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I don't think I need levothyroxine, but my Dr. does
History: Nodules found on my thyroid in 2008. Ultrasound showed 2 on left side, 1 on right side. FNA at some point had indeterminate results. 2013 ultrasound showed no changes.
This past October I mentioned to my PCP that the nodules seemed larger. Ultrasound results:
1. Enlarged thyroid gland
2. Left lobe nodules which are TR3 measuring up to 2.5 cm. Comparison to previous exam is difficult because the nodules were not measured separately but instead measured as a single nodule. Consideration for fine-needle biopsy versus one-year follow-up
TI-RADS Biopsy Reference: Journal of the American College of Radiology, Volume 14, Issue 5, 587 - 595
Reference: ACR TI-RADS recommendations for thyroid nodules (Tessler et al., May 2017):
TR5 (> or = 7 points): FNA if > or = to 1 cm longest axis, follow-up if 0.5 - 0.9 cm every year for 5 years
TR4 (4-6 points): FNA if > or = to 1.5 cm longest axis, follow-up if 1 - 1.4 cm in 1, 2, 3 and 5 years. No FNA or follow-up if or = to 2.5 cm longest axis, follow-up if 1.5 - 2.4 cm in 1, 3 and 5 years. No FNA or follow-up if < 1.5 cm.
TR2 (2 points) & TR1 (0 points): No FNA or follow-up recommended
I can't find an electronic copy of my FNA results done 12/28/21. The results say "follicular lesion of undetermined significance (2.29 x 1.39 x 2.52 cm)" and "Aspirate material and cell block show follicular epithelial cells with focal cytologic and achitectural atypia." He actually biopsied 2 nodules, both confirmed TR3. One nodule extended into the isthmus.
Because I was starting to have trouble swallowing, the ENT/surgeon I'm seeing recommended surgery to remove my left lobe and isthmus. We did that on March 29th.
On April 25th, approximately 4 weeks after surgery, I had Free T4 and TSH tested.
Free T4: 0.96, range = 0.08-1.80 NG/DL (It was 1.10 in 2018)
TSH: 3.190, range = 0.400-4.500 MCIU/ML
I felt no different post-surgery than I did before. I had no symptoms of hypothyroid. Rather than discuss things, my surgeon's office sent a postal letter telling me I needed to be on 50 mcg of levothyroxine, and to pick up my prescription at my drug store.
I have been taking 50mcg/day for 2 weeks now. My blood pressure is slightly elevated. My heart feels a bit big for my chest, and it feels like it's beating harder. For much of the day I feel jittery, like I have low blood sugar, or I'm coming down from a jolt of adrenaline. When I try to do fine-motor activities I notice my fingers are trembling ever so slightly. I'm sometimes nauseous, and I'm gassy. By the end of the day I have a low grade headache.
I have left voicemails with the surgeon's nurse (my instructed method of communication) 3 times about this, with no response.
I'm inclined to have my PCP manage my thyroid from now on, but she's unwilling to take over until the surgeon has completely released me. I don't see him again until July. I don't want to feel like this for 2 more months!
I'm inclined to reduce my dosage, but I'm unsure of the best way to do that. Thoughts? Thanks in advance.
This past October I mentioned to my PCP that the nodules seemed larger. Ultrasound results:
1. Enlarged thyroid gland
2. Left lobe nodules which are TR3 measuring up to 2.5 cm. Comparison to previous exam is difficult because the nodules were not measured separately but instead measured as a single nodule. Consideration for fine-needle biopsy versus one-year follow-up
TI-RADS Biopsy Reference: Journal of the American College of Radiology, Volume 14, Issue 5, 587 - 595
Reference: ACR TI-RADS recommendations for thyroid nodules (Tessler et al., May 2017):
TR5 (> or = 7 points): FNA if > or = to 1 cm longest axis, follow-up if 0.5 - 0.9 cm every year for 5 years
TR4 (4-6 points): FNA if > or = to 1.5 cm longest axis, follow-up if 1 - 1.4 cm in 1, 2, 3 and 5 years. No FNA or follow-up if or = to 2.5 cm longest axis, follow-up if 1.5 - 2.4 cm in 1, 3 and 5 years. No FNA or follow-up if < 1.5 cm.
TR2 (2 points) & TR1 (0 points): No FNA or follow-up recommended
I can't find an electronic copy of my FNA results done 12/28/21. The results say "follicular lesion of undetermined significance (2.29 x 1.39 x 2.52 cm)" and "Aspirate material and cell block show follicular epithelial cells with focal cytologic and achitectural atypia." He actually biopsied 2 nodules, both confirmed TR3. One nodule extended into the isthmus.
Because I was starting to have trouble swallowing, the ENT/surgeon I'm seeing recommended surgery to remove my left lobe and isthmus. We did that on March 29th.
On April 25th, approximately 4 weeks after surgery, I had Free T4 and TSH tested.
Free T4: 0.96, range = 0.08-1.80 NG/DL (It was 1.10 in 2018)
TSH: 3.190, range = 0.400-4.500 MCIU/ML
I felt no different post-surgery than I did before. I had no symptoms of hypothyroid. Rather than discuss things, my surgeon's office sent a postal letter telling me I needed to be on 50 mcg of levothyroxine, and to pick up my prescription at my drug store.
I have been taking 50mcg/day for 2 weeks now. My blood pressure is slightly elevated. My heart feels a bit big for my chest, and it feels like it's beating harder. For much of the day I feel jittery, like I have low blood sugar, or I'm coming down from a jolt of adrenaline. When I try to do fine-motor activities I notice my fingers are trembling ever so slightly. I'm sometimes nauseous, and I'm gassy. By the end of the day I have a low grade headache.
I have left voicemails with the surgeon's nurse (my instructed method of communication) 3 times about this, with no response.
I'm inclined to have my PCP manage my thyroid from now on, but she's unwilling to take over until the surgeon has completely released me. I don't see him again until July. I don't want to feel like this for 2 more months!
I'm inclined to reduce my dosage, but I'm unsure of the best way to do that. Thoughts? Thanks in advance.
Just a couple of comments for you. First, your FT4 is a bit lower than required for many people; however, how you feel is more important. Lab tests are not always accurate, so if it were me I would not take any thyroid med unless I started having hypo symptoms. There is an old saying that I like a lot. "If it ain't broke, don't fix it."
Second, a 50 mcg dose will do nothing for your thyroid levels. Starting doses of thyroid med are not additive to prior levels because when ;you take the med it drops your TSH and that results in less output of natural thyroid. Net effect is very little, until the dose is high enough to essentially suppress TSH. Then further increases will start to raise FT4 and FT3 levels. So why start on the med if you don't have symptoms?
Second, a 50 mcg dose will do nothing for your thyroid levels. Starting doses of thyroid med are not additive to prior levels because when ;you take the med it drops your TSH and that results in less output of natural thyroid. Net effect is very little, until the dose is high enough to essentially suppress TSH. Then further increases will start to raise FT4 and FT3 levels. So why start on the med if you don't have symptoms?
1 Comments
Doc gave me the option to stop taking the thyroid, and I have stopped. I'm also looking for a new, more responsive doctor to manage it.
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