Is it possible to have nodules but thyroid is normal?

[Kelfish]

So, I’ve been feeling horrible for a couple years now. Major fatigue, edema in my feet, hands and face, feeling like I’ve had a stiff neck for months, not being able to lose weight, etc..

I’ve been to the doctor multiple times and they tell me nothings wrong. I’m stressed, depressed. I actually had a doctor laugh at me. Telling me all my symptoms are normal.

Anyway, for about the last six months or so, I started feeling a lump in my throat and a clicking. I feel like I can’t swallow right. He tells me my thyroid feels normal and my TSH is in the normal range. It’s 1.09.  So it can’t be my thyroid.
He refuses to do a full thyroid panel saying I don’t need it because the TSH is normal.

I finally talked him into giving me a thyroid ultrasound.  Well, he sent me an email saying I have multiple nodules and another ultrasound needs to be done in twelve months. THAT’S IT!! Nothing about what a nodule is, the size, how many, or if it’s the reason I feel the lump in my throat and can’t swallow.
So, my question is, is it possible to have nodules with nothing else wrong. Or are nodules always a sign that something else is wrong?

[gimel]

I agree with Barb's overall assessment.   I do think you should emphasize that symptoms are the most important indictor of thyroid status.   That TSH has only a negligible correlation with Tissue T3 Effects, which determine a person's thyroid status.  And Free T4 has only a weak correlation with Tissue T3 Effects.    There is no blood test that can be used to reliably make a pass/fail decision about a person's thyroid status.    That is why symptoms that occur with hypothyroidism more often  than otherwise are the best indicator.  You might use the following link and check the boxes for symptoms you have and then look at the total score and see how it compares to the rankings.  Then you can give a copy to your doctor.  

http://www.thyroid-australia.com/lowthyroid.htm

Reverse T3 is another indicator of tissue thyroid levels, so try to get a Free T3 test done so that you can calculate the Free T3 to Reverse T3 ratio.   It should be at least 1.8 and some sources say 2.0.  With your Reverse T3 in the upper part of its range, your Free T3 will need to be near the top of the range for best results in relieving symptoms.  

I would also request a test for cortisol since it also affects thyroid.  

[Barb135]

Please check the reference range for the Free T4... I've never seen one that goes from 0 - 1.  They're usually something like 0.8-1.8 or something similar.  You couldn't have a Free T4 of 0 and be considered in range.  

Your vitamin D is way too low; that needs to be at least 60-70.  The doctor may prescribe you a mega dose for a few weeks or have you supplement an OTC.

Your B-12 is also way too low.  It needs to be at/near the top of the range.  If your doctor says it's okay, you'll have to supplement on your own.

Was there a reference range for the B-9?

Both, low vitamin D and B-12 can cause symptoms similar to hypothyroidism, but that still doesn't mean you aren't hypo.  Your Total T3 is only 36% of its range so we can assume that Free T3 would be equally low in its range, had your doctor chosen to order that instead of the obsolete Total T3.  

The TPOab doesn't indicate Hashimoto's, but the TgAb might.  

We'll have to see what the rest of the test results are... I don't know that the Reverse T3 will do a lot of good right now, but we'll see.

I'm still leaning toward Secondary/Central hypothyroidism, though you do need to get the vitamin D and B-12 up where they need to be...

[Kelfish]

Sorry reference range for t4 .08-1.5 and for b9 >=5.4.
They did give me a vitamin d supplement I have to take once a week for 12 weeks.

[Kelfish]

So it been awhile but I finally got the results back from my labs on 7/19/18.  

TG AB <0.4           Range <=0.3
Thyroglobulin 9.90     Range <=1.99
TPO AB <3.0.       Range <=5.5
T3 94      Range 58-159
Free T4 1.1.   Range 0.8-1.5
TSH .72      Range .35-4.0
Reverse T3 21   Range 8-25

I noticed that my thyroglobulin is kinda high.  I was wondering what this means.  also I have an appointment tomorrow 8/17 and was wondering if there were any questions I should ask or any extra labs I should ask for.  Thanks for all your help.

[Barb135]

Wow, that took a long time to the labs...

Is that Thyroglobulin or Thyroglobulin Antibodies?  There are tests for each and they mean different things... If it's TgAb (antibodies), then it indicates Hashimoto's, though they can be present in small amounts in other autoimmune conditions as well.   We don't really have any other possibilities, so we'll assume Hashimoto's.

Both your Free T4 and T3 are lower than they should be.  Your Free T4 is at 43% or range; recommended is mid-range; that's not "horrible", but it's low enough to cause issues.  Your T3 is only at 36%, which is pretty low considering that recommended level is upper half to upper third of range.   The problem is that the doctor ordered Total T3 instead of Free T3, so we still don't have the whole picture since a good portion of the Total T3 is bound by protein and can't be used.

Your rT3 is higher in the range and could indicate that too much Free T4 is being converted to rT3 instead of Free T3.  

I think you've had all the labs for now.  I suspect the doctor is going to look at the labs, specifically the TSH and tell you everything is okay... don't let them get by with that, because your labs indicate hypo.

[Barb135]

Not everyone gets all of the same symptoms.  Swelling/edema is a common hypo symptom and it's not unusual to feel the heat when swollen.    

If you notice, when you're swollen, your fingers and toes probably feel stiff and a little painful... That's caused by inflammation.  It happens to me, as well.  It sort of goes with the territory of being hypo...

