI (thyroid stimulating immunoglobulin.) If you have any of these, yes..............it would be autoimmune.

Thyroid Disease and depression sometimes go hand in hand. Do you have the ranges of lab results such as TSH , Free T3 and Free T4? Ranges are not universal and vary from lab to lab. If you do, I thank you in advance.

Also, if I were you, I would insist on an FNA (fine needle aspiration) to rule out cancer. Why? Because isoecohic is suspicious. Also, FNA would be "definitive" of Hashimoto's if certain Hurthle cells are found in pathology that are indigenous to Hashimoto's. Some Hurtle cells indicate cancer and that is why I make the distinction

Ultrasound features of follicular lesions include:
-hyperechoic/isoechoic in echotexture (Fig. 12); hypoechoic lesions have a higher risk of being malignant (Fig. 13) [51]

So...............you want to make sure it is not follicular cancer. I hope and pray not.

Here is info and if you hold the mouse arrow over the figure numbers, it will show you the film of each lesion or irregularity.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1665239

I am very very sorry about the removal of your kidney and I hope as of this posting, you are doing a whole lot better. Sounds like you have been through a lot here lately.

Andros


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## ruby (Aug 30, 2009)

Thank you, Andros, for your reply. As i noted, I really am very new to the "thyroid" world, with all its initials and numbers, etc. The ranges on the numbers I posted in my other email indicate that each of those is at the borderline between low and normal. Because the results of my sonogram--basically the technician was a bit freaked out doing the test, saying she'd never seen a thyroid like mine before--and the "low/normal" numbers, my doc said, "auto-immune thyroid disease."

I do have an appt with my doc this afternoon and he is going to test for antibodies, though he fully expects that they wil be there. I didn't talk to him--rather I did get hold of my psychiatrist and she talked with him about further testing, etc. I think that she said he is going to add another med to my synthroid (a T3 med?). I may end up being hospitalized for this sinking, intractable depression. And if so, I wouldn't be surprised if they did some more testing.

I'm still navigating all of this and you both here have been very helpful to me to get started on the road. Not sure where it will lead, but I surely hope that I feel a LOT better before too long. Unfortunately, our semester starts next week and I supposed to start teaching in 8 days.:eek:

But I'm pursuing help and I do believe that I have a good set of doctors caring for me, all connected to NYU Medical Center, which I've found to be a wonderful hospital.

Thanks again. May I let you know when I get further answers?

Ruby, who is trying her d****est to


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## Andros (Aug 26, 2009)

ruby said:


> Thank you, Andros, for your reply. As i noted, I really am very new to the "thyroid" world, with all its initials and numbers, etc. The ranges on the numbers I posted in my other email indicate that each of those is at the borderline between low and normal. Because the results of my sonogram--basically the technician was a bit freaked out doing the test, saying she'd never seen a thyroid like mine before--and the "low/normal" numbers, my doc said, "auto-immune thyroid disease."
> 
> I do have an appt with my doc this afternoon and he is going to test for antibodies, though he fully expects that they wil be there. I didn't talk to him--rather I did get hold of my psychiatrist and she talked with him about further testing, etc. I think that she said he is going to add another med to my synthroid (a T3 med?). I may end up being hospitalized for this sinking, intractable depression. And if so, I wouldn't be surprised if they did some more testing.
> 
> ...


Hi, Ruby............good to hear from you. The limbic system is dependent on T3 for mood control so I am not surprised that you are down in the dumps if not downright depressed and I am so glad that you have your psychiatrist to be proactive in your situation as well.

I have to say that Graves' Disease did a number on my psyche and thank god I had the sense to seek counseling for myself which I did for 2 years and it was so worth every penny. Most psychologists and psychiatrists are very very skilled and helping those who have chronic conditions get on track and stay on track w/ their lives. I am very grateful to that profession.

That said, "Back to you!" Yes, you probably do have antibodies and autoantibodies. And I believe it is best to know that. I don't like guessing games not to mention that it is good to have a "baseline" so that somewhere down the road, if need be, you can be tested again to see where you are at w/ antibodies. And I believe your treatment regimen will be based on what antibodies are evident as well.

And please press for an FNA.

Aside from the depression, what other physical symptoms do you have? And of course, I and others will be interested in what your doc has to say.

Lu Anne


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## ruby (Aug 30, 2009)

Thanks for you encouragement, Lu Anne. Today the doc upped my synthroid to 75 and added Cytomel (can't remember the dosage and the scrip is at the pharmacy). My doc and psych agree that my depression is sinking so quickly that I need to be hospitalized, so i am waiting for a bed to open up there. I imagine I'll be having lots of testing while there. So I may be out of touch for a bit...but I hope to come back with a better report than this. Thanks. Ruby


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## Andros (Aug 26, 2009)

ruby said:


> Thanks for you encouragement, Lu Anne. Today the doc upped my synthroid to 75 and added Cytomel (can't remember the dosage and the scrip is at the pharmacy). My doc and psych agree that my depression is sinking so quickly that I need to be hospitalized, so i am waiting for a bed to open up there. I imagine I'll be having lots of testing while there. So I may be out of touch for a bit...but I hope to come back with a better report than this. Thanks. Ruby


The Cytomel should immediately help the depression. I hope that the starting dose is within the usual prescribing protocul which is 5 mcg. once per day and then you work up to twice per day and so on as per labs and clinical evaluation. It is a very very powerful substance so caution must be used.

Ruby, you sound like a very very sweet lady and if you don't mind, I am going to say prayers for you.

You will be missed and I hope to hear from you soon.

http://www.kingpharm.com/Products/Alphabetic_Listing_of_Pharmaceutical_Products.cfm

Scroll down to Cytomel and read the prescribing information. I have been around a long time and have seen many disasters from the docs Rx'ing too much.

Andros


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## Andros (Aug 26, 2009)

ruby said:


> Thanks for you encouragement, Lu Anne. Today the doc upped my synthroid to 75 and added Cytomel (can't remember the dosage and the scrip is at the pharmacy). My doc and psych agree that my depression is sinking so quickly that I need to be hospitalized, so i am waiting for a bed to open up there. I imagine I'll be having lots of testing while there. So I may be out of touch for a bit...but I hope to come back with a better report than this. Thanks. Ruby


Hi, Ruby! Just wondering how you are getting along on the Cytomel??? I know your semester started and you are most likely very busy but we sure would like to hear how you are doing.


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