# Multinodular Goiter with Normal blood tests and scan.



## ladybrittain

Hello,

I'm new to this site and would like to know if anyone has ever dealt with this issue. This of course happens after I've been complaining forever. Also, let me add I've gone into full blown menopause and it seems my issues have gotten worse over the months. I'm on HBP medicine, anti-depressants and premarin.

When I went for my check-up my doctor noticed a lump on my neck and sent me for a thyroid ultrasound. These were the results:
Thyroid is homogeneous echotexture. Right Lobe measures 5.7 x 1.6 x 1.7 cm, the left lobe measure 4.5 x 1.0 x 1.7 cm Several bilateral thyroid nodules are identified., 2 of them hypoechoic versus cyst measuring about 0.3 x 0.2 x 0.3 cm, one cystic measuring 0.8 x 0.3 x 0.5, 2 regular nodules 0.6 x 0.3 x 0.6 cm and one more cystic nodule 0.8 x 0.3 x 0.5. There were a total of 6 nodules identified. The isthmus measures 3 mm in maximal AP diameter.

So afterwards she sent me for a thyroid uptake and scan. The findings were:
There is physiological tracer distribution in the thyroid gland which has a normal size, shape and location. The nodules described on the recent ultrasound are not visualized by this scan. I find that hard to believe, I see my swollen throat and nodules daily now. Plus my throat feels like something is stuck in it and I have swallowing problems and shortness of breath. I'm so tired all the time with dry skin, and hacking cough. I've gained weight while exercising, etc... I have all the symptoms of hypothyroidism and some hyper back and forth. All my blood tests also came back normal.

My TSH was 1.6 and the other panels were as follows:
T4 Thyroxine 10.1
Free T4 Index (T7) 2.7
Free T4 1.1
T3, Total 113
T3 uptake 27
Thyroid Peroxidase
Antibodies <10
Thyroglobulin Panel
Antibodies <20
Thyroglobulin 21.3

I don't know what any of this means. I can't for the life of me understand how a scan can come back normal and not see any enlargement or nodules. My doctor wants me to go to the surgeon and get it taken out since it is so large and I'm having the symptoms. I'm so confused right now and I'm just in tears cause they can't tell me anything more. Could my tests have been done wrong? I've set up an appointment Monday with an Endocrinologist. So I can hardly wait. In the meantime I'm just worn out and miserable, I'm just in tears about it. Does it sound like I could have thyroiditis? This has been going on for awhile and when I complained my doctor would just say I was not drinking enough water that is why my throat is so red. I'm not going back to her after this. I just need someone to talk to about this, I feel like a crazy woman right now. Thank you for listening.

ladybrittain
Thyroid Newbie


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## GD Women

People can have thyroid nodules without being thyroid.

Nodules your size and causing issues should be taken out.

Once out you WILL become thyroid/hypo.


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## ladybrittain

Thank you for responding GD Women. Would my goiter be causing my issues if all the tests are normal, as far as tiredness, dry skin, brain fog, etc... I was told once I had very high calcium, but my doc ran another test and it came down. She thought I might have a parathyroid problem, but when she reran the test it was down again. Maybe the new doc Monday will go a different route. I just wanted to try medicine to see if they would shrink before going under the knife. I guess I will just have to be patient and wait to see what this doctor says. Thanks for your help.


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## GD Women

Thyroid Ultrasound, thyroid uptake and scan will not tell if a nodule is benign or malignant.

Needle Biopsy or Fine Needle Aspiration is not recommended by some medicals because suspicious thyroid tumor/nodules in the gland can felt on physical exam alone. http://www.thyroidcancer.com/thyroid_tests.htm
And may be the reason your doctor suggest surgery.

Thyroid suppression by medication has been found not to work once off the medication. So you will be waisting precious health and healing time.

The vast majority of thyroid nodules do not cause symptoms. When levels are normal symptoms might be from other health issues that mimic or share thyroid symptoms. Full blown menopause is a classic.

Excess TBG or low levels of TBG are found in some families as an hereditary trait. It causes no problem except falsely elevating or lowering thyroid levels. Thereby people are frequently misdiagnosed as being hyperthyroid or hypothyroid, but they have no thyroid problem and need no treatment.

