# Graves and Hashimoto with multiple nodules



## katbid23 (Oct 20, 2010)

Hello, I'm new here so I hope I am doing this right. I am a 45 year old female and experiencing hyper and hypo symptoms. Well only weight gain on the hypo side. All other symptoms are from the hper side. I am posting my Ultra Sound and lab results. 
US: The right lobe measure 1.3x5.1x1.3 cm. The left lobe measures 2.3x4.9x2.3cm. The isthmus measures 3mm. Both lobes and the isthmus demostrate uniform echotexture. There is a 6mm hypoechoic solid nodule centered in the right lobe.There are two large nodules within the left thryoid lobe. The larger, more superior lesion measures 2.0x2.1x2.2 cm and is a mixed cystic and solid not nodule. The slightly smaller, more inferior nodule is an extirely solid isoechoic mass that measures 1.6x1.5x1.4cm. No abnormal vascularity. No suspicious calcifications.

Blood work: 
Bun/Creatinine 34 ref range 8-27 
T4 Free 1.38 ref range 082-1.77 
TSI: 213 ref range 0-139 
TSH: 0.006 ref range .450-4.5 Test done in June was TSH of 0.01 
Thyroid peroxidase TPO: 35 ref range 0-34

I just had an uptake done and go back to my endo on the tomorrow for results. When I last saw the endo he told me that I have Graves and Hashimoto and called it hashitoxicosis. But he still says I am hyperthyroid. I don't understand all of this. I have symptoms of both hypo and hyper.

I am not on any thyroid meds and never have been.

What kind of questions should I be asking at my next vist? What type of treatment will I be looking at?

Thanks


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## nikimcn (Oct 16, 2010)

Hi there.
I'm just as new here as you 
I have just been dx with Hashimoto's disease~only~for now.
I go to the endo dr on nov 9th.
i'm picking up some lab tests today to share with the group here as well.
i have multiple nodules on my thyroid as well.
i'm 38.
our problems sound similar.:hugs:


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## katbid23 (Oct 20, 2010)

Good Luck and please post your results. I really don't understand all of this and I seem to be more confussed everytime I go to the Endo. Whenever I ask a question he pats my leg and tells me not to worry. Hard not to worry when he starts our conversation with "bad news" and "your results are very unusual"...


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## McKenna (Jun 23, 2010)

Hi and welcome!

Well, you're definitely hyper and it's good you're not on thyroid hormone. Has he talked about giving you anti-thyroid meds?

Nasdaqphil, the site owner, wrote an article on hashitoxicosis. I found it very helpful and I'm sure you will too:
http://www.thyroidboards.com/hashitoxicosis/

I wish you well on your appointment tomorrow.


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## Andros (Aug 26, 2009)

katbid23 said:


> Hello, I'm new here so I hope I am doing this right. I am a 45 year old female and experiencing hyper and hypo symptoms. Well only weight gain on the hypo side. All other symptoms are from the hper side. I am posting my Ultra Sound and lab results.
> US: The right lobe measure 1.3x5.1x1.3 cm. The left lobe measures 2.3x4.9x2.3cm. The isthmus measures 3mm. Both lobes and the isthmus demostrate uniform echotexture. There is a 6mm hypoechoic solid nodule centered in the right lobe.There are two large nodules within the left thryoid lobe. The larger, more superior lesion measures 2.0x2.1x2.2 cm and is a mixed cystic and solid not nodule. The slightly smaller, more inferior nodule is an extirely solid isoechoic mass that measures 1.6x1.5x1.4cm. No abnormal vascularity. No suspicious calcifications.
> 
> Blood work:
> ...


Hi and welcome to the board. You are not both. TSI is definitive for hyperthyroid. Many,myself included, gained weight whilst hyper. Symptoms sometimes cross over.

Solid is not good. As far as I am concerned, that is analogous to calcifications. I sincerely hope you are going to have FNA (fine needle aspiration) of those nodules.

Sadly, hyper and cancer are often found together. So, please press for FNA.

Here is info about nodules
http://www.aafp.org/afp/2003/0201/p559.html

Part of your thyroid is really not looking so great.

Please keep us in the loop re all of this.


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## katbid23 (Oct 20, 2010)

Thank all of you very much. I have read the two links that were mentioned and they were the most informative that I have found so far. I will post my results from the Uptake tomorrow on Friday. I'm sure he is going to want to do the FNA... I am not looking forward to that at all. I heard it is painful.


