Help with Lab Results and Imaging Tests

[JMC72]

Hi.
New to the forum.
Family history of goiters, Hashis, Low Thyroid.

I had an US in November. They found a tiny cyst and originally said my thyroid was homogeneous but I had a second opinion done and after reading the SAME images, they found my glands to be HETEROGENEOUS.

I also have a nodule or tiny bumps in the area that apparently only I can feel, (my doctor said the lump I feel is "PROBABLY" a swollen gland and WILL NOT send me for a repeat US because she doesn't feel anything and says I just had one even though I told her that this wasn't there then.

I am also confirmed to have enlarged lymph nodes in the neck from 2 previous CT Scans done NINE MONTHS APART. They are not going away. The problem is they too are being ignored because they do not meet the CT requirements of lymphadenopathy since they are all around 1.3cm and not larger.

My labs are VERY confusing so I was hoping for an opinion.

TSH
DEC 2009 - 1.72
DEC 2010 - 2.77
NOV 2011 - 2.86
DEC 2011 - 9.10 - ?
JAN 2012 - 3.93

T4
DEC 2011 - 8.35
JAN 2011 - 8.00

FREE T4
DEC 2009 - 0.88
NOV 2011 - 0.80
DEC 2011 - 0.87

TOTAL T3
DEC 2011 - 201 (H)

THYROGLOBULIN      
JAN 2011 - 46.0  (H)

TPO
JAN 2011 - 69.0 (H)

TSI
JAN 2011 - 28%

I understand that the levels are too low to be Hashis or Graves, per my doc but when I was tested one year ago TPO was < 10 & Thyro AB was < 20.

I also have clinical symptoms of Thyroid Eye disease so is that still possible even though bloodwork doesn't show Graves?
Since my primary & endo only dx on LAB RESULTS do I need to go to an opthamologist to be diagnosed? I think you can have thyroid eye disease and not have Graves, not sure.

I have EXTREME fatigue, dyspnea, dsyphagia, hoarseness and I realize that a tiny cyst would not cause this but I just know something is not right. Since the US, my labs as well as my symptoms have totally progressed.

Any comments would help.

Thank you.

[Mark Lupo, M.D.]

Heterogeneity on ultrasound combined with the positive thyroperoxidase antibody and the borderline TSH levels are all consistent with an autoimmune thyroiditis due to Hashimoto's.  The high total T3 most commonly in the setting would be due to estrogen containing birth control pill.  Reactive lymph node enlargement is not uncommon with Hashimoto's.  It is probably worthwhile seeing an endocrinologist for consultation, preferably one who does his/her own ultrasound in the office to further clarify the situation.

[JMC72]

Thank you. I appreciate your response and will find another endo...

      "The high total T3 most commonly in the setting would be due to estrogen containing birth control pill."
I am not on the pill, or anything like it... I had a Tubal Ligation in 2009... does this change anything about my T3 results?

Thanks!!!