# Hot Nodule



## Shzen (Oct 14, 2015)

I need help. I feel horrible (LONG list of thyroid symptoms for years) I've had an RAI (confirmed toxic multinodular goiter), an ultrasound (showing the two largest ones being 4.1cm and 4.9cm), biopsy (both sides came back benign).

What is standard treatment for a hot nodule with mild elevation in blood work but with a very long list of thyroid symptoms? I am not on medication nor does she plan on doing so. She doesn't want to do anything (surgery, RAIU, nor meds).

Can hot nodules affect the body without showing up in blood work? I don't know where to go from here!

I am looking for a new Dr, however, I don't know what they should be doing for me....if anything.

I'm thrilled that I do not have cancer, however, I'm where I started still feeling horrible with no relief in sight!

Thank you for ANY help you can give me with this issue!

Feeling defeated!


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## joplin1975 (Jul 21, 2011)

What does your blood work look like? Can you post labs with reference ranges?

I think it's odd your doctor is not considering surgery. Benign or not, those are large nodules... Usually anything over 3cm-ish would start surgery discussions.


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## Shzen (Oct 14, 2015)

My labs were done in a private small time lab (felt like I was teleported back to the 80's or before) in Sept.

TSH 0.37 ( 0.27 - 4.20)

Total T3 1.58 (0.75 - 1.78)

Free T4 1.48 (0.93 - 1.71)

Several people I have talked to said their labs were normal, however, their Drs put them on meds and will either be performing surgery soon or waiting to see if the nodules respond to the meds.

Is this standard procedure?

Second question: If I have Hashimoto's (I have yet to be tested as she won't test me) could this be countering the hot nodule and showing up fairly normal numbers?

The goiter/nodules (though I don't know the exact size before the tests) has visibly it has grown since I was first diagnosed in Sept.

I am looking for a new Dr, but I need to know what I should expect of him or her in regards to treatment.


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## webster2 (May 19, 2011)

Wow, you must feel awful. My first experience with thyroid issues was a hot nodule. My GP sent me to a general surgeon ( this was 25 years ago) and he said the only option was a partial thyroidectomy. It sure sounds like you need to search out a new medical provider. Would an ENT be helpful?

Hot nodules make your body hyperthyroid. The nodule itself is producing thyroid hormone as well as the thyroid producing hormone. I remember sweating profusely even without exertion. I lost a lot of weight without trying. I slept a lot.

Those are some big nodules and must be uncomfortable. I really think if you can find an ENT, it might be your best bet.


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## joplin1975 (Jul 21, 2011)

I think it's standard procedure if the nodule is 1-2cms (roughly). If your nodule is 4cms, it's going to (if it's not already) compress other structures in your neck so for most, standard procedure would be surgery.

Usually if you have a ill-functioning nodule, you'll have antibodies. Antibodies will often skew your lab results so they look normal, but really aren't.


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## Shzen (Oct 14, 2015)

webster2 said:


> Wow, you must feel awful. My first experience with thyroid issues was a hot nodule. My GP sent me to a general surgeon ( this was 25 years ago) and he said the only option was a partial thyroidectomy. It sure sounds like you need to search out a new medical provider. Would an ENT be helpful?
> 
> Hot nodules make your body hyperthyroid. The nodule itself is producing thyroid hormone as well as the thyroid producing hormone. I remember sweating profusely even without exertion. I lost a lot of weight without trying. I slept a lot.
> 
> Those are some big nodules and must be uncomfortable. I really think if you can find an ENT, it might be your best bet.


The thing that made me nervous about the local ENTs is all of them are surgeons. I know this may be what I need done, but I if I had other options I didn't want this to be the first and only option because that's a big part of their business.

I wish she would explain to me (besides giving me a page on goiters) what is going on and how we plan to fix it.....though it sounds like she doesn't have any plans at all. She told me to make an appointment to see her in 6 months. BTW, I've only seen her once.


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## Shzen (Oct 14, 2015)

joplin1975 said:


> I think it's standard procedure if the nodule is 1-2cms (roughly). If your nodule is 4cms, it's going to (if it's not already) compress other structures in your neck so for most, standard procedure would be surgery.
> 
> Usually if you have a ill-functioning nodule, you'll have antibodies. Antibodies will often skew your lab results so they look normal, but really aren't.


That's what I've been reading. And it is compressing already. I have pains in my collarbone, jaw, neck and into my ear.

Good to know! I'm trying to arm myself with info so I can move forward as I wouldn't have even found any of this out if I didn't make (seriously make) my old GP retest me and check my thyroid.


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## Shzen (Oct 14, 2015)

I've only seen my Endo once.... I was sent to have tests and then her assistant called my husband (I still haven't gotten the results from them) and told him my nodules were benign and that she didn't want to see for another 6 months?! Yesterday I then wrote her this note (on the medical portal that we can converse back and forth on):

I'm thrilled my biopsies came back benign. I'm glad that is behind me, however, I have symptoms upon symptoms that are not being dealt with. I have a list of questions for you.