Are you keeping notes or a journal of your symptoms so you can show them to the new doctor?  If not, I'd recommend you do so.  It's hard to remember everything when we're sitting in front of them, so it's a good idea to have things written down, with dates, so you have notes on how often certain symptoms are happening.   You'll also have it for your own records as well.

We're here for any further questions you have during your wait.  I know a month seems like a long time, but hopefully, it will go quickly...

[Kelfish]

I actually got in to see a doctor and had to almost have a breakdown for him to run my labs. He finally agreed and now that I’m getting some of my labs back , I’m so confused! I was trying not to comment till they all came in but I’m just so curious.

TSH- .75  range (0-4)
Free t4- 1.1 (0-1)
T3- 94 (58-159)
TPOAB-<3.0

Vitamin d- 28
B9- 9.4
B12- 395 (200-910)
Iron- 90 (37-145)
Ferritin-108 (13-126)

I’m still waitng on the reverse t3 and the thyroglobulin antibodies.

This is not what I expected at all. I think it’s telling me that I’m hyperthyroid. I’ve never considered that because I was always tired and overweight. I’m just so confused.

I started looking for hyperthyroid symptoms and noticed I do have a lot of the symptoms, like light periods and anxiety. My eyes are always watery. I just thought it was allergies. But I didn’t think you can be hyper and overweight. It like I feel so bad most of the time and I can’t get the one good symptom. Lol.

Anyway, can you look at the the numbers and tell me what you think. Maybe I’m reading it wrong.

[Barb135]

I'm glad to hear that you got a new doctor.  It's very upsetting to know that your old doctor was so arrogant treated you badly.  You don't necessarily need an endo if your new doctor is willing to run the proper tests.  Many primary care doctors are very good at testing/treating thyroid conditions and actually do better than some endos.  I've currently kicked my endo to the curb and have my primary doctor managing my thyroid because he's doing a better job than the endo did.  All the endo wanted to look at was my TSH and she was keeping me hypo because of it.  

If the new doctor will run the tests and comes up with a diagnosis, then you can decide whether you want/need an endo... Of course, it's up to you, but if you do get a referral to an endo, make sure to check credentials because not all endos are good thyroid doctors... many specialize in diabetes, not thyroid...

After you've seen the new doctor, please update here, on this thread so we can keep all your information together.   I'll look forward to the update...

[Kelfish]

I’m still waiting to see my doctor. It’s about a month wait but I’ve been calling daily to see if there are any cancellations. I just had a couple questions about symptoms.
I’ve been reading through a few of the threads and a lot of people say they feel cold. Honestly, I hardly feel cold. A lot of the times my body feels normal but my hands and feet feel extra hot. Most of the time, when they are hot, it’s the days where I’m feeling really swollen.
I’m just trying to narrow down my symptoms and see if they are consistent.
I just can’t wait to get the test done a be done with all of the wondering.

[Barb135]

It is possible to have nodules and still have thyroid hormone levels in the normal ranges, but your doctor isn't even testing your thyroid hormone levels... He's only testing TSH, which is a pituitary hormone, not a thyroid hormone.  Many doctors do consider TSH the gold standard in thyroid testing, but it's not...

You have a lot of symptoms that are often connected with hypothyroidism and/or Hashimoto's Thyroiditis... my first suggestion would be to try to get your doctor to test for thyroid antibodies to see if you have Hashimoto's.  Hashimoto's is an autoimmune condition in which the body sees the thyroid as foreign and produces antibodies to destroy it.   The antibodies can be present for years before they've done enough damage to cause actual thyroid hormones (and TSH) to go out of range, but even if your thyroid hormones are in range, they may be too low in the ranges to be considered adequate.  

Nodules are very common with Hashimoto's.  

Another possibility with a TSH as low as yours is a condition known as Central or Secondary hypothyroidism.  With Secondary hypothyroidism, the thyroid actually works fine, but the pituitary gland doesn't produce enough TSH to stimulate the thyroid to produce adequate thyroid hormones.  This is a problem with the hypothalamus/pituitary axis and would need a different set of tests.  Many doctors miss Secondary hypothyroidism because they focus on TSH and when it's in the normal range they consider everything wonderful...

At any rate, try to get your doctor to confirm/rule out Hashimoto's first and if he refuses to do that, you'll need to find a different doctor.  I probably would anyway, because I'd not tolerate having any doctor laugh at me for having symptoms such as you have.  I had them when I was very hypo and I know what they feel like.  Had my doctor laughed at me, I'd not have stayed with him beyond that appointment... in fact, he did indicate at one point that he thought I was something of a hypochondriac and I did leave him for a doctor that would take my symptoms seriously...

In addition to hypothyroidism, there are vitamin/mineral deficiencies that can cause some of the symptoms you mention.  They include Vitamin B12, D, and ferritin, which is the iron storage hormone.  These vitamins/minerals are also necessary for the proper metabolism of thyroid hormones, so even if your body is producing adequate amounts if you're deficient in one or more of these, you may not be using the hormones properly.

It's also important to have adequate magnesium which is necessary for proper absorption of vitamin D and calcium.  

There are other things involved too, but the first thing you need is a full thyroid panel, with antibodies. The antibody tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb) to confirm/rule out Hashimoto's... Once we know that and whether or not you have the vitamin/mineral deficiencies, we can go from there...

[Kelfish]

Thank you for your response. I actually did get a new doctor and have an appointment this coming week. I’m going to ask her for the thyroid panel and also to be referred to endo. I will update once I get more test results.