# New Test Results In - more confused/conflicted now...



## xroswellx (Aug 25, 2016)

Hello again! I finally received the results of the labs I requested and I am just as conflicted with what to do as before.

Quick back story of you are unfamiliar: In July 2015 had random tachycardia and palpitations start. Thyroid was tested and results were normal (listed in signature below). Put on propranolol for two months. then taken off and the tachycardia went away, kind of. Started a weird cycle of normal HR in the morning, slowly increasing to around 100 by mid-day, then slowly decreased around bedtime. Went on like that for a month or two, then stopped. Last bout of tachycardia was October 2015. December 2015 I found a lump on my next that appeared to come out of nowhere, front right side and felt like there was a golfball under my skin (size wise). Urgent care did TSH and FT4 tests, TSH was 0.09 (0.4-4.5). Had an ultrasound in January and "the right thyroid lobe measured 4.7 x 3.1 x 2.9 cm. The left thyroid lobe measured 3.7 x 1.4 x 1.4 cm. Large cystic focus with intraluminal debris and septations occupying the right thyroid lobe measuring 3.6 x 2.6 x 2.7 cm. No vascular flow. Within the right aspect of the thyroid isthmus a small hypoechoic nodule was identified measuring 6 x 9 x 6 mm. Within the left aspect of thyroid isthmus a 1.6x 0.8 x 1.6 cm solid nodule is identified. It is slightly hypoechoic. No abnormality identified in the left thyroid lobe." Referred to and endocrinologist. Bloodwork in April came back normal (also below). Thyroid Uptake & Scan showed heterogeneous isotope distribution with two areas of intense concentration (presumably where the nodules are?). Biopsy of nodules came back benign. Endo diagnosed as toxic multinodular goiter causing hyperthyroidism, recommended removal/destruction of thyroid. Met with the surgeon in June and the TT is scheduled for three weeks from today.

Back to now - I requested new bloodwork from my PCP because I feel fine and have had no symptoms of being hyper that I can tell for almost a year and am hesitant to have my thyroid removed if I feel fine.

TSH - 0.72 (0.4-4.5)

FT4 - 1.0 (0.8-1.8)

T3 Uptake - 21 (22-35%)

TSI - <89 (<140% baseline)

TPO (Antibodies) - 1 (<9)

TBII - 14 (< or = 16%)

Everything that I have read indicates that the results above do not indicate hyper, which leaves me even more conflicted. Two tests, five months apart are showing "normal" (at least non-hyper) results.


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## joplin1975 (Jul 21, 2011)

Well...

I wouldn't call them totally normal. You should have no TSI at all. TSI can wax and wane, which likely explains the changes in symptoms. It can also skew blood work results.

A TSI result of lower than 140% just means you don't have lab work for a clinical diagnosis of Grave's.

TSI is an insidious antibody that can really wreck havoc on your body. I still would be leaning toward a TT...but that's just me.


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## jenny v (May 6, 2012)

Have they done another ultrasound recently to see if those nodules have grown? Even if you are currently feeling well, you've got TSI and a low FT4, so you're probably going to wax and wane with symptoms. And if those nodules are growing, it can make surgery more complicated the longer you wait.


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## xroswellx (Aug 25, 2016)

They haven't. I haven't heard from my endo or surgeon since June.

I forgot to mention changes in the nodules. When first found the lump in December it was in the middle area of the neck (I found it while moisturizing) and now it seems to be lower, closer to my clavicle. I'd say it seems an inch or two lower. Based on how I described it to my PCP in December "By my feeling it seems about 3/4" by 1 1/4". " Feeling it now, it seems bigger (maybe 1" by 1 1/2"?).

The nodule is why I am still considering surgery (in addition to the scan showing it as "hot") I have realized that the feelings I've had in my throat that I always thought were normal, probably aren't. I get a "full" feeling in my throat every now and then, that feels like something is stuck. It's a weird pressure feeling that makes me a tad nauseous (like someone is putting pressure on my throat. Kind of like the pressure from the FNA.) There's also an occasional click sound/feeling when I swallow that goes away when I change neck positions.


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## joplin1975 (Jul 21, 2011)

xroswellx said:


> The nodule is why I am still considering surgery (in addition to the scan showing it as "hot") I have realized that the feelings I've had in my throat that I always thought were normal, probably aren't. I get a "full" feeling in my throat every now and then, that feels like something is stuck. It's a weird pressure feeling that makes me a tad nauseous (like someone is putting pressure on my throat. Kind of like the pressure from the FNA.) There's also an occasional click sound/feeling when I swallow that goes away when I change neck positions.


