Hi Darmstrong72,
If you haven't already met with your doctor to discuss these results, I'll try to help clarify what the ultrasound means for you.
TSH 0.07 is low, which might indicate hyperthyroidism (too much thyroid hormone), however free T4 and free T3 are normal (although they might be on the high side of normal). Hyperthyroidism is often associated with Graves disease, or a hyperfunctioning thyroid nodule (also called a "hot nodule", a nodule that produces a lot of thyroid hormone). I would not worry about TSH unless you are having symptoms of hyperthyroidism (anxiety, fast or irregular heartbeat, trouble sleeping, etc.). If you wanted to share you free T3 and free T4 results with the test range listed, that can help some people figure out if you might have hyperthyroidism as well as list any symptoms you are experiencing. If your doctors think that one of the nodules might be causing hyperthyroidism, there are some imaging tests they can do to see if it is "hot". Hot nodules are usually not cancerous
As for your ultrasound results, your thyroid size is about normal (towards the small size of normal) and since they haven't made notes about the texture, it probably a normal texture (sometimes Graves or Hashimoto's can be detected by a heterogeneous texture of the entire thyroid).
Thyroid nodules are very common, and often don't have anything to do with thyroid hormone or TSH levels. Hashimoto's or Graves can cause a multinodular goiter (whole thyroid is larger than normal and full of nodules), but that doesn't sound like what you have. I was told by my ENT that 30% of women in their 30s have nodules, 40% of women in their 40s, 50% or women in their 50s, etc, so it is very, very common for a woman to have some nodules. The majority of thyroid nodules are benign (90-95% are benign). But, based on some factors (size, texture, and vascularity), the risk of cancer increases (this doesn't mean you have cancer! But I will point out why they need to biopsy.)
Heterogenously hypoechoic solid nodule - this is the one to be concerned about and to do a biopsy on. Heterogeneously means the texture is not consistent throughout the nodule itself. Hypoechoic means the texture of the nodule appears darker on the ultrasound than the surrounding tissue. Hypoechoic nodules have a greater chance of being malignant. Since the nodule is heterogenous, this means parts are hypoechoic or darker, other parts of the nodule are probably similar to the rest of your thyroid, this makes it more suspicious than if it was a solid texture. Internal vascularity means they can see blood flow inside the nodule, and this also increases the chance of being malignant. Most smaller nodules (less than 1 cm or sometimes less than 1.5 cm) will not be biopsied because the chance of cancer increases once they are above about 2cm. So because of size alone (3.0cm) the large nodule on the right lobe will need to be biopsied by a fine needle biopsy.
The two smaller nodules on the left lobe are both less than 1 cm each, and it is unlikely they will be biopsied (although they will probably want to monitor by ultrasound sometime in the future (1 year, 2 years?) to see if they change in size.
Again, I want to stress that there is still a low chance that your nodule is malignant, but it is important to check it out to make sure it is benign. If it comes back benign, they may recommend you have follow-up ultrasounds every so often to see if anything changes.
Good luck and take care,
Sarah