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Please help interpret ultrasound results
What do these U/S findings of my thyroid suggest? Should I be worried?
I was then sent for an ultrasound, which reads The right lobe of the thyroid measures 7.9 x 2.1 x 2.3 and the left lobe of the thyroid measures 7.3 x 1.8 x 2.3 cm in diameter. The isthmus measures 9 mm in thickness. Echogenic nodular area in the left lobe measures 0.9 x 0.8 cm , can be representative of a functioning nodule. Further evaluation with nuclear imaging recommended. Impression nodular goiter.
I was then sent for an ultrasound, which reads The right lobe of the thyroid measures 7.9 x 2.1 x 2.3 and the left lobe of the thyroid measures 7.3 x 1.8 x 2.3 cm in diameter. The isthmus measures 9 mm in thickness. Echogenic nodular area in the left lobe measures 0.9 x 0.8 cm , can be representative of a functioning nodule. Further evaluation with nuclear imaging recommended. Impression nodular goiter.
COMMUNITY LEADER
Goiters can be caused by a number of things. Typically, cancer resides in a nodule, not the thyroid itself. When the thyroid is enlarged/swollen, which is what a goiter is, that's caused by inflammation. That's quite often caused by an autoimmune process and in your case, my guess is Hashimoto's.
When one is in the throes of an autoimmune attack, the goiter can get quite large, nodules can grow, etc.
It's important to remember that < 5% of all thyroid nodules are cancer, so it's pretty rare.
Your ultrasound report mentioned that your nodule could be functioning (producing hormones independently of the thyroid), but since your thyroid levels showed you to be hypo on the second set of labs, I'd say that's not happening.
To answer your question, yes I've heard of thyroids being as large as yours and not being cancer. Autoimmune conditions can do strange things to our thyroid gland. When the antibodies are attacking there's a lot of inflammation going on.
You need the antibody tests I mentioned above to confirm Hashimoto's. Once started on thyroid hormone medication, the swelling/inflammation will often be alleviated. In the meantime, be sure not to rub/palpate the area as that irritates and keeps the swelling irritation from getting better. When I had pain/swelling from my goiter, laying a cool cloth across my neck soothed the pain considerably.
Monday is only a few days away now, so try to relax and not worry. If we look hard enough, we can always find the worst case scenarios, but they're not typical. My policy is to stop googling once I start scaring myself and wait for my doctor's interpretation.
I'm here for you to talk to in the meantime... :-)
When one is in the throes of an autoimmune attack, the goiter can get quite large, nodules can grow, etc.
It's important to remember that < 5% of all thyroid nodules are cancer, so it's pretty rare.
Your ultrasound report mentioned that your nodule could be functioning (producing hormones independently of the thyroid), but since your thyroid levels showed you to be hypo on the second set of labs, I'd say that's not happening.
To answer your question, yes I've heard of thyroids being as large as yours and not being cancer. Autoimmune conditions can do strange things to our thyroid gland. When the antibodies are attacking there's a lot of inflammation going on.
You need the antibody tests I mentioned above to confirm Hashimoto's. Once started on thyroid hormone medication, the swelling/inflammation will often be alleviated. In the meantime, be sure not to rub/palpate the area as that irritates and keeps the swelling irritation from getting better. When I had pain/swelling from my goiter, laying a cool cloth across my neck soothed the pain considerably.
Monday is only a few days away now, so try to relax and not worry. If we look hard enough, we can always find the worst case scenarios, but they're not typical. My policy is to stop googling once I start scaring myself and wait for my doctor's interpretation.
I'm here for you to talk to in the meantime... :-)
1 Comments
I forgot to mention that cancer is also, often, calcified or solid growths within a nodule... your ultrasound says nothing about any of that. It only mentions the goiter, which is can be explained by inflammation and the nodule, which they believed to be functioning, but which appears not to be, as I explained above.
COMMUNITY LEADER
Sorry I missed your response yesterday... You have to be careful of "Dr Google"... it tends to scare people unnecessarily, sometimes. By "thyroid induced coma" I assume you mean myxedema coma, which is what happens when thyroid hormones get too low? That only happens in the very worst cases hypothyroidism. Although your labs certainly indicate you're hypo, the chances of going into a coma are slim to none.
