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Anything serious from this ultrasound result?

Hello friends. I am Asian F, 130 lbs and 5'4. No other symptoms or conditions. Just got my ultrasounds result. Is it serious?
FINDINGS
      Thyroid gland
          Size
              Right lobe: 5.7 x 2.5 x 1.8 cm
              Left lobe: 5.0 x 2.1 x 1.5 cm
              Isthmus thickness: 0.9 cm
          Enlarged
          Diffusely heterogeneous
          Left lobe
              Nodule 1
                  Size: 8 x 6 x 4  mm
                  Upper pole
                  Solid, No calcifications
      Lymph nodes
          Likely benign
              Right 25 x 7 x 5 mm, high
              Left 21 x 8 x 3, mid
  
  IMPRESSION:
      1. Enlarged, diffusely heterogeneous thyroid gland, suggestive
         of thyroiditis.
         2. Left thyroid nodule.
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649848 tn?1534633700
COMMUNITY LEADER
No, it’s really nothing to worry about.  It does indicate that you have Hashimoto’s and the nodule will have to be watched to track whether it grows or not.  It’s quite small, at this point, so they wouldn’t do anything with it, since it doesn’t have suspicious characteristics.  

Since your ultrasound indicates Hashimoto’s, I’d have to wonder if you’ve had a thyroid blood panel (TSH, Free T4 and Free T3) and what those results (with reference ranges might be).  I’d also wonder if you’ve had thyroid antibodies tested.  

I’d also be interested in what prompted this ultrasound, since thyroid ultrasound is not a “routine” test.   Do you have symptoms of a thyroid condition or been diagnosed with one?  If so, please list your symptoms and tell us what condition you’ve been diagnosed with.  
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12 Comments
Thank you! My grandma had enlarged thyroid and I got check-ups once a year. The doctor could feel that my thyroid is somewhat enlarged so she sent me to the test. So I think so far so good: no symptoms.
It’s great that you have no symptoms of a thyroid condition.  Just be aware that Hashimoto’s slowly (usually) destroys thyroid function so check out symptoms of hypothyroidism so you can be aware of them.  

The main ones are weight gain for no reason, inability to lose weight, fatigue, constipation, hair loss (especially the outer eyebrows), swollen face/puffiness under the eyes, muscle aches/pains, brain fog, etc.  That’s the “short list”; there are over 300 symptoms; unfortunately, many doctors don’t recognize them all.  

So have you had your actual thyroid levels tested - not just TSH, but the other tests I mentioned along with the antibody tests?  
Thank you very much again! So far, I haven't seen any of these symptoms. Hopefully, I will be able to manage it. I got this result yesterday and I am still waiting for my doctors to follow up. I will keep in mind that the tests are important and will let them know. @Bard135 Thank you again. I will keep you posted.
Yes, make sure you stress the blood tests I mentioned, particularly, the antibody tests at this point, since you have symptoms of hypothyroidism.  Also, please make sure that whenever they do thyroid function tests, they do the entire panel, not just TSH.  

Please do keep me posted.  
Hello, I got the tests result:

TSH with reflex: 0.33: lower than normal
T3 total: 94: normal
Free T4: 1.2: normal
TPO antibodies: 8.0 normal.

Any thoughts?
Yes, there are further thoughts…  Free T4 is normal, but recommendation is for it to be about mid range.  Every lab has their own ranges, but yours appears to be lower than mid range.  

Second:  Total T3 is obsolete. You need to have Free T3, which is not the same.  Total T4 show the entire amount of T3 in your blood, most of which is bound to a protein and can’t be used.  Free T3 shows just the amount that’s FREE - not bound to the protein and is what’s actually used by almost every cell in the body.  In addition, again, you didn’t post the ranges but your TT3 seems to be lower than it should be.  

Third:  There’s another thyroid antibody called Thyroglobulin Antibodies (TgAb), which also identifies Hashimoto’s.  Since your TPOab were negative/normal, you need to have the TgAb tested in order to make sure you aren’t misdiagnosed.   It’s possible that antibodies haven’t ramped up yet but some people are diagnosed with Hashimoto’s, based on thyroid characteristics — back to the ultrasound, which says your thyroid is suggestive of “thyroiditis”.  

Although your TSH is lower than normal, your actual thyroid hormones indicate they’re actually lower than normal.   This means you could have a condition called “Secondary” or “Central” hypothyroidism, which means the thyroid is working well, but there’s a pituitary issue in which the pituitary gland isn’t calling for the thyroid to produce adequate hormones.  

