Thyroid ultrasound and Free T4, TSH Results - Do I need to be worried about these?

[Lme367]

Are these results something need to worry about? Thanks in advance for any advice.
ULTRASOUND - Isthmus 4 mm, no focal nodules seen -  Right Lobe measures 7.9 x 3.8 x 4 cm, Nodules: upper pole hypoechoic measuring 1.8 x 1.3 x 1.3 cm, mid zone solid and cystic measuring 6.3 x 3.1 x 4.8 cm. - Left Lobe measures 5.6 x 1 x 1.3 cm. Nodules: upper pole hypoechoic cystic measures 5 x 3 x 4 mm. Parathyroid glands not visualized.
TSH was 2.810   Free T4 was 0.98    Free T3 was not tested

[Barb135]

Thank you for the verification.  It's very odd that a nodule would be 6.3 centimeters and not millimeters in size as that's quite large.  

I agree with FNA on the largest nodule.  Also with Red_Star on getting the antibody tests for Hashimoto's.

Your Free T4 is quite low in the range.  Do you have symptoms of hypothyroidism?  You should try to get Free T3 tested, as well.

[Lme367]

Yes my goiter is quite large. It is visibly noticeable. I got a same day call from my PCP with these ultrasound results and I am a bit nervous. You all seem very  informed and have suggested tests that I will also bring up to the specialist they want me to see. I have been reading through some of these threads about what is considered "normal range" and what tests they should be conducting. I am very curious to see what tests they suggest and the reaction I get if ask for some of these tests if they don't offer them. I am not familiar with what the symptoms of hypothyroidism are? I basically feel fine. My own health took a backseat to my daughter's health for quite a few years; she passed away in July, and now I am trying to take care of myself. I am not hugely overweight although at 51 I could stand to lose a few pounds... the only other major thing is that I was severely b12 deficient (<150, normal range 232-1245), I called back in to have an injection and started sub-lingual b12 daily (2,000 units/day). One later it was re-tested and within normal range (637). Other than that I haven't noticed anything....

[Lme367]

Sorry that should read that I was called back in to have a b12 injection and that one month later it was re-tested.

[Red_Star]

Do you know why your B12 was so low?

[Red_Star]

*

[Barb135]

Red_Star... is the reason you put the asterisk because your comment did not post?  If so, we need to report that's still happening...

[Red_Star]

Hey Barb, my comment didn't post.

[Lme367]

Hi guys - no I have no reason for why my B12 was so low. Vitamin D was low too but PCP said that is to be expected in the part of the US I live in, that just about everyone here is low on D.  I did finally meet with the endocrinolgist  I was referred to and am currenlty awaiting FNB results - he took 3 samples, and I mentioned those two things to him. He said the nodule/tumor is very large, it was too big to fit entirely on the screen of his ultrasound machine (as big as the enitre right side of my thyroid gland).  I asked what would happen if the results of the biopsy came back inconclusive and he said that they have come so far with genetic testing that if it comes back inconclusive they would send the tissues to Pittsburgh for testing of the most common gene markers that they know are found in follicular thyroid cancer (he said the tumor has some characteristics of that). I believe he is thinking it is just a benign tumor. If that is the case I have more leeway in deciding when it gets removed but he said  it will eventually have to come out. He does not anticipate that it will stop growing and will eventually start causing me problems.

[Red_Star]

A TSH above 2 is never a good sign.  Test thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb).  

[Lme367]

I hank you very much - will ask about that!

[Barb135]

Can you verify that the mid zone nodule on the right lobe is really 6.3 x 3.1 x 4.8 "cm"?  

Was there a section on the report with an "impression" or "recommendation" on it, such as recommending an FNA or anything?

Also, what was the reference range for the Free T4?  Ranges vary from lab to lab and have to come from your own report.

[Lme367]

Hi thanks for responding and yes unfortunately that is the size of the mid zone nodule. The range for the Free T4 was  0.82 - 1.77 ng/dL and the Impression from the ultrasound reads as follows: Bilateral thyroid nodules. At clinical discretion, sugeest fine-needle aspiration of the largest nodule on the right and continued sonographic surveillance of the samller nodules.

[Lme367]

Oh and sorry the results for the left side should read: Left Lobe: Measures 5.6 x 1 x 1.3 cm. Nodules: Upper pole hypoechoci, solid and cystic, measures 4 x 3 x 3 mm, Upper pole hypoechoic, cystic, measures 5 x 3 x 4 mm. And the TSH range in case it is needed was 0.450 - 4.50.