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Need help understanding Thyroid ultrasound. Copy of report posted below.

Study Result

Narrative & Impression

ACCESSION: 9533804

CLINICAL HISTORY: Patient with previous benign thyroid biopsies previous nodules
who presents for additional evaluation at this institution

COMPARISON: None available

TECHNIQUE: Grayscale and color Doppler imaging the thyroid gland was performed

FINDINGS: Right: Right thyroid lobes enlarged measuring 5.7 x 1.4 x 1.2 cm in
greatest longitudinal, AP and transverse dimensions respectively. Is mildly
heterogeneous with no dominant solid mass seen. The isthmus is normal measuring
2 mm. There is increased color flow vascularity throughout the entire right
thyroid lobe.

Left: The left thyroid lobes enlarged measuring 6.7 x 2 x 2.1 cm. There is a
complicated solid mass with some central necrosis and a thickened rim and
peripheral calcification in the lower pole measuring 2.8 x 2.2 x 2 cm. There is
increased color flow vascularity throughout the entire left thyroid lobe but the
mass is hypovascular.

IMPRESSION:
1. THYROMEGALY. THERE IS A DOMINANT COMPLICATED MIXED SOLID AND CYSTIC MASS WITH
THICKENED CALCIFIED GRANULOMA IN THE LOWER POLE THE LEFT THYROID LOBE MEASURING
UP TO 2.8 CM. THERE IS HYPEREMIA THROUGHOUT SUGGESTIVE OF A COMPONENT OF
THYROIDITIS.
2 Responses
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Avatar universal
Symptoms:  insomnia, anxiety, tension, jittery, brain fog, constipation, I have a tightness in my neck on the left side and sometimes I feel a tightness in my face on the left that extends to my left ear.
One concern I have is that I already have another autoimmune disease.

Bloodwork:
TSH .718 uIU/mL       Range .3 - 4.0 uIU/mL

Thyroid Peroxidase     <9 LU/mL      Range  0 - 34 IU/ml

T3     107 ng/dl           Range 71 - 180ng/dl

T4Free     1.18 ng/dl           Range .80 - 1.80ng/dl
        
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2 Comments
Have you ever had Thyrogolobulin Antibodies (TgAB) tested?   TgAB is another antibody test that could confirm/rule out, Hashimoto's.  

It's a fairly large nodule, so that could be putting the pressure on your face.

I would, definitely, expect your TSH to be higher, with those T3 and FT4 results.  How long ago were those done?  Unfortunately, the doctor ordered Total T3 instead of Free T3, so we don't really know how much you have available for use.

Entocort is a corticosteroid and can lower TSH levels.  Without adequate TSH to stimulate the thyroid, your actual thyroid hormone levels wouldn't be as high as they otherwise might, which could cause your symptoms.  

Have you had an organ transplant?  CellCept is used to prevent rejection.  

Bloodwork was done in December 2022 and the ultrasound in January 2023.   The girl that did the ultrasound did mention having a biopsy.  I figure that will be done when I see the endocrinologist.
I do have an appointment with and endocrinologist, but it is not until May 12th. Hopefully he will check the TgAB and Free T3. I will definitely ask. I haven't taken Entocort since 2014 but still take Cell Cept.  I have not had an organ transplant.  My autoimmune Hepatitis (I have heard this is kind of rare) is just my immune system attacking my liver.    The Entocort healed my liver, but I take the Cell Cept to keep the inflammation from coming back.    My concern is that my thyroid is probably autoimmune related since I already have one autoimmune disease.    I am also concerned about waiting 4 months.  My current doctor has not given me any insight as to what is going on or what the results mean.  She just referred me to and endocrinologist.  
649848 tn?1534633700
COMMUNITY LEADER
Sorry for the late response.  Is the  nodule in question (on the left thyroid lobe) the same one that's been biopsied previously and found to be benign?  

It looks like the right lobe is swollen (goiter), but with uniform blood flow, there doesn't seem to be any significant issue.  The isthmus is normal - no problem there.

If I were going to be concerned about anything, it would be the left lobe, which has the dominant nodule.  Thyromegaly is, basically, a goiter.

There's nothing mentioned about the need for biopsy and they mention "thyroiditis".  This could be, either, Hashimoto's Thyroiditis or Graves Disease, so I'd have to ask if you've had a full thyroid hormone panel.  I'd also wonder, since this seems to be an ongoing thing, whether you've been diagnosed with a thyroid hormone issue - either hyperthyroidism or hypothyroidism and whether or not you're currently taking a thyroid replacement medication.  

If you've had a thyroid panel (TSH, FT4, FT3 and maybe antibody tests), could you please post the results of those tests, along with their corresponding reference ranges?   If you're taking a thyroid medication, which med(s) and what dosage(s) are you taking.  

Last, but certainly not least, what, if any symptoms do you have?
Helpful - 0
1 Comments
Thank you for your response.    
I was diagnosed with a nodule 17 years ago.  I did have a biopsy then.  The nodule never really changed, and I never took any meds.  About 13 years ago I was diagnosed with autoimmune hepatitis and took Entocort for about 4 years and am still taking Cell Cept.  I did have an ultrasound on my thyroid in 2018 and no changes.  I moved in 2019 and no longer have an endocrinologist.  So, all the changes probably started around 2019.  I
I do have bloodwork.  Everything was in normal range.  I can attach a copy of the report tomorrow.  

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