To put it in perspective for you, when I was diagnosed with hypothyroidism, my TSH was 55.5 and my Free T4 was well below the reference range. A normal, resting heart rate is 60-100 and my heart rate was dropping into the low 30's while I slept. All of these are indications that I was extremely hypo, but I didn't go into myxedema coma...
May 14th is only a couple of weeks away, so it's up to you whether you want to wait. It takes 4-6 weeks for thyroid medication to reach full potential and if they order a nuclear medicine scan, you will have to be off all thyroid hormones for 3 weeks prior to the scan, so if you don't have a lot of symptoms, you might be better off to just wait. By not starting medication, you will be able to schedule the nuclear medicine scan right away instead of having to wait. Once the scan is over, you can start on medication right away if you haven't swung back to hyper again...
To put it in perspective for you, when I was diagnosed with hypothyroidism, my TSH was 55.5 and my Free T4 was well below the reference range. A normal, resting heart rate is 60-100 and my heart rate was dropping into the low 30's while I slept. All of these are indications that I was extremely hypo, but I didn't go into myxedema coma...
May 14th is only a couple of weeks away, so it's up to you whether you want to wait. It takes 4-6 weeks for thyroid medication to reach full potential and if they order a nuclear medicine scan, you will have to be off all thyroid hormones for 3 weeks prior to the scan, so if you don't have a lot of symptoms, you might be better off to just wait. By not starting medication, you will be able to schedule the nuclear medicine scan right away instead of having to wait. Once the scan is over, you can start on medication right away if you haven't swung back to hyper again...
2 Comments
Thank You! I appreciate your response. I'm very worried because my thyroid measurements are VERY big, and I don't think that's normal. Sometimes, it looks as if it's increased in size, but it may just be my anxiety speaking. May 14 is Monday and I just want answers!
I know that you cannot diagnose me over the internet. But you've been so helpful! It's worth a shot to ask, have you read of goiters as large as Mine that ended up not being cancer? It seems Dr. GOOGLE has me convinced that goiters are caused by the difficult to treat and lethal thyroid cancers and I'm just so depressed by this knowledge.
COMMUNITY LEADER
Unfortunately, your doctor is ordering outdated tests so it's kind of hard to determine, exactly what's going on. Your doctor should be ordering Free T3 along with the Free T4, instead of the T3 Uptake and Free Thyroxine Index, which are outdated (both are indirect ways of measuring Free T4). Thyroxine is Total T4, which is also outdated.
That said, with your TSH as high as it is and Free T4 way below range, your latest test shows that you're quite hypo. Do you have a lot of symptoms of hypothyroidism?
All things considered, it looks as though you might have Hashimoto's Thyroiditis. One of the characteristics of Hashimoto's is to swing back and forth from hyper to hypo as the thyroid "sputters" and releases extra hormones at times and not enough at other times. This often happens prior to it finally "dying" off. Plus it's also possible that nodule is hyper-functioning at times. A nuclear medicine scan might help, but if the nodule isn't hyper-functioning when you have the scan, that won't help, either.
If you see your primary again prior to seeing the endo, you can ask for antibody testing to determine if you have Hashimoto's. The tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb). You need them both since they're both markers for Hashimoto's and some of us have one or the other and some have them both.
It's possible that the nodule could be causing your goiter, but equally possible that it's a combination between Hashimoto's and the nodule causing the goiter.
Next time you get thyroid function tests, make sure they order, both, Free T4 and Free T3, instead of the outdated tests your primary doctor has been ordering. That way, we can tell exactly what your thyroid is doing/not doing.
When, in May, is your appointment with the endo? If your thyroid doesn't sputter/produce some hormones again, you're going to become quite hypo (more so than you are now). It's not good to let that go untreated for very long, as hypothyroidism can cause a lot of symptoms and have adverse effects on the body. On the other hand, if they do a nuclear med scan, you'll have to come off thyroid medication anyway, so if it's not too long, it might be worth waiting...
That said, with your TSH as high as it is and Free T4 way below range, your latest test shows that you're quite hypo. Do you have a lot of symptoms of hypothyroidism?
