# RAIU, Labs, Nodule...update..please advise



## Christinals (Sep 9, 2010)

Met with Endo today to go over my RAIU, Scan & labs.

TSH 0.35 (.45-4.50) Low
My Protein 8.2 (6.0-8.0) High
TPO-Ab 320 ( <35) Higher than last time
TgAb 1283 ( <41) A little higher than last time
T4 11.2 (4.5-12.5)
Not sure why my T3 wasn't done. Next time I guess.

Okay now for my RAIU & Scan.....
After 4hrs the uptake was 3%
After 24hrs the uptake was 6%
Nodule did not uptake....(eventhough I saw the scan I didn't see a "definate cold spot" because most of the thyroid didn't uptake) Does this indicate the nodule is in fact cold or not?

The ultrasound shows the nodule has grown from 1.4cm to 2.5cm (again, could this be tech error? If not is 1cm in 6mos enough to worry about?)

The ENDO says it looks like it's just inflamation and it will probably correct itself over time. However, since the nodule has grown and did not uptake, we could do the FNA or wait and see...........I chose the FNA (scheduled November 9th) He thought that was the better idea too. Just to get it off my mind. It's probably nothing.

SO here we go again. 
Please, if you have any information or guidance it would be very appreciated!
I am tired of thinking. My hopes were high today that perhaps it would show something. It didn't matter WHAT it showed, I just wanted something a little more concrete than the docotor saying "it will correct itself over time maybe two months or _*two years*_" (that's what the ENDO said).
UGH, oh well.

Thanks again all!
:hugs:


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## Christinals (Sep 9, 2010)

I have read two conflicting reports. Is a low TSH HYPER or HYPO...(either way my levels aren't that bad)


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## Andros (Aug 26, 2009)

Christinals said:


> Met with Endo today to go over my RAIU, Scan & labs.
> 
> TSH 0.35 (.45-4.50) Low
> My Protein 8.2 (6.0-8.0) High
> ...


Were you on any meds when you had the RAIU?


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## McKenna (Jun 23, 2010)

I think it's very good that you are getting the FNA done. I'm certainly not an expert, but my understanding is that nodules are usually slow growing, according to the ENT who did my FNA.


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## greatdanes (Sep 25, 2010)

When my TSH was .35 I was mildly hyper, all other thyroid labs stayed in range. I was not symptomatic so no treatment except my own concoction of supplements that got it in range. I also had 2 cysts and two nodules. Now I am severly hyper but the cysts and one nodule dissapeared and I only have one small nodule left. Your nodule sounds cold, do you have graves?


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## Christinals (Sep 9, 2010)

No Graves, no medication. No medication when I had the uptake either. I was very strict with my low iodine diet before the test too.

Interestingly enough, I have had a really great week. My symptoms have been much better. Funny, maybe my TSH needs to be lower? I don't know. My heart palps, and anxiety have been very low. Energy level is great too. He says I will probably go back and forth for a while. My only concern right at this moment is the nodule. I can actually feel the nodule and the "swelling" of the right side.

If the nodule is not seen or doesn' uptake, and the majority of the thyroid doesn't uptake is that really considered a "cold nodule"? I understand cancer is very rare. I also read online that low TSH has low risk of cancer? anyone agree/dissagree?

Thanks everyone for your responses.
-Christi


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## greatdanes (Sep 25, 2010)

Christinals said:


> No Graves, no medication. No medication when I had the uptake either. I was very strict with my low iodine diet before the test too.
> 
> Interestingly enough, I have had a really great week. My symptoms have been much better. Funny, maybe my TSH needs to be lower? I don't know. My heart palps, and anxiety have been very low. Energy level is great too. He says I will probably go back and forth for a while. My only concern right at this moment is the nodule. I can actually feel the nodule and the "swelling" of the right side.
> 
> ...


Yes, it's even more rare to have a nodule be cancer while hyper, more common while hypo or euthyroid. It still happens, but it's comforting to know that the chances are slim. This is why if my nodule grows, I will just bypass the uptake, and shoot straight for FNA, b/c I don't wanna go through all the ''results'' that may end up being inconclusive, or results that don't reveal much. Yes benign nodules can grow, that's how many are found b/c they grew. Try not to over-think and just wait on the FNA results. I know, easier said than done, LOL:hugs:

Oh and stop researching, everything is scary and boogiemanish out there lol!


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## Christinals (Sep 9, 2010)

greatdanes,

I love your response...lol
Thanks 
You are a sweetie!


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## greatdanes (Sep 25, 2010)

I know how it feels to excessively worry. I've had to talk myself down and pray a lot the past few weeks. Hope you are feeling better.


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## Christinals (Sep 9, 2010)

Hey greatdanes,

Has it been a rough couple weeks? I saw that you were frustrated with your Dr on some issues. How are you feeling today? I know that for me, prayer (especially when it comes to anxiety) helps me stay focused and helps me maintain what sanity I have left during those rough periods. Prayer and LOTS of breathing... 

I hope you have a calm, restful, and happy weekend!
:hugs:

PS..Your comments and support means so much. Thx


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## Christinals (Sep 9, 2010)

Benign FNA! Hooray.
It has grown to 3cm now, but no cancer.

Antibodies still bad, but my TSH was 1.61 (.45-4.50)
The Dr. Says he thinks it's probably chronic thyroiditis.
No meds, because my TSH was normal this time. He says he will see me in 4months to check the nodule and blood work again. Any thoughts?
Thanks.