It would also help to know your Labs reference range to determine what might be going on.


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## Andros

ladybrittain said:


> Thank you for responding GD Women. Would my goiter be causing my issues if all the tests are normal, as far as tiredness, dry skin, brain fog, etc... I was told once I had very high calcium, but my doc ran another test and it came down. She thought I might have a parathyroid problem, but when she reran the test it was down again. Maybe the new doc Monday will go a different route. I just wanted to try medicine to see if they would shrink before going under the knife. I guess I will just have to be patient and wait to see what this doctor says. Thanks for your help.


Sonograms miss a lot; a radioactive uptake scan would have been a better choice.

Here is info and welcome to the board.......

Ultra-sound limitations

http://www.radiologyinfo.org/en/info.cfm?pg=us-thyroid


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## ladybrittain

Thanks for replying Andros.

I did do a thyroid uptake scan it came back normal and couldn't detect the nodules and also said my thyroid was normal size. I'm baffled by that and think maybe the test was incorrect or something happened. I listed the size of my goiter and it is still there (big) with me being able to see one of the nodules. GD Women I've added my ranges below in parenthesis.

My TSH was 1.69 (I don't have the range for this) and the other panels were as follows:

T4 Thyroxine 10.1 (4.5-12.5)
Free T4 Index (T7) 2.7 (1.4-3.8)
Free T4 1.1 (0.8-1.8)
T3, Total 113 (76-181)
T3 uptake 27 (22-35)
Thyroid Peroxidase
Antibodies <10 (<35)
Thyroglobulin Panel
Antibodies <20 (<20)
Thyroglobulin 21.3 (2.0-35.0)

My calcium was very high (my doctor said) the time before this one and now it is 9.99 which is approaching the high end and from what I've read it will go up and down and I have all the systems for hyperparathyroidism. My husband say's I've really been mean the last couple of months and this talks about how it affects your attitude and my bones/tendons are always in pain so I put it off to my fibromyalgia. Maybe it is all connected, I will have lots of questions for the doctor on Monday.


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## Andros

ladybrittain said:


> Thanks for replying Andros.
> 
> I did do a thyroid uptake scan it came back normal and couldn't detect the nodules and also said my thyroid was normal size. I'm baffled by that and think maybe the test was incorrect or something happened. I listed the size of my goiter and it is still there (big) with me being able to see one of the nodules. GD Women I've added my ranges below in parenthesis.
> 
> My TSH was 1.6 and the other panels were as follows:
> T4 Thyroxine 10.1 (4.5-12.5)
> Free T4 Index (T7) 2.7 (1.4-3.8)
> Free T4 1.1 (0.8-1.8)
> T3, Total 113 (76-181)
> T3 uptake 27 (22-35)
> Thyroid Peroxidase
> Antibodies <10 (<35)
> Thyroglobulin Panel
> Antibodies <20 (<20)
> Thyroglobulin 21.3 (2.0-35.0)
> 
> My calcium was very high (my doctor said) the time before this one and now it is 9.99 which is approaching the high end and from what I've read it will go up and down and I have all the systems for hyperparathyroidism. My husband say's I've really been mean the last couple of months and this talks about how it affects your attitude and my bones/tendons are always in pain so I put it off to my fibromyalgia. Maybe it is all connected, I will have lots of questions for the doctor on Monday.


Do you have the report from the radioactive uptake? Did the radiologist include any "remarks"which they always do? What was the rate of your uptake, did they tell you?

You do have antibodies indigenous to thyroid and even though some of them are in the "less than" range, this does indicate that something is afoot.


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## ladybrittain

It was an oral pill of I-123

Rate of uptake was 11.5% at 4 hours and 24.5% at 24 hours. (ref.range: 4 hours 5-15% and 24 hrs 10 to 25%

There is physiological tracer distribution in the thyroid gland which was a normal size, shape and location. The nodules described on the recent ultrasound are not visualized by this scan.