All things considered, it looks as though you might have Hashimoto's Thyroiditis. One of the characteristics of Hashimoto's is to swing back and forth from hyper to hypo as the thyroid "sputters" and releases extra hormones at times and not enough at other times. This often happens prior to it finally "dying" off. Plus it's also possible that nodule is hyper-functioning at times. A nuclear medicine scan might help, but if the nodule isn't hyper-functioning when you have the scan, that won't help, either.
If you see your primary again prior to seeing the endo, you can ask for antibody testing to determine if you have Hashimoto's. The tests you need are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb). You need them both since they're both markers for Hashimoto's and some of us have one or the other and some have them both.
It's possible that the nodule could be causing your goiter, but equally possible that it's a combination between Hashimoto's and the nodule causing the goiter.
Next time you get thyroid function tests, make sure they order, both, Free T4 and Free T3, instead of the outdated tests your primary doctor has been ordering. That way, we can tell exactly what your thyroid is doing/not doing.
When, in May, is your appointment with the endo? If your thyroid doesn't sputter/produce some hormones again, you're going to become quite hypo (more so than you are now). It's not good to let that go untreated for very long, as hypothyroidism can cause a lot of symptoms and have adverse effects on the body. On the other hand, if they do a nuclear med scan, you'll have to come off thyroid medication anyway, so if it's not too long, it might be worth waiting...
1 Comments
My appointment is May 14th. I don't feel very symptomatic at all. I feel tired at times, but I suspect that would be normal due to waking up at night with my 5 month old. Other than that, I don't generally feel bad. Do you think it would be worth it to wait? Google has me frightened of going into a thyroid induced coma, which is what prompted my third visit to the doctor.
Thank you again for your responses. It's all very informative and helpful!
Thank you again for your responses. It's all very informative and helpful!
COMMUNITY LEADER
It sounds like you might have a nodule that's producing hormones independently of your thyroid. This is called a "toxic nodule"
Do you have hyperthyroidism? Have you had thyroid function tests done? That would be Free T4, Free T3 and the pituitary test, TSH. If you have results for those, please post them so we can see what your thyroid is actually doing. Be sure to post reference ranges with any results, since ranges vary from lab to lab and have to come from your own report(s).
Also, have you been diagnosed with, either, Hashimoto's Thyroiditis or Graves Disease? Both are autoimmune conditions that, ultimately, destroy the thyroid.
Do you have hyperthyroidism? Have you had thyroid function tests done? That would be Free T4, Free T3 and the pituitary test, TSH. If you have results for those, please post them so we can see what your thyroid is actually doing. Be sure to post reference ranges with any results, since ranges vary from lab to lab and have to come from your own report(s).
Also, have you been diagnosed with, either, Hashimoto's Thyroiditis or Graves Disease? Both are autoimmune conditions that, ultimately, destroy the thyroid.
1 Comments
Thank you for your reply. A little background, I had a baby in November. 3 months later I went to my Primary care physician for a routine check up. My TSH came back hyper at .01 L. The doctor then ran the test again, and my results came back hypo at :
T4 Free [direct] .50 LOW ref .82- 1.77
TSH 11.590 HIGH ref .450 - 4.500
T3 Uptake 26 ref 24 to 39
This is when she noticed the swelling in my neck. I opted to not take any medicine and wait for my endo appointment which is coming up in May. However, a week Ago I went back to my Primary doctor and she ran my TSH again and it came back normal at
THYROXINE 4.7 [4.5 - 12.]
T3 Uptake 26 [24-39]
FREE tyroxine index 1.2 [1.2 -4.9]
However the swelling in my neck is still there.
What Do you think? Could this nodule be causing my Goiter?
T4 Free [direct] .50 LOW ref .82- 1.77
TSH 11.590 HIGH ref .450 - 4.500
T3 Uptake 26 ref 24 to 39
This is when she noticed the swelling in my neck. I opted to not take any medicine and wait for my endo appointment which is coming up in May. However, a week Ago I went back to my Primary doctor and she ran my TSH again and it came back normal at
THYROXINE 4.7 [4.5 - 12.]
T3 Uptake 26 [24-39]
FREE tyroxine index 1.2 [1.2 -4.9]
However the swelling in my neck is still there.
What Do you think? Could this nodule be causing my Goiter?
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