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## Andros (Aug 26, 2009)

katbid23 said:


> Thank all of you very much. I have read the two links that were mentioned and they were the most informative that I have found so far. I will post my results from the Uptake tomorrow on Friday. I'm sure he is going to want to do the FNA... I am not looking forward to that at all. I heard it is painful.


For some it is and for some not. I will pray not in your case. Most describe it as a "pinch!" I never had it so don't count on me. LOL!

Others will chime in, I am sure.

Please let us know when the FNA is scheduled. This way we can send out thoughts (and what have you) with you.


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## McKenna (Jun 23, 2010)

I would definitly push for the FNA. Don't wait on the doctor to suggest it. My experience, and many others on here, has been that you need to be proactive with doctors regarding thyroid issues.

The FNA is uncomfortable, but over pretty quickly. They will most likely give you a shot to numb the area. That needle is small. The biopsy needle is larger so if you are squeemish about needles, don't look when the bring it out. You will feel some pinching and a lot of pressure. They need to push it in and out a few times to get samples. When it's over, they put a bandaid over the area and you can go home to ice it. You might have some slight bruising in the area, just like how you can get some slight bruising when blood is taken from your arm.

I'm curious as to how your doc came to the conclusion that you have Hashi's? Did you have prior labs that showed hypo?


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## greatdanes (Sep 25, 2010)

Wow, you have some doctors who don't want to admit to Hashitoxicosis then we have one that uses the word loosely without even doing an antithyrogblubin test? Intersting. Also note that 75% of hypoechoic solid nodules are found to be benign. Still get a FNA but no reason to get worked up without having results( not sayin u are)


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## GD Women (Mar 5, 2007)

greatdanes said:


> Wow, you have some doctors who don't want to admit to Hashitoxicosis then we have one that uses the word loosely without even doing an antithyrogblubin test? Intersting.


In the defense of most doctors: antibodies are not always necessary to diagnose Graves' or Hashi. A savvy doctor knows how to read thyroid test and can tell which autoimmune disease a person has. If a doctor is unsure due to other health issue that look like thyroid, even symptoms as well as levels, then antibodies are done to confirm what the doctor possibly already knows or to differentiate thyroid from other (autoimmune) diseases. However, the doctor needs to test the FTs as well as TSH.


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## katbid23 (Oct 20, 2010)

Well not to good news. My uptake showed Photopenia (cold nodule) and the thyroid uptake was 45% with normal being 10-30. He is not doing an FNA and does not think RAI would be bennificial. He wants to do a total thyroidectomy. I am suppose to start taking 90mg of Tapazole today with repeat labs in 5 weeks. He said that I he has to get me out of the hyper stage before surgery can be performed. I don't know, I'm really scared and don't know what to do. I haven't taken my first dose yet because I'm actually contiplating "doing nothing". I'm scared to take the drug because of possible side effects. I'm afraid to have a total thyroidectomy. I'm in the Army reserves and I am also full time civilian for the Army. If they kick me out of the reserves, I will loose my civilian job too. I just don't know what to do at this point. I don't want to blow up like a balloon either. I asked the dr why he couldn't just remove the nodule or do a partial. He said that the nodule would probably come back. Final DX was Graves with Toxic Multinodule Goiter. So my question is? What happens if I do nothing? My blood pressure is fine and I haven't lost weight. My main complaint right now is I just have the shakes. I can live that. I saw an ophthamologist and he said my eyes are fine. He said I may have a little problem with the muscle in my left eye but it wasn't anything serious. He also told me that if I have a total, that it could make my eyesight a lot worse. He said I should go on steriods two weeks before the surgery. I'm so lost right now and even though I do have support from my family, I feel alone.


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## McKenna (Jun 23, 2010)

I'm sorry you have to go through this, but it's good you got a diagnosis. It's your decision to have surgery or not, but I wanted to tell you that I don't think the surgery would cost you your job or lifestyle. I'm scheduled for a TT next week and the recovery is not long and replacement meds will be started soon after. Many people go on to have their thyroids removed and do very well. I personally have two friends that don't have a thyroid and they are doing fantastic. They both work full time jobs and neither are overweight in the slightest.

I don't think Graves is something you can just "let go". Damage can be done to your heart, eyes and other areas by remaining in a hyper state for so long. If you feel you want to try the anti-thyroid meds first, then make sure you get a FNA of the nodule. Cold nodules can mean cancer. I have a cold one too, which is part of the reason I want it out.

I wish you well in whatever you decide.


