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Can some please help

I need worst and best case to process this EXAM: US THYROID/PARATHYROID   INDICATION: Hyperthyroidism   COMPARISON: Thyroid uptake and scan dated 04/22/2021   FINDINGS: Thyroid size: Right: 5.1 x 2.0 x 1.7 cm; left 5.7 x 2.6 x 1.3 cm; isthmus (AP diameter): 0.2 cm   Texture: Homogeneous with numerous small hypoechoic nodules throughout.  These all measure less than 5 mm in diameter.       Nodule #: 1   Size: 2.4 x 1.4 x 1.4 cm.  Location: Left; mid   Composition: Solid/almost completely solid (2)   Echogenicity: Isoechoic (1)   Shape: Not-taller-than-wide (0)   Margins: Smooth (0)   Echogenic foci: None (0)   ACR TI-RADS total points: 3; ACR TI-RADS risk category: TR3 (3 points)       There is no associated cervical adenopathy identified.   IMPRESSION: Multinodular thyroid with a single dominant 2.4 x 1.4 x 1.4 cm solid nodule with a TI rads score of 3.  Follow-up ultrasound in 1, 3, and 5 years is recommended per TI rads recommendations below.       ACR TI-RADS recommendations   TR5 (>=7 points) - FNA if >=1 cm, follow-up if 0.5 - 0.9 cm every year for 5 years   TR4 (4-6 points) - FNA if >=1.5 cm, follow-up if 1 - 1.4 cm in 1, 2, 3, and 5 years   TR3 (3 points) - FNA if >=2.5 cm, follow-up if 1.5 - 2.4 cm in 1, 3, and 5 years   TR2 (2 points) & TR1 (0 points) - No FNA or follow-up       ACR Thyroid Imaging, Reporting and Data System (TI-RADS):
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Avatar universal
So a few days ago I puked up what looked like mucus?! I’ve been coughing up mucus for as long as my Symptoms started however I have no related cough. It was a lot 1/2 a cup at least if not more very thick I was choking on it?! It was bright red in parts, blue, light neon green and yellow and a little brown?! Mind you this was a.m I hadn’t eaten since dinner the day before. I have an arithmia 8/10 blood pressure checks I do at home and palpitations once so severe I felt like I was being punched in the chest it was very pronounced you could probably see it! Could this be related to my initial symptoms before Graves diagnosed mind you I started with and still have abdominal pain and my abdomen is hard like I’m pregnant sometimes and I swear I feel movement like something dragging across the inside. I’m EXHAUSTED. I’m swelling in my fingers and smiles ankles. My arms have been starting to tingle almost send get cramping pains I feel like they are heavy on occasion. And my legs nodule has grown drastically since my ultrasound it is visible and tender to the touch my throat feels like someone is having my neck not hard enough to Choke me but applying pressure. I don’t have a blockage I don’t think I go potty just fine however that has been green like greener than it should be on several occasions. Sorry for all the detail. I’m seeing my endo on June 29th and I’m starting to worry.
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I wouldn't wait till June 29th.   You should see your primary care dr and have him/her request a full thyroid panel lab test and run other ones as well.  The test results should be ready within 2-3 days and you will know where you stand.  The endo is just going to do the same thing.  Good luck and try to see your PCP ASAP.
Avatar universal
Also my symptoms started with severe abdominal pain upper right I still have it, nausea and vomiting, EXHAUSTED, can’t eat, can’t sleep, muscle weakness, joint pain, headaches, lower back pain, pins and needles, swelling in abdomen it gets really hard, toes turned blue, HOT OT COLD no in between. Dr wanted to explore small intestine but can’t because I’m unregulated.
Helpful - 0
I can comment on the thyroid ultrasound --- most thyroid nodules are non-cancerous.  Numerous small nodules in the thyroid might indicate an autoimmune disease - both Graves disease (which causes hyperthyroidism) or Hashimoto's (usually causes hypothyroidism but sometimes can cause hyperthyroidism early on in disease progression).  It sounds like the hypoechoic nodules are too small to note sizes or numbers of, indicating they are probably not a cancer concern at this point.  (I had Hashimoto's and my thyroid texture was heterogenous nodularity - which meant lots of small nodules.)

The one larger nodule that you have is isoechoic, which means the texture is similar to the rest of the thyroid.  This has a lower risk of thyroid cancer compared to a hypoechoic nodule.  The size is right at the border of where they might recommend a fine needle biopsy, the biggest dimension is 2.4 cm, if it were 2.5 they would do a biopsy.  I think it is probably up to your doctor whether they recommend doing a biopsy now or another ultrasound in a year to see if the size has changed.  I hate to give worst case scenario because there might be multiple things going on and I can only comment about what I have my own experience with, which is my thyroid (which I had removed due to thyroid cancer).  Odds are low that your one larger thyroid nodule is cancerous.  If it is, the doctors would recommend surgery, and depending on whether it has spread or not, you may or may not need radioactive iodine treatment.  Most thyroid cancers in someone your age have an excellent prognosis, and at this point there is no reason to assume that you even have thyroid cancer.

