A goiter and nodule almost 2cm on CT. TSH, antibodies normal?

[Tiredgirl68]

A goiter was seen on a CT scan with a lone nodule that is almost 2cm. TSH was normal at 1.000. Antibodies- Peroxidase normal at 12, thyroglobulin normal at <1.0. The doctor didn’t test any other thyroid levels. I am having almost every symptom for low thyroid. Can you have a normal thyroid function and have a goiter and nodule? What is going on?

[gimel]

Well, your Dr. is totally wrong, and very unlikely to change if he still believes that.   There is extensive scientific data showing that, except at extreme levels beyond their reference ranges, TSH has only a very weak correlation with Free T4 or Free T3, and a negligible correlation with TISSUE  T3 EFFECT, which determines your thyroid status.   This is due to the numerous variables involved that affect TISSUE T3 EFFECT.  So how is TSH supposed to be the only diagnostic needed, if it cannot even be used as a reliable surrogate for the active thyroid hormones,  FT4 or FT3 levels, much less the other variables that are so important?  The easy answer is that it cannot and does not.  Period.  
  
You can find this info through my Journal, from which I suggested reading at least the one page Overview that also includes a link to the full paper.   You need a good thyroid doctor and that does not necessarily mean an Endo.   As I mentioned we will be happy to try and help locate a good thyroid doctor if you will give us your location.  

[gimel]

There are other members who can give you good insight on the ultrasound results.  I just wondered if you have been able to get the recommended testing done, and if so, please post results and their reference ranges shown on the lab report.

[Tiredgirl68]

No. Dr says my TSH and antibodies tests are normal, and “that’s all you need”...

[gimel]

To confirm for yourself that those symptoms are not just age related, I suggest that you use the following link and check any symptoms you have and then tell us the score at the bottom, that is automatically calculated for you.

You should be aware that being an Endocrinologist does not guarantee a good thyroid doctor.  Most of them specialize in diabetes, not thyroid.  Most also have the "Immaculate TSH Belief" and only pay attention to that for diagnosis and treatment.   That is totally wrong.  If they go beyond TSH it will be to test Free T4 and then  use "Reference Range Endocrinology", by which they will tell you that a thyroid hormone test for Free T4 that is anywhere within range is adequate.  That is also very wrong.   Very few doctors are knowledgeable enough and willing to diagnose clinically, based on evaluation of symptoms, supported by expanded testing  like I mentioned, and then treat as needed to relieve symptoms, rather than just based on test results.  

That is why I mentioned that we might be able to help locate such a good thyroid doctor if you are interested and will give us your location.    

[Tiredgirl68]

Update: just got my ultrasound report: impression:Left : 1. 3.1 x 1.7x 2cm solid hypoechoic nodule with Doppler flow TR4. Numerous other suncentimeter spongiform nodules have a benign appearance, measuring up to 6 mm,TR1. FNA biopsy is indicated at this size. Right:  numerous subcentimeter spongiform nodules, measuring up to 6mm, benign in appearance TR1.
Should I be concerned?

[gimel]

You certainly have many symptoms that are frequently  related to hypothyroidism.   Your difficulty swallowing/choking would be related to the goiter/nodule.    Since your doctor has not bothered testing beyond TSH and  TPO ab/TG ab and an ultrasound, you have no info on the actual thyroid hormones.   Based on that experience I suspect that you will have difficulty getting the needed testing done.  You need to be tested for Free T4, Free T3, Reverse T3 (at least initially), cortisol, Vitamin D, B12 and ferritin.   Do you think you could get your doctor to do this for you?  

Also, you need to find out if your doctor is willing to diagnose and treat clinically (for symptoms) rather than just based on blood test results.  Also you need to find out if the doctor is willing to prescribe T3 meds such as Armour Thyorid, NatureThroid, or NP Thyroid, instead of just T4 meds.  If either answer is no, then you will need to find a good thyroid doctor that will do so.   For that  we may be able to help, dependent on  your location.  

If you want to confirm anything I have said, please click on my name and then on my personal page, scroll down to my Journal and read at least the one page Overview of a full paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.

[Tiredgirl68]

Thank you so much! I was seeing an ENT for a different issue, and the thyroid showed up incidentally on a CT. I haven’t had the Ultrasound yet. I have decided after the ultrasound I’m going to ask for a referral to an endocrinologist. I’m not sure if the ENT knows what to order blood work wise or treatment wise etc. I appreciate your advice, as thryoid wasn’t on my radar at all. I assumed all these weird random symptoms I’ve had for at least a year were age related etc.

[gimel]

TSH is a pituitary hormone that has only a weak correlation with either thyroid hormone, Free T4 or Free T3, and a negligible correlation with the extent of Tissue T3 Effect, which determines a person's thyroid status and possible symptoms.   In addition most doctors don't recognize anything other than primary hypothyroidism, characterized by a high TSH and relatively low Free T4 and Free T3.   Much more common is central hypothyroidism which is due to a hypothalamus/pituitary dysfunction resulting is a TSH that is too low to adequately stimulate the thyroid gland.    Doctors like to think that central is rare, but it is just because it is rarely diagnosed due to the over-reliance on TSH tests.

In trying to assess a person for the possibility of hypothyroidism the most important indicator is an evaluation to determine if there are multiple symptoms that occur more often with hypothyroidism.  This should be supported by tests for Free T4 and Free T3, not Total T4 and Total T3.  You should be tested for Free T4 and Free T3 every time you go in for tests.  

So before further discussion please tell us all the symptoms you seem to have.    

[Tiredgirl68]

Tiredness, very cold hands and feet, difficulty getting them warm even with gloves etc, weight gain, memory loss, dry skin, hair thinning and trouble getting my hair dye to take, heart palpitations. I also have noticed trouble swallowing pills and choking while swallowing . Tight throat and having to clear my throat constantly. ??