That is all I see. I don't understand it. Even the nurse said she doesn't understand how it didn't pick up the size of the goiter. Could it be a mistake?


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## Andros

ladybrittain said:


> It was an oral pill of I-123
> 
> Rate of uptake was 11.5% at 4 hours and 24.5% at 24 hours. (ref.range: 4 hours 5-15% and 24 hrs 10 to 25%
> 
> There is physiological tracer distribution in the thyroid gland which was a normal size, shape and location. The nodules described on the recent ultrasound are not visualized by this scan.
> 
> That is all I see. I don't understand it. Even the nurse said she doesn't understand how it didn't pick up the size of the goiter. Could it be a mistake?


Something is wrong somewhere as I am sure you have seen other's reports of RAIU on this board and the radiologist always gives measurments of the R lobe, L lobe, isthmus and so on. Plus much more.

Maybe you should call the radiologist that did the scan and inquire? I am wondering? That is totally strange.

I am with you; it is mystifying.


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## ladybrittain

Yes I have seen other peoples tests. That is why I'm so confused. I'm so glad that you agree with me. Everyone I talk to about it thinks it is strange. I can tell you that the guy that was doing the test was having some issues with his machine. He kept turning it off and having to start again. Unfortunately, I don't know the radiologist it was at one of the hospitals that my pcp sent me to. This is why I decided to go to an endocrinologist. My appointment is Monday morning and I will definitely be keeping you posted. I just know I feel awful. Today is definitely not a good day for me. Also, I don't see Free T3 on my results is one of those T3 Total or T3 Uptake a Free T3? All of this is very confusing to me.


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## Andros

ladybrittain said:


> Yes I have seen other peoples tests. That is why I'm so confused. I'm so glad that you agree with me. Everyone I talk to about it thinks it is strange. I can tell you that the guy that was doing the test was having some issues with his machine. He kept turning it off and having to start again. Unfortunately, I don't know the radiologist it was at one of the hospitals that my pcp sent me to. This is why I decided to go to an endocrinologist. My appointment is Monday morning and I will definitely be keeping you posted. I just know I feel awful. Today is definitely not a good day for me. Also, I don't see Free T3 on my results is one of those T3 Total or T3 Uptake a Free T3? All of this is very confusing to me.


Aaaaaaaaaaaaaaaaaaaaaw; {{{{ladybritain}}}} Many of us know and understand how hard it is to be ill and try to advocate for one's self at that same time.

Monday can't come soon enough and I know you feel the same. I hope the endo is a good one and toss in a bit of caring too. You need a good doc right now.


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## GD Women

ladybrittain said:


> Also, I don't see Free T3 on my results is one of those T3 Total or T3 Uptake a Free T3? All of this is very confusing to me.


Neither are. But T3 total will suffice.

RAIU evaluation of thyroid function. It can also find areas of the thyroid gland that are overactive or underactive. RAIU helps doctor to know if the thyroid gland is working properly, find the cause of an overactive thyroid gland and plan the treatment for hyperthyroidizm. As well as, distinguished early Hashi, hyperthyroidism, goiter, hypothyropidism, iodine over load, subscute thyroiditis, colloid nodular goiter, Graves Disease, Painless (silent) thyroiditis and toxic nodular goiter

A thyroid scan can show the size, shape, and location of the thyroid gland. It can also find areas of the thyroid gland that are overactive or underactive. The camera takes pictures of the thyroid gland from three different angles.

Normally RAIU and SCAN are done together at the same time.


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## rukiddingme

Hey, ladybrittain -

I saw your post, and have been watching the boards for a few weeks, and figured since we have something in common, that I should join the boards and reply

I went in for an MRI on my upper back about a month ago. I have spondylitis, so they were looking for arthritis in my back. What they found was a huge goiter in my neck. Long story short, I went to an endo, got labs, sonogram, biopsies and uptake done. My end said prior to results on uptake test that he usually saves surgery for last, he felt that it would be the first recommendation for me. *He said that he didn't think the goiter would absorb the iodine* for the uptake scan. Also, if you are hyperthyroid, he said that the iodine won't absorb as much, and if you are hypothyroid it absorbs a lot. Uptake scan came back and luckily for me, it absorbed over 70%. So, I don't have to have surgery and the doc is using RAI to dissolve the goiter. He diagnosed me with Hashimoto's. I go hypo and hyper. *My blood tests for thyroid have always cone back normal, also.*. And a month after RAI, my blood tests are still normal. I have to go in every month until my thyroid tests aren't normal anymore. The RAI will probably destroy my thyroid. Good luck with everything, and I am glad you decided to see an endo!