If you have hyperthyroidism, then the doctors will probably want to treat this with either drugs or kill off part of the thyroid with radioactive iodine, because having too much thyroid hormone can result in serious medical problems like rapid heart rate and irregular heart rhythm, and if untreated could be fatal (depending on the severity).  If your large nodule is cancerous (which odds are very low at this point that is is cancer, and further testing needs to be done), they might recommend removing part of your thyroid or your whole thyroid, which would mean you would be dependent on thyroid hormone for the rest of your life (sounds bad, but many people are living today with no thyroids, and many more take thyroid hormone to treat hypothyroidism).

It looks like they are comparing this to a thyroid uptake scan (small amount of radioactive iodine used to image thyroid and see if any nodules are expressing more than others).  Did you also have an uptake scan done?  Is that how they've determined hyperthyroidism?  Were there any hot or cold nodules?  (Hot nodules that express more thyroid hormone than they should can cause hyperthyroidism and are usually not cancerous.)

As for your symptoms...  Have they tested thyroid hormones or TSH?  I'm assuming they are doing blood tests and testing for TSH and hopefully freeT4 and freeT3 to make a diagnosis of hyperthyroidism.

Most of the symptoms you have reported are commonly associated with either hyperthyroidism, hypothyroidism, or both.  Can't eat, can't sleep, nausea, vomiting, hot all the time are associated with hyperthyroidism (probably headaches and pins and needle feeling as well).  I've experienced muscle weakness, sleep problems, joint pain, headaches and coldness with hypothyroidism, but some of those are probably also associated with hyperthyroidism.

The endocrine system/thyroid hormone controls the digestive tract, and people with hypothyroidism often have constipation (I know this because my doctors constantly asked me if I was constipated as an indicator of whether I had hypothyroidism or not - this was never one of my many symptoms but one they were focused disproportionately on for some reason).  People with hyperthyroidism can have the opposite problem (runny/loose BMs/diarrhea).  

Whether your abdominal issues are connected to your thyroid in any way, I don't know and can't know.  Those are certainly concerning symptoms, hopefully you can figure out what is going on soon.  (And it is possible the are related to your thyroid - almost every human cell in the body has thyroid hormone receptors, which means when thyroid hormone is too high or too low a lot of different systems/body parts are affected).

I don't know if any of this was helpful.  Hopefully your doctors will help you find the best course of treatment, and quickly.  The scariest part of my whole thyroid journey was in between learning I had suspicious thyroid nodules and learning I would need thyroid surgery, I had so much anxiety about what might happen.  By the time I was actually diagnosed with thyroid cancer, my right thyroid lobe was already removed and I had a plan for what would happen next (rest of thyroid removed by surgery) and I was much less anxious.  

Hyperthyroidism itself can cause anxiety, so hyperthyroidism combined with troubling symptom must be really hard.  I'm sorry you have to go through this.

Good luck, and I hope you are feeling better soon.

Thank you Sarah, yes I have hyperthyroidism and I have Graves Disease as well. My numbers for my TSH0.02, T4- 4.21 and T3- 361. The said it was working so fast digging testing they couldn’t even register it. I have severe unregulated graves and I’ll in the middle of genetic counseling as my mother and sister have lynch syndrome. I started the Methomayzol? Not sure I got that right but I can’t do it. I’m covered in a rash, I’m tired and moody and ITCHY. My anxiety is through the roof and the palpitations have Gotten hard like someone is punching me in my chest. I can’t even lift my left arm the muscles hurt so bad. I’m starting to feel depressed I’ve noticed I’m secluding  myself. I just want to be Normal again.
I'm so sorry to hear you have all that going on.  I'm not sure how quickly the medication works to counteract Graves/hyperthyroidism, but hopefully once that brings down your thyroid hormone levels some of the symptoms will go away.   Are some of those symptoms new?  It looks like muscle pain , vomiting, tingling, headache, fatigue, and hives (itchiness?) are all apparently common side effects for the medication (I just googled it - not an expert) - I have no experience with hyperthyroidism and don't know if that's something that persists the whole time you're on the medication or not.

I can't even begin to imagine how difficult this must be to deal with while also going through genetic counseling for Lynch syndrome.

When I was going through hypothyroidism before and after my thyroid surgeries, I shut out my friends and family from what was going on.  It is sometimes so hard to explain to others what you're going through, because what you are going through is often unimaginable to someone who hasn't experienced it themselves.   I don't have any answers, all I can say is I'm so sorry you have to go through this, and that hopefully there will be symptom relief, either with the medication or further treatment for Graves.  It has taken me over two years after my thyroid surgery to feel like myself again, and while I was going through it, I never thought things would go back to normal.  I am feeling much more like myself today than I was a year ago.
I was on PTU (alternative to methimazole) for about 1 year and eventually went with the radiation ablation.  Patience is something you have to accept with any thyroid medication.  It takes several weeks before you start to notice a change and up to a month for  the full effect.  Keep reminding yourself that it will get better and try not to get worked up.  My resting heart rate was over 120, lost a ton of weight, couldn't sleep and felt jittery all the day.  Just remember that you will slowly feel better with time and hopefully the doctor can find the right treatment.  You are not alone, we've all gone through similar experiences and eventually got better...hang in there.
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