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## Andros (Aug 26, 2009)

Christinals said:


> Benign FNA! Hooray.
> It has grown to 3cm now, but no cancer.
> 
> Antibodies still bad, but my TSH was 1.61 (.45-4.50)
> ...


I am so glad to hear this wonderful news!!

What a relief!

So, how do you feel? Did the doctor run a Free T3 and Free T4 along w/the TSH??


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## Christinals (Sep 9, 2010)

Nope he sure didn't.
"Next time" he says.
How do I feel? well today I feel great. 
Ask me again tomorrow..lol
I have asked for a copy of the FNA report.
He wrote down: benign, atrophic cellular patent with involutional change....not sure what ANY of that means. and don't care as long as it's benign! LOL

Quick question, since now I don't have the diagnosis (like before) of hashi's....the antibodies? Should I be at all concerned about those? Should they be watched or tested again later?

Thanks Andros  for everything.


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## Andros (Aug 26, 2009)

Christinals said:


> Nope he sure didn't.
> "Next time" he says.
> How do I feel? well today I feel great.
> Ask me again tomorrow..lol
> ...


Okay............this may be a bit confusing but I will try. Chronic Thryoiditis is a term used interchangeably w/Hashimoto's. They are one and the same. As far as I am concerned, the only real true test of whether the patient has Hashimoto's is the appearance of certain Hurthle Cells that are indigenous to Hashimoto's (chronic thryoiditis) upon FNA pathology.

So, what I suggest you do is query the doctor or the Pathologist as to whether or not these Hurthle Cells were present. You "do" need to know this.

It is true that patients with Hashimoto's present w/high titers of TPO (antimicrosomal antibodies) but that is only "suggestive" and representative of a myriad of other autoimmune diseases.

There are also Hurthle Cells indigenous to thyroid cancer which gratefully we know you do not have with this FNA.

Read this; you will have to scroll down to see what I am telling you.

http://books.google.com/books?id=_b...v=onepage&q=Hashimoto's Hurthle Cells&f=false


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## Christinals (Sep 9, 2010)

Thanks Andros.

Okay. The Dr. emailed me the pathology report. Doesn't say anything about Hurthle cells.

This report is more like a packet...lol I will try to keep this short.

Numerous clusters of bland follicular cells. For the most part they are of a benign atrophic pattern. Cytoplasm is delicate and weblike. Microfollicular & papillary atypias are absent. On one slide clusters of pigmented histocytes with involutional change or perhaps microcystic change.

Assessment: Boipsy is benign 3cm nodule. 
Biopsy due to positive anti-thyroid antibodies. 
Follow up with physician.

It shows a pretty picture of one of the slides...lol

Since it says nothing re: Hurthle cells, it can't be hashi's am I right?

Have a happy Thanksgiving everyone.
:hugs:


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## Andros (Aug 26, 2009)

Christinals said:


> Thanks Andros.
> 
> Okay. The Dr. emailed me the pathology report. Doesn't say anything about Hurthle cells.
> 
> ...


That is absolutely correct. The pathologist would most definitely note the presence of Hashimoto's Hurthle cells if they were there.

Good deal. You will need regular follow-ups though and I am sure your doctor will discuss this with you.

You may find this an interesting read........

http://www.thyroidmanager.org/Chapter8/8-frame.htm

One has to pay attention to wording. For instance, it says, "High titers of TPO are considered to be a Hallmark of Hashimoto's." And I certainly agree w/that but that is not a "definitive" diagnosis. You see?


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## Christinals (Sep 9, 2010)

It the summary of the pathology report it says:

Right thyroid: 2.5 X 2.5 cm Thyroid nodule, colloid rich and atrophic cellular patent with involutional change and possible coexisting chronic thyroiditis.

If it does not show Hurthle cells, no Hashi's right?

Sorry if I'm driving you crazy. I appreciate your help.
Hope you had a wonderful Thanksgiving day! Next stop...Christmas


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## Andros (Aug 26, 2009)

Christinals said:


> It the summary of the pathology report it says:
> 
> Right thyroid: 2.5 X 2.5 cm Thyroid nodule, colloid rich and atrophic cellular patent with involutional change and possible coexisting chronic thyroiditis.
> 
> ...


That is correct about the Hurthle Cells indigenous to the thyroid. It would have been duly noted if they were present in this particular biopsy. However, this not a specific statement. Chronic Thyroiditis is used interchangeably w/ the word Hashimoto's so I would definitely push for clarification here.

Okay........editing here. I had to double check that out. You in fact "do" have Hashimoto's. I guess it would have been to easy to say so. Aaaaaaaaaaaaaaargh. So now we know. Chronic Thyroiditis/Hashimoto's. Which ever word you prefer. It threw me because no mention was made of the Hurthle Cells and I still wonder if they were present of if this is another guestimate.

Please query your doctor about this. I really would like to know and I know you would also.

Here is reference.
http://www.nlm.nih.gov/medlineplus/ency/article/000371.htm

■Colloid nodule. Most thyroid nodules are colloid nodules - noncancerous (benign) overgrowths of normal thyroid tissue. You may have just one colloid nodule or many. Although these nodules may grow larger, they don't spread beyond your thyroid gland.
http://www.mayoclinic.com/health/thyroid-nodules/DS00491/DSECTION=causes


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## Andros (Aug 26, 2009)

Christinals said:


> I have read two conflicting reports. Is a low TSH HYPER or HYPO...(either way my levels aren't that bad)


It could be either depending on where your FT4 and FT3 is plus do you test positive for TSI (thyroid stimulating immunoglobulin) and others such as TBII and Trab.

By the way; you certainly are no bother to me. I love this stuff.


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