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## Andros

rukiddingme said:


> Hey, ladybrittain -
> 
> I saw your post, and have been watching the boards for a few weeks, and figured since we have something in common, that I should join the boards and reply
> 
> I went in for an MRI on my upper back about a month ago. I have spondylitis, so they were looking for arthritis in my back. What they found was a huge goiter in my neck. Long story short, I went to an endo, got labs, sonogram, biopsies and uptake done. My end said prior to results on uptake test that he usually saves surgery for last, he felt that it would be the first recommendation for me. *He said that he didn't think the goiter would absorb the iodine* for the uptake scan. Also, if you are hyperthyroid, he said that the iodine won't absorb as much, and if you are hypothyroid it absorbs a lot. Uptake scan came back and luckily for me, it absorbed over 70%. So, I don't have to have surgery and the doc is using RAI to dissolve the goiter. He diagnosed me with Hashimoto's. I go hypo and hyper. *My blood tests for thyroid have always cone back normal, also.*. And a month after RAI, my blood tests are still normal. I have to go in every month until my thyroid tests aren't normal anymore. The RAI will probably destroy my thyroid. Good luck with everything, and I am glad you decided to see an endo!


Hi there and welcome! When will you have your RAI? I think you are hyper, not hypo.

Hypothyroid patients usually take up too little iodine and hyperthyroid patients take up too much iodine. The test is performed by giving a dose of radioactive iodine on an empty stomach. The iodine is concentrated in the thyroid etc..

http://www.endocrineweb.com/tests.html

It might be wise to have TSI (thyroid stimulating immunoglobulin) lab before you have RAI. This will determine hyper if any TSI is present. You should have none. If you do, you are hyper.

In any case, RAI would be the way to go as long as you agree that is what you wish to do.

Have you had any of the 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/understanding/conditions/thyroid.html

Once again, welcome!


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## rukiddingme

Andos - I keep getting confused! Thanks for the clarification I took RAI last month. So, right now, I guess I am in the waiting period to see how much of my thyroid gets destroyed... All I know for sure is that I have been feeling really terrible for a looong time, and am hoping this will help- especially with the fatigue! It's hard keeping up with my 4 and 5 year old! I have been feeling better this past month, so hopefully, it's shrinking. The goiter is/was moving a nerve bundle and I fringing on my treachea. I was really out of breath all the time and seem to be doing better, now. 
I guess I am confused about the whole hash/graves thing. Is it possible to be both and isn't this weird that my blood tests are normal?


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## Andros

rukiddingme said:


> Andos - I keep getting confused! Thanks for the clarification I took RAI last month. So, right now, I guess I am in the waiting period to see how much of my thyroid gets destroyed... All I know for sure is that I have been feeling really terrible for a looong time, and am hoping this will help- especially with the fatigue! It's hard keeping up with my 4 and 5 year old! I have been feeling better this past month, so hopefully, it's shrinking. The goiter is/was moving a nerve bundle and I fringing on my treachea. I was really out of breath all the time and seem to be doing better, now.
> I guess I am confused about the whole hash/graves thing. Is it possible to be both and isn't this weird that my blood tests are normal?


That is why the antibodies' tests are so important because you can have thyroid panel in normal range yet be terribly sick.

When are you due for labs? 
Are you on Thyroxine replacement yet? Do you feel the goiter shrinking?

Hashi's and Graves' are close relatives. To my knowledge, the only real test for Hashi's is FNA whereupon if certain Hurthle cells are present which are indigenous to Hashi's then it is positive that you have Hashi's.

Stick around; there is lots and lots of knowledge and experience here!


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