# Need an opinion



## cphorse28 (Mar 5, 2011)

This is my second post and I hope someone can shed a little light on these results and give me a hint on what questions to ask, etc. I have had 2 ultrasounds, the RAI study, a FNA, and some bloodwork. This all started back in 2010 when my GP noticed something amiss with my bloodwork and ordered the RAI and an ultrasound. From all indications, he felt this was thyroiditis and would eventually 'calm' down. Six months later "it has still not calmed down. The ultrasound from 2/28/11 revealed:
Indications: Hyperthyroidism
Findings: R Lobe: 3.1 x 1.2 x 1.4 cm Mid pole solid 1.1 x 0.6 x 0.5 cm hypoechonic nodule
L Lobe: 3.6 x 1.4 x 1.0 cm Mid pole solid 1.1 x 0.7 x 0.5 cm hypoechoic nodule
Isthmus 23 mm
Conclusion: Overall the size of the thyroid gland is similiar, howwever the heterogeneity of the thyroid tissue including hypoechoic solid nodules appears more evident.
I was sent to a surgeon for a FNA on 03/31/11 which was benign. (I have another ultrasound ordered for Oct. 11)
Bloodwork on 3/7/11:
Anti-TPO 38.2 A (Reference range < 9)
TSH = 0.269 (Reference Range 0.340-5.600)
Free T3 = 3.3 (Reference range 2.0 to 3.5)
CBC = WNL for all
Hepatic Profile was WNL of the Reference Range, but slightly towards the high side with all the values
Cholesterol was 197 (HDL = 48, LDL 130, and Triglyceride = 97)
01/27/11
TSH = 0.28 (Reference range = 0.34 -5.60)
Free T4 = 0.81 (Reference range (0.58 - 1.64)
I'm on Tapazole 10 mg, Diovan, and Bystolic (had real issues with Blood Pressure!)
I'm female and 52 - 5'4" and 165 lbs and very active (have gained 5 pounds in a year)
First available endo appot in my area is Oct. 19 - but I have been referred to a larger city hospital (1st available appt there is Aug)
Any comments?


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## Andros (Aug 26, 2009)

cphorse28 said:


> This is my second post and I hope someone can shed a little light on these results and give me a hint on what questions to ask, etc. I have had 2 ultrasounds, the RAI study, a FNA, and some bloodwork. This all started back in 2010 when my GP noticed something amiss with my bloodwork and ordered the RAI and an ultrasound. From all indications, he felt this was thyroiditis and would eventually 'calm' down. Six months later "it has still not calmed down. The ultrasound from 2/28/11 revealed:
> Indications: Hyperthyroidism
> Findings: R Lobe: 3.1 x 1.2 x 1.4 cm Mid pole solid 1.1 x 0.6 x 0.5 cm hypoechonic nodule
> L Lobe: 3.6 x 1.4 x 1.0 cm Mid pole solid 1.1 x 0.7 x 0.5 cm hypoechoic nodule
> ...


As you probably already know, solid nodules are of a great concern and it seems you have several. Did they do FNA of all the solid nodules?

Did you say RAI (radioactive isotope) and mean RAIU (radioactive uptake?) Maybe? Was a bit confused on that one.

Would you consider having your thyroid gland removed?

Have you had any of the antibodies' tests listed below?

TSI (thyroid stimulating immunoglobulin),TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/


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## cphorse28 (Mar 5, 2011)

Thanks for your response - yes both the solid nodules were biopsied. Sorry for the wrong initials on the test - it was the iodine uptake study that takes a couple of days to complete (that was done over nine months ago and no one seemed really excited by the results). I would consider having the thyroid removed since the nodules seem to have grown fairly rapidly (to me at least) over the past year and I don't really want to live from test time to test time. I'd rather get healthier and then take a pill everyday if I have to.


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## Andros (Aug 26, 2009)

cphorse28 said:


> Thanks for your response - yes both the solid nodules were biopsied. Sorry for the wrong initials on the test - it was the iodine uptake study that takes a couple of days to complete (that was done over nine months ago and no one seemed really excited by the results). I would consider having the thyroid removed since the nodules seem to have grown fairly rapidly (to me at least) over the past year and I don't really want to live from test time to test time. I'd rather get healthier and then take a pill everyday if I have to.