1. What is the state of my thyroid? Do I have thyroiditis?
2. Did any of my tests indicate Hashimoto's?
3. Do I have any hot nodules?
4. I went to the Cardiologist and he put me back onto a beta blocker and felt that after I "fixed" my thyroid that my chronic hypertension and tachycardia would be resolved. That leads me to my next question.
5. What am I suppose to do in the meantime with all these symptoms: terrible body pain, joint pain....especially in my hips, sore throat, constantly having to clear my throat, my voice going off and on, pain in my neck, and jaw that goes up to my ears, coughing, brain fog, memory problems...I am constantly forgetting day to day words and what I was going to say, terrible time concentrating, chronic fatigue, beyond excessive yawning, super heavy and painful periods, no sex drive, weak muscles, dizziness, shaking, cold hands and feet, and then high body temperature at different times, chest discomfort, pain walking up stairs (and exercise), pain and exhaustion after little exertion which makes exercise almost impossible, shortness of breath, my muscles knot up, muscle spasms, my feet hurt so bad I have to wear slippers all the time to reduce the pain I feel from walking on them, burning throat (different then the sore throat), constant dry mouth....constantly thirsty, my eyes constantly hurt (feel dry and uncomfortable but are constantly teary), blurry vision, hair loss, dry skin, terrible headaches, hemorrhoids, having to sleep on my side so I can breath okay, gas pain (however this has gotten better since I went gluten free), nervous, irritable, bouts of depression, anxiety (which has gotten a bit better in the last few days possibly due to the betablocker). I know this list is overwhelming....but this is what I have been living with.
6. My goiter and or nodules have gotten larger since I saw you. Is this normal? And is there something I can do about it?

She wrote back saying I have thyroid nodules, one which is overactive. She stated that my condition (toxic mulitnodular goiter) is different than Hashimoto's (note has never tested me even though I've asked her to...she said it wasn't her department that I'd have to go to a Rheumatologist.) That was her response.


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## joplin1975 (Jul 21, 2011)

The biggest concern is the a hyperactive thyroid (and/or nodules can cause cardiac damage if left untreated. I think your cardiologist was right on the mark.

I would absolutely get a surgical consult. I think the suggestion of an ENT is a great one.


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## Andros (Aug 26, 2009)

SUGGESTED TESTS
TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin and 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/
(Copy and paste into your browser)

TBII
http://www.ncbi.nlm.nih.gov/pubmed/9364248
http://en.wikipedia.org/wiki/Anti-thyroid_autoantibodies
(Copy and paste into your browser)

Blocking TRAbs (also known as Thyrotropin Binding Inhibitory Immunoglobulins (TBII)) competitively block the activity of TSH on the receptor. This can cause hypothyroidism by reducing the thyrotropic effects of TSH. They are found in Hashimoto's thyroiditis and Graves' disease and may be cause of fluctuation of thyroid function in the latter. During treatment of Graves' disease they may also become the predominant antibody, which can cause hypothyroidism.
Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/health-medicine/understanding-thyroid-why-you-should-check-your-free-t3
(Copy and paste into your browser)

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm
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Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.
Understanding Thyroglobulin Ab.
http://www.labtestsonline.org/understanding/analytes/thyroglobulin/test.html
(Copy and paste into your browser)

Thyroglobulin Ab and cancer
http://qjmed.oxfordjournals.org/content/59/2/429.full.pdf
(Copy and paste into your browser)

Another Thyroglobulin and cancer
http://www.mdlinx.com/endocrinology/newsl-article.cfm/3305021/ZZ5052128790304906121963/?news_id=811&newsdt=092010&subspec_id=419
(Copy and paste into your browser)

I hope you do see an ENT. She's not my doc but I don't like her. She is just skimming the surface w/you.

You need the FREES and Thyroglobulin and Thyroglobulin Ab lab tests. And most likely you need your thyroid out.

For your edification; if the FNA is not done in the right spot, something can be missed. So, cover your back!

Bless your heart; I am so sorry you are suffering like this.


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## Shzen (Oct 14, 2015)

joplin1975 said:


> The biggest concern is the a hyperactive thyroid (and/or nodules can cause cardiac damage if left untreated. I think your cardiologist was right on the mark.
> 
> I would absolutely get a surgical consult. I think the suggestion of an ENT is a great one.


At least my heart rate is under control now with medication. I will be seeing my new GP this Friday and see if he has an ENT he will refer me to.



Andros said:


> SUGGESTED TESTS
> TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin and Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.
> 
> You can look this stuff up here and more.........
> ...


Yeah, I don't like her either! lol

I will be requesting TSH, Free t4, t3 , TPO, and TSI this Friday. Would you recommend Reverse t3 as well? Am I missing anything?

Note: I am rereading what you have posted, Andros! I have it (tests to request) all written down now. I can't think very clearly.... I don't know how I missed that before! I will read through it again tomorrow.

Thank you for your kind words and help!


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