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## greatdanes (Sep 25, 2010)

katbid23 said:


> Well not to good news. My uptake showed Photopenia (cold nodule) and the thyroid uptake was 45% with normal being 10-30. He is not doing an FNA and does not think RAI would be bennificial. He wants to do a total thyroidectomy. I am suppose to start taking 90mg of Tapazole today with repeat labs in 5 weeks. He said that I he has to get me out of the hyper stage before surgery can be performed. I don't know, I'm really scared and don't know what to do. I haven't taken my first dose yet because I'm actually contiplating "doing nothing". I'm scared to take the drug because of possible side effects. I'm afraid to have a total thyroidectomy. I'm in the Army reserves and I am also full time civilian for the Army. If they kick me out of the reserves, I will loose my civilian job too. I just don't know what to do at this point. I don't want to blow up like a balloon either. I asked the dr why he couldn't just remove the nodule or do a partial. He said that the nodule would probably come back. Final DX was Graves with Toxic Multinodule Goiter. So my question is? What happens if I do nothing? My blood pressure is fine and I haven't lost weight. My main complaint right now is I just have the shakes. I can live that. I saw an ophthamologist and he said my eyes are fine. He said I may have a little problem with the muscle in my left eye but it wasn't anything serious. He also told me that if I have a total, that it could make my eyesight a lot worse. He said I should go on steriods two weeks before the surgery. I'm so lost right now and even though I do have support from my family, I feel alone.


I've been a military dependent for 38 yrs, born into it, then married into it-AF-Army. Having a TT is not grounds for discharge, in fact a lady in my husbands company had a TT due to cancer 3 yrs, and she is still in.


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## katbid23 (Oct 20, 2010)

Thank you so much for your reply. I do feel better knowing that my career won't be in danger. I have been in 26 years and it is a way of life that I don't want to give up yet. Thank you for sharing your personal knowledge.


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## katbid23 (Oct 20, 2010)

Good luck McKenna on your TT. Please let me know how it goes. I hope it goes well for you. Did you have to take Tapazole before the surgery?


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## McKenna (Jun 23, 2010)

No, I'm not on tapazole. I'm hypo right now and on thyroid meds. I was hyper a few months ago when my TSI shot up, and I got put on beta blockers for the heart palps.

Have you decided to go ahead with the tapazole? I don't have any experience with anti-thyroid meds, but I'm sure if you look around on the Graves forum here you can see some personal experiences.

Hang in there! I know it's scary, but it really is a good thing when you start finding out what's wrong and make moves to correct it.


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## Andros (Aug 26, 2009)

katbid23 said:


> Well not to good news. My uptake showed Photopenia (cold nodule) and the thyroid uptake was 45% with normal being 10-30. He is not doing an FNA and does not think RAI would be bennificial. He wants to do a total thyroidectomy. I am suppose to start taking 90mg of Tapazole today with repeat labs in 5 weeks. He said that I he has to get me out of the hyper stage before surgery can be performed. I don't know, I'm really scared and don't know what to do. I haven't taken my first dose yet because I'm actually contiplating "doing nothing". I'm scared to take the drug because of possible side effects. I'm afraid to have a total thyroidectomy. I'm in the Army reserves and I am also full time civilian for the Army. If they kick me out of the reserves, I will loose my civilian job too. I just don't know what to do at this point. I don't want to blow up like a balloon either. I asked the dr why he couldn't just remove the nodule or do a partial. He said that the nodule would probably come back. Final DX was Graves with Toxic Multinodule Goiter. So my question is? What happens if I do nothing? My blood pressure is fine and I haven't lost weight. My main complaint right now is I just have the shakes. I can live that. I saw an ophthamologist and he said my eyes are fine. He said I may have a little problem with the muscle in my left eye but it wasn't anything serious. He also told me that if I have a total, that it could make my eyesight a lot worse. He said I should go on steriods two weeks before the surgery. I'm so lost right now and even though I do have support from my family, I feel alone.


Honey bunny; Your doc is doing the right thing by you. It would be far worse to have cancer and leave it untreated.

Surely you have someone in the Reserves to whom you can talk about your medical situation and possible temporary leave?

Keeping you in my thoughts and prayers here.

And by the way, anything can trigger the eye infiltration. There are absolutely no guarantees no matter which way you go. And he too is a good one; yes................you go on steroids prior to the surgery. In many many cases this has been "preventive!"

Also; consider this.........................leaving your hyperthyroid untreated could eventually render you completely unable to do your job. Just give it some thought.

We are here for you and will support whatever you decide to do.


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