I most definitely agree with that! Plus, it usually is not a good idea to stay on antithyroid meds and beta blockers forever. I don't know if you are being medicated for hyper? It is very very hard on your body as are the Rx's.

Do you ever have swollen lymph nodes in the neck/clavical area? And as you know doubt know, rapid growth (actually most growth fast of not) is not desirable.


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## cphorse28 (Mar 5, 2011)

Re: medication for hyperthyroidism - I can't get an appointment with the endo I want until October, 2011. Both the surgeon and my GP have tried "to move up the appointment" with no success. We also tried at Johns Hopkins and their next available appointment is August (I'm on the cancellation list though). So in the meanwhile I tried the other endo here in town and have an appointment scheduled for May, 2011. How long do most folks stay on meds (for hyper and beta blockers) before they turn to other treatments? I know there are a lot of factors to consider and everyone if different - but is a year too long or average?


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## lainey (Aug 26, 2010)

>>I can't get an appointment with the endo I want until October, 2011.Both the surgeon and my GP have tried "to move up the appointment" with no success.<<

Okay, what good doctor is too busy to see a patient who is sick, with requests from a surgeon and another doctor, for 6 months?

Really, I am glad you are seeing a more accommodating endo next month.

A year is not too long to stay on anti-thyroid meds, some stay longer. The problem is your liver can be damaged by these, so its function needs to be monitored.


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## Andros (Aug 26, 2009)

cphorse28 said:


> Re: medication for hyperthyroidism - I can't get an appointment with the endo I want until October, 2011. Both the surgeon and my GP have tried "to move up the appointment" with no success. We also tried at Johns Hopkins and their next available appointment is August (I'm on the cancellation list though). So in the meanwhile I tried the other endo here in town and have an appointment scheduled for May, 2011. How long do most folks stay on meds (for hyper and beta blockers) before they turn to other treatments? I know there are a lot of factors to consider and everyone if different - but is a year too long or average?


It differs from individual to individual and a lot of the success rate depends on how advanced the case is. If caught early on, your chances are better of getting it to quiet down for a while.


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## cphorse28 (Mar 5, 2011)

I finally got in to see the endo I wanted (cancellation list worked!!!). He really spent a lot of time with me and ordered a bunch of tests. Below are the results
Aldosterone, Fasting <4 ng/dL (reference range <=21 - range based on upright AM collection)
Normetanephrines, free = 0.6 nmol/L (reference range = <0.9)
Metanephrine, free = <0.20 (reference range = <0.50)
Renin <0.6 ng/mL/h (reference = peripheral vein spec. Na-deplete, upright: Mean = 5.9; Range: 2.9 - 10.8
Na-replete, upright: Mean = 1.0; Range = <=0.6 - 3.0
Cortisol = 10.1 (reference = <10 mcg/dl)
Cholesterol = 239
Triglyceride = 136 (<150)
HDL = 38 (>39)
LDL = 174 (high)
Hepatic Profile was in normal range except for Alk Phosphatase = 131 (range 38 -126)
Free T4 = 0.68 (reference 0.58 - 1.64 ng/dl)
TSH = 0.957 (reference 0.340 - 5.60) - this is the highest it's been in a year - been on Tapazole 10 mg since 2/25/11
Free T3 = 3.5 pg/mL (reference = 2 - 3.5)

I have another appt with the endo in 3 weeks. I have been diagnosed with Graves - my biggest problems have been getting my blood pressure under control and the frequent bowel movements. A few problems with my energy level and sleeping - I also get hot! I've had ultrasounds, FNA, and an uptake scan. My FNA sample was labeled benign but the sample wasn't great and I'm scheduled for another ultrasound in September. (I have two solid nodules - a little over 1 cm each and they have grown since last year). The endo ordered some of the tests above because I have had a persistent sore throat for two weeks. Any comments would be greatly appreciated


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## Andros (Aug 26, 2009)

cphorse28 said:


> I finally got in to see the endo I wanted (cancellation list worked!!!). He really spent a lot of time with me and ordered a bunch of tests. Below are the results
> Aldosterone, Fasting <4 ng/dL (reference range <=21 - range based on upright AM collection)
> Normetanephrines, free = 0.6 nmol/L (reference range = <0.9)
> Metanephrine, free = <0.20 (reference range = <0.50)
> ...


Hi......................not good about the sore throat. That could be from the Methimazole. Has your doctor checked your white blood cell count?


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