Yup, that's pretty normal for having an abnormal nodule!


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## jenny v (May 6, 2012)

Honestly, it's up to you. It's your neck and thyroid, lol!

But in my opinion, I would keep the surgery date. The nodules are growing, you've got antibodies which can make it harder to stabilize (your immune system is fighting your thyroid and that won't stop), you're having physical symptoms (all of which I had when my thyroid was growing back into my neck), and they won't get better over time.

Do you feel comfortable with the surgeon? Does he do a lot of thyroid surgeries?


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## Lovlkn (Dec 20, 2009)

I would do the surgery. 
At one point during my treatment I showed " normal" on antibodies but that was short lived.

Your thyroid sounds like it may be growing. Thyroid disease can flair and sometimes appear normal - it cycles and will likely continue to do so
In your case.


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## xroswellx (Aug 25, 2016)

Thanks for all of the advice.

I've asked for a follow-up ultrasound, scheduled for next week. Based on how the nodule feels to the touch I imagine is has grown quite a bit.


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## xroswellx (Aug 25, 2016)

And the confusion continues...

I don't have the official report yet, but the summary I was given over the phone was that there are nodules (duh) but there is no change since January.

:confused0006:


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## joplin1975 (Jul 21, 2011)

You might have overall thyroid swelling (which is common). When you get a copy of the report, look to see what the say is the overall thyroid volume or measurements.


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## xroswellx (Aug 25, 2016)

I posted on another board and a woman there suggested that, given my history and TSI level, that I may have Graves and that it is currently in remission - does that sound likely/plausible?

Does it matter to know that my mother has an auto-immune disease (myasthenia gravis)?


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## xroswellx (Aug 25, 2016)

Official results are in. I'm posting the full original and full follow up for comparison.

1/12/2016

"Indication: Lump in throat, lump in right side throat since 26 December
2015

Comparison: None

Findings:

The right thyroid lobe measured 4.7 x 3.1 x 2.9 cm. The left thyroid lobe
measures 3.7 x 1.4 x 1.4 cm. Large cystic focus with intraluminal debris
and septations occupying the right thyroid lobe measuring 3.6 x 2.6 x 2.7
cm. No vascular flow. Within the right aspect of the thyroid isthmus a
small hypoechoic nodule was identified measuring 6 x 9 x 6 mm. Within the
left aspect of thyroid isthmus a 1.6x 0.8 x 1.6 cm solid nodule is
identified. It is slightly hypoechoic. No abnormality identified in the
left thyroid lobe

Impression:

1. 3.6 x 2.6 x 2.7 cm complex cystic structure with septations in
intraluminal debris within the right thyroid lobe

2. 2 solid nodules the thyroid isthmus. The larger of the 2 nodules
measures 1.6 x 0.8 x 1.6 cm. Consider FNA of this larger solid nodule ..
Otherwise recommend ultrasound follow-up in 6 months ."

10/12/2016

"Clinical history: Lump in the throat. Abnormal thyroid tests.

Comparison: Comparison is made with prior dated 01/12/2016.

Findings:

Directed grayscale sonographic evaluation of the thyroid is performed
with color Doppler interrogation. Right thyroid is enlarged measuring 6.1
x 3.1 x 2.6 cm. Within the right thyroid there is a large cystic nodule
with peripheral septation and density measuring 2.7 x 2.5 x 1.7 cm. There
is also a solid nodule with mild color flow adjacent to it measuring 1.6
x 1.4 x 1.5 cm. A smaller nodule is seen on the right as well near the
midline measuring 6.2 x 5.2 mm with overlying color flow. No lesion deep
to the right thyroid. Left thyroid measures 3.6 x 1.5 x 1.2 cm with a
small 0.81 x 0.72 x 0.48 mm nodule which appears solid with overlying
color flow. There is also a nodule with peripheral color flow within the
isthmus measuring 1.3 x 0.75 cm which is solid.

Impression:

1. Solid nodule is noted adjacent to a large more cystic lesion within
the right thyroid. Cystic septated nodule appears unchanged and is large.
However, the more adjacent solid nodule was less well appreciated on the
prior though does appear to have been present. This does not appear
significantly changed. There is also a smaller nodule on the right which
appear similar.

2. Solid nodule on the left is unchanged and there is a solid nodule
within the isthmus also unchanged. If not already performed, FNA should
be considered of the larger solid nodules though the 1 on the right may
be technically difficult due to its medial position and deep location.
Otherwise, ultrasound follow-up in 6 months would be recommended.
Details, as above."


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