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Thyroid nodules

I've had multinodular goiter for over 15 years. One large in left lobe of 2.2. cm with vascularity. TSH was 0.45. t3 and T4 normal. Raiu scan showed 6hr uptake of 24.1% and 24 hr uptake of 57.5%. It Said no focal areas of abnormal activity detected. Distribution of radionuclide is uniform and symmetric. No extra thyroidal accumulations are seen. There is no focal lesion to indicate hyper functioning nodule. Does this mean I have cold nodules? If not what does it mean?
Best Answer
649848 tn?1534633700
The report says "Distribution of radionuclide is uniform and symmetric", meaning the nodule takes up the same amount radionuclide as the surrounding thyroid tissue.

A "hot" nodule is one that takes up more of the isotope and is producing thyroid hormone independently of the thyroid.  A hot nodule is rarely cancer.  

A cold nodule is one that takes up less iodine and does not produce thyroid hormones.  A cold nodule can be cancer, but less than 5% of all thyroid nodules end up being cancer.  

Your report states that there is "no focal areas of abnormal activity", which which indicates there's nothing suspicious or concerning, even though the nodule is relatively large.   The report should have an "impression" at the bottom which would indicate what follow up, if any, is recommended.   Most multinodular goiters should be rechecked annually, unless the report indicates that it should be done more often.

Are you taking a replacement thyroid hormone medication?  Thyroid medication will often help shrink nodules.  If you're taking replacement medication, what medication and dosage, and how long have you been taking it?

Your TSH was relatively low... what was the normal T4 level and was that Free T4 or Total T4?  They aren't the same test and there's a huge difference in the information provided.  If the report says, simply, T4, that means it was Total T4 and isn't as useful as Free T4.  Was there, by any chance a T3 or Free T3 test done?

What, if any symptoms do you have?
Hi, the labs were Free T4 @ 1.5 ( range 0.8-1.8) and Total T3 @ 143 ( range 76-181).  I am not taking any thyroid hormone medication. The impression doesn't state what is recommended which I thought was weird. It just says "Markedly abnormal study with increased radioactive iodine localization in 6 and 24 hours. There is no focal lesion to indicate hyper functioning solitary nodule." I have an appointment with the specialist in the next week and then see if they want to do the biopsy.
Also only symptoms I have are thin hair which I've had even as a teenager ( over 20 years) , get cold easily, occasional migraines, and my neck looks enlarged.
This doesn't make sense:  "It Said no focal areas of abnormal activity detected."  Then in your follow up comment:  ""Markedly abnormal study with increased radioactive iodine localization in 6 and 24 hours."  

Is it just the iodine uptake they're looking at, as abnormal?  What are the reference ranges for uptake?

Your Free T4 is on the high side, indicating that you might be hyper; however, your Total T3 is at 64% of range.   The problem is that Total T3 doesn't really tell much because most of that is bound by protein and can't be used.  They should have tested Free T3, which is the amount of T3 unbound and available for use by the body.

Have you had and antibody tests to determine whether or not you have Hashimoto's or Graves Disease?  To diagnose Hashimoto's, you need Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).  The definitive test for Graves Disease is Thyroid Stimulating Immunoglobulin (TSI).  Although Hashimoto's is most often associated with hypothyroidism, it often begins with periods of hyperthyroidism alternating with, either, hypo or normal.  Graves Disease is always associated with hyperthyroidism.  

Your symptoms are more indicative of hypothyroidism.   Your neck, most likely, looks enlarged because of the nodular goiter.
Reference ranges are 8-16% at 6 hours and 20-30% at 24 hours. Mine were 24.1% at 6 hours and 57.5% at 24 hours. I'm seeing the specialist next week. The PCP said I may have hyperthyroidism but couldn't explain the abnormal comment on the report and impression. He said they may want to remove my thyroid which I'm not sure I want to do. I'm going to request the bloodwork to test for hashimotos and Graves when I see the specialist.
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