What could a TSH of .46 and a multi-nodular thyroid mean?

[outdoorsymama]

I’m 48 and I’ve been under the care of my endocrinologist for 10 years. My TSH has always run on the borderline low end - .46 recently. I had a hot nodule and hyper symptoms initially and he has never prescribed meds. The largest nodule grew from 1.6 to 2.1cm over the past 10 years. I have both hyper and hypo symptoms and he is just now sending me for a FNA which has me frightened some. Anyone else experience these symptoms? And have a diagnosis? From the multiple posts I’ve read, I feel like a lone ranger.

[outdoorsymama]

Thank you all. The radiologist and the sonographer determined what I can actually feel or is palpable, it is not my thyroid or a nodule after all. In fact, they said in ten years that my nodules had changed at all and that they look for stability. They even said it was not a lymph node. It is hard and adjacent to the left side of my trachea. So I am back to the doctor next week.

[outdoorsymama]

Oops... had *hardly* changed at all.

[Barb135]

Have you had anything tested other than TSH?   You said you have, both, hyper and hypo symptoms - what are those symptoms?

[Barb135]

Is TSH the only blood test your doctor has ordered?  TSH is a pituitary hormone and is not a good indicator of thyroid status.   It's usually low in hyperthyroidism as thyroid hormone  levels  go higher, but can be either high or low in hypothyroidism as thyroid hormone levels decline, depending on the cause of the hypothyroidism.

What about Free T3, Free T4 or antibody tests?   If you have results for any of the other tests, please post them, along with their reference ranges, which vary from lab to lab so have to come from your own report(s).  Once we know your actual hormone levels, we'll have a much better idea whether you have hyperthyroidism or hypothyroidism.  

It sounds as if you might need to find a different endocrinologist once you've had the FNA.  

[Sarahjogs]

Hi outdoorsymama,

I had a multinodular goiter with lots of nodules.  I have Hashimoto's, which is an autoimmune disease, and by the time my thyroid problem was diagnosed, one of my nodules ended up being suspicious and unfortunately it was thyroid cancer.  (All people are different - in no way do I think you have cancer just because that's what I had).

Have you been tested for Hashimoto's or Graves disease?  Those are two autoimmune diseases that affect the thyroid, and both can cause multinodular goiters if untreated over a long period of time.  These diseases are usually the cause of a multinodular goiter in countries where iodine has been added to salt and other foods (like in the US).  The  blood test involves measuring antibody levels of antibodies to thyroid proteins (Thyroglobulin and Thyroid peroxidase antibodies for Hashi's,  Thyroid peroxidase and TSI (thyroid stimulating immunoglobulin)).

Grave's disease generally causes hyperthyroidism, Hashimoto's can start by causing hyperthyroidism symptoms but eventually leads to hypothyroidism as the disease progresses.  It can sometimes be frustrating to get treatment for Hashi's, because as the immune system attacks the thyroid, less thyroid hormone (T4) is made, which causes TSH to increase, telling the thyroid to grow, grow, grow, and then once the thyroid grows, more T4 is made and TSH comes back down, and might appear normal on a blood test despite many hypothyroidism symptoms.  TSH is not a great way to diagnose a thyroid problem, especially if it is in range but you are experiencing thyroid related symptoms.  I had been having many thyroid symptoms for years and had a multinodular goiter, and my TSH was 3.4 (range 0.45-4.5), and the doctors kept telling me my thyroid hormone level was fine (it was not fine).

Some people have both Graves disease and Hashimoto's, I don't think that is very common, but based on experiencing many hyper and now some hypo symptoms, I think it would be worth getting tested for both.

As for the nodule side of things - please know that most thyroid nodules are benign!  90-95% are benign.  If you have a thyroid disease like Hashi's and go through periods where you have high levels of TSH, your thyroid and any nodules will continue to grow because TSH (thyroid stimulating hormone) causes thyroid growth, but this isn't something that you should automatically assume is cancer.  Just because a nodule has grown doesn't mean it is cancer, just that it has now reached a size where it is more beneficial to do the FNA to make sure it is benign.  I have an aunt who had a thyroid nodule removed when she was 15, she gets periodic thyroid ultrasounds and thyroid nodule biopsies since then and she's now 55, and her biopsies keep coming back benign.

In all honesty, waiting for the fine needle biopsy was the worst part of my whole thyroid diagnosis - by the time my cancer diagnosis came around for me, it was after my surgery and after the cancer was out of my body, so there was a lot less to be anxious about at that point.

Good luck with your biopsy, and I hope you can figure out what is causing your symptoms and get some treatment.

[Gracevd70]

I had multiple FNB and it's not that bad , you won't know anything until the biopsy results come back.  

My thyroid saga started out just like you the only difference between us was my primary doctor for 12yrs ignored all professionals advice to send me to Endo due to enlarged thyroid gland and nodes (I had no idea of any of this) never had access to health record and I trusted my doctor that my panic attacks and inability to swallow and random weight gain/lose were me being a weight worrier.  She loved to blame me for my panic attacks...my panic attacks were so bad I would black out almost crashed my car once and to this day I won't drive on the highway...all in my head more like throat..lol

For years I would flip flop back and forth between hyper and hypo symptoms and never knew this was and issue and now I do ...I was diagnoised with thyroid cancer in 2016  had thyroidectomy in 2016 and still struggling with possible recurrence right now, because I haven't suffered enough.

Do the biopsy and see what it reveals... good luck.