Since you don’t seem to have symptoms of hypothyroidism, at this time, I’d strongly suggest you encourage your doctor to do regular tests and that you also look up the symptoms of hypothyroidism… there are approximately 300+ of them.  I can post a link, but I’ll have to wait until I’m on my computer.  
Hello Bard135,

As a scientist turned manager in pharma, I have to say you are absolutely more knowledgeable than most of doctors I could have met. I’m in Boston and see doctors in one of the most prestigious hospitals in the world, yet it looks like they are not as knowledgeable as you. I will definitely tell me PCP what you told me. Just curious, how did you get educated on those knowledge?

Thanks!
Another thought: maybe I should see an endocrinologist specialized in thyroid disease?
Thank you for the compliment…  I’ve gotten my knowledge from research.  My story is pretty long so I’ll give you the “Reader’s Digest” version.  I was diagnosed with hypothyroidism in early 2008 but my doctor refused to test anything other than TSH and that’s how he prescribed my thyroid med.  TSH was up, I got a big dose; TSH tanked and he started backing down on the dose.   He refused to test antibodies because he said “the treatment won’t change, so why waste the money?”  Hmmm - well, it wasn’t his money, right?  

I’d found this forum and asked about Free T3.   In his opinion… “that’s only for research purposes.”   As I read more and more, I realized that yeah - research on MY body…

I’d been referred to an ENT because of problems with my vocal cords (ultimately had a couple of surgeries), but then when I had other issues with my throat/neck my pcp insisted that the ENT had done something “wrong”.  Since the pcp refused to do the tests I wanted, I went back to the ENT and explained what was happening.  The day I was in his office, I was obviously ill and once I told him what was going on, he sent me to an ultrasound and ordered blood test for TPOab.  Both indicated Hashimoto’s, which ended up being the diagnosis.  He referred me to an endo who did pretty well as he sort of let my symptoms be the guide.  I was with him for about 7 years before he left the area.  

At that point, I ended up back with the ENT and he referred me to a different endo… Unfortunately, she ended up being from h***.  Although she tested FT4 and FT3, all she would look at was TSH and kept wanting to cut my med back because my TSH was in the gutter, even when actual thyroid levels were low or below range and symptoms were horrible  

I ended up going back to my pcp for treatment because he was willing to let my TSH live in the basement, in order to keep FT levels normal.  A couple of  years ago, his NP suggested that I try a new endo in town so I did.  Again, it was a total disaster because all he’d look at was TSH.  As long as my TSH was “normal”, he was happy, even though I had a huge variety of hypo symptoms.  I finally got so sick, I went back to my pcp and asked him to manage my thyroid issue again.  He increased my dosage above what it had been prior to the endo and I’m back among the living again.  Although, I’d like my FT levels to be higher, he’s reluctant to increase my dosage  because he knows the standard of care is “normal TSH”.  

Anyway, because it was this forum that helped me get better, I’ve stuck around to  pay it forward and continue to try to stay up on thyroid research.  Some doctors are beginning to understand that TSH isn’t the bottom line, many others stay with TSH because that’s what the American Thyroid Association (ATA) and the American Association of Clinical Endocrinologists (AACE) advocates even though they say that each case should be treated individually.  

That’s a lot more history than you wanted to know, but there it is.   I also have pernicious anemia and require weekly Vitamin B-12 shots.  Vitamin B-12, iron, vitamin D, selenium and zinc are all necessary for adequate thyroid metabolism… I’ve been low in all of them and have to supplement.  If you haven’t been tested for those (particularly, vitamin B-12), I’d strongly suggest you ask for those tests.  

Forgot to answer your question about getting an endocrinologist… it’s up to you, but I’m one who did horribly with endo’s - some are good, some are horrible.  All you really need is a doctor who understands how the thyroid works and is willing to prescribe medication based on FT levels, not TSH.  They will also need to be able to recognize that symptoms of a thyroid condition can be numerous and affect every part of the body.  
I am fully HASH, my antibodies are super high...and I have none of the symptoms you mention. I feel cold cold all the time, sick to my stomach, hair loss, palputations, weakness...every case is so different...
Merchitas... Cold intolerance is a major symptom of hypothyroidism, as are the other symptoms you have.  Just because I didn't list them above, doesn't mean they aren't symptoms of Hashimoto's/hypothyroidism.  Hair loss, palpitations and weakness can also be symptoms of hypothyroidism.  
649848 tn?1534633700
COMMUNITY LEADER
Because the thyroid controls so many body processes, including metabolism, heart rate, body temperature, etc, hypothyroidism does affect the whole body.  

Following is a site that lists over 300 symptoms of a thyroid condition:
https://hypothyroidmom.com/300-hypothyroidism-symptoms-yes-really/
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