About blood results for thyroid problem

[CindiW2]

I would like to understand what these results mean. I had two tests about 6 weeks apart. Same results. After the tests I took a radioactive scan and then US, but I would like to know more about the blood test results and what they might indicate. Would these indicate hyperthyroid or hypothyroid?
Free T4 - 1.3 ng/dL
TSH - 0.19 mIU/L

[gimel]

Good questions for the doctor.

[gimel]

Following is a link to some useful info on nodules.  

https://www.endocrineweb.com/conditions/thyroid-nodules/thyroid-nodules-prevalence-symptoms-causes-diagnosis-treatments

There is an association between Hashi's and nodules, but not all Hashi's patients have nodules.  Have a look at this info.

https://www.ncbi.nlm.nih.gov/pubmed/3605864

[CindiW2]

Thanks again. I have been doing a lot of reading about this. Including from nih.gov. I can see reseasrch is still going on, naturally I don't want to have cancer -- But -- if I do, I do. What strikes me odd is that the first time they took a radioactive iodine scan, the dr said there is a cold nodule on the right side. Then when they took the US, apparently what showed up is this "huge" nodule on the left side, and nothing showed up on the right side where the cold nodule was supposed to be. I'll keep in touch, thank you again. So now my question is: why didn't the "huge" nodule show up with the radioactive uptake or scan, whatever they call it? And why didn't the cold nodule show up on the US?

[gimel]

First thing to understand is that hypothyroidism is not, as usually assumed, just inadequate thyroid hormone.   Instead, it is"insufficient T3 effect in tissue throughout the body due to inadequate supply of, or response to, thyroid hormone".    So it is not just thyroid hormone, but the body's response to it, which is affected by a number of  body processes and variables.   And TISSUE T3 EFFECT determines your thyroid status.  

Due to the number of processes and variables  TSH has only a negligible correlation  and Free T4 and Free T# have only weak correlations with TISSUE T3 EFFECT.   So there is no direct measure of TISSUE T3 EFFECT.  Instead we are left with indirect measures, of which the most important is signs/symptoms that occur more frequently with hypothyroidism, followed by expanded biochemical tests to support clinical findings.    

You have a number of symptoms that can be related to hypothyroidism.    You have only limited test results to date.  Those don't really reveal much.  You need to get your doctor to test for Free T3, Reverse T3, cortisol, Vitamin D, B12 and ferritin, in order to have a better understanding of what is going on.  Also, it would be good to test for TPO ab and TG ab, as suggested by Red_Star.  

If you will get those done and then post results and reference ranges we will be glad to help interpret and advise further.  If you want to confirm what I have said, click on my name and then scroll down to my Journal and read at least the one page overview of a paper on Diagnosis and Treatment of Hypothyroidism: A Patient's Perspective.  

[CindiW2]

Thanks, a LOT! And I mean that. So the problem (situation) now exists as to whether I should have a FNA for the very large nodule they found. I can hardly imagine it is cancerous, but then you never know, I suppose. So maybe I'll wait to have the FNA until after the tests are done. Thank you, thank you thank you.

[CindiW2]

Also -- my concern before taking any treatment (medication) is that big nodule they discovered with the US. Are nodules associated with Hashimoto's disease, or is that just incidental? I mean does a person diagnosed with Hashimoto's disease necessarily have a nodule?

[gimel]

For diagnosis, evaluation of symptoms is even more important than blood test results.  Please tell us about any symptoms you have.

[CindiW2]

I complained to my doctor about my often extreme fatigue. That's when she ordered the T4 and TSH tests. Followed by the radioactive iodine test which they said indicated a cold nodule on my right lobe, but did not seem to show up on the US. (the next test). The big nodule apparently showed up on the left side, somehow the cold nodule did not show on the US.
I have gained weight, but that's because I eat too much and don't exercise because I hurt my leg and I am not inclined to exercise right now. So I walk when I can, but not very much. I suddenly got constipated a few months ago -- although I had that problem for a while over the years, it hit hard a few months back and she prescribed Miralax. I did not take too well to Miralax, so I find a stool softener + helps. I don't consider the weight gain a symptom. Because I eat too much and don't exercise. I am depressed I think sometimes (don't want to do things) because I have too much to do and a sick husband. So that depresses me, but I don't put that as a symptom. Irritability was asked as a symptom, but I've been irritable for many years with various people. The TSH remained the same two tests in a row.
So the big problem for me now is: what do I tell my doctor, I am reluctant to get the nodule aspirated.
Today I feel OK. More or less. Not so cloudy headed.
Evidently the Free T4 is within the standard range. I don't think I had a free T3 test, I will ask my family dr about it. I think the associate professor dr. may be getting tired of me because the PA recommended my left lobe entirely removed, as I said, and I just was not convinced, and she seemed to go along with it. I am going to call my family dr tomorrow to see what she says, she told me her mother has an enlarged goiter so I assume she's familiar with things. Thanks again.
To sum up:
Symptoms: very tired a lot. I attribute much of that to depression, but I'm not sure. Been that way for years.
Constipation.
a little hoarseness, not much, people don't notice it, but I do.
I cough sometimes when I sing, don't know why, so that stops me from singing.
(And that's about it.)
Free T4 - standard range
TSH - very low I suppose, from the standard

[Red_Star]

Not sure of your reference range for free T4.

[CindiW2]

OK, thanks for even looking. I didn't think the reference range was important, of course I don't understand what it means, but here's what results show:
Free T4 - Standard Range - 0.8-1.8 - Your Value - 1.3 ng/dL
TSH/Thy.Stim.Horm (OO) - Standard Range - 0.40-4.50; Your Value - 0.19 mIU/L Flag - L

[Red_Star]

Generally speaking TSH goes down with hyperthyroidism and up with hypothyroidism. But as TSH is not a thyroid hormone this test alone can miss a diagnosis. So you need to look at free T4 and free T3. These are both thyroid hormones. Hyperthyroidism is too much thyroid hormone so you would see free hormone levels above the range. As your free T4 is still in range it does not indicate hyperthyroidism. I suspect you have Hashimoto's thyroiditis and TSH can fluctuate up and down with this autoimmune disease. Ask your doctor to test thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibodies (TgAb).

[CindiW2]

Another question about Hashimoto's disease. Is it the normal course to aspirate the nodule is Hashimoto's is suspected?

[Red_Star]

It isn't necessary to have an FNA biospy just because you have Hashi's. A biospy would be recommended in your case as it's so large. Hashimoto's thyroiditis is the most common cause of hypothyroidism. And as many of us know, you can suffer low thyroid symptoms with free hormones in normal range! It's just not our normal!  Check out Hypothyroid Mom's article: 300+ Hypothyroidism Symptoms…Yes REALLY. And that is not a complete list of possible symptoms either!