heterogenous goiter?? normal bloodwork??? WHAT???

[mommy2two2008]

Hi all - I am reposting from a while ago.  New here and really looking for some help / thoughts.  30 yrs old - felt like a lump was in neck 3 wks ago w/ pulling sensation in neck, jaw, chin.  Have intermittent swollen right neck glands and ear pressure/fullness and this was happening at same time.  Was not worried abt glands, but lump feeling was new.  ENT would take a month so went to endo b/c of location of the "feeling".  Endo said I had small goiter, larger on right. Ordered bloodwork and ultrasound.  Nurse said blood was normal with Free T4: 1.45, TSH 1.04 & TPO ab: <10.  Ultrsound showed "heterogeneous echo texture thyroid in upper limits of normal, larger on right.  No suspicious focal lesions.  I have been having horrible symptoms since then.  My sternomastoid muscle on right always feels contracted now.  I can see a portion of the sterno muscle (above thyroid) that looks to have a lump on mid-right of my neck when swallowing and a vein over it (this is in addition to the visible thyroid movement).  Have muscle and physical weakness, severe fatigue (have had this for quite some time), weight varys month to month, dizzy, etc.  Have not had a period this month (definately not pregnant).  I go back to endo Thurs.  I have a history of night sweats since 16 due to endometreosis surgery (surgery again at 19).  2 kids ages 5 & 3.  Can you have Hashi's with normal blood test?  Is there something to indicate what could cause this stuff?  Feeling worse by the day.  I also have ENT appt for 5/1 - not taking any chances.

[898]

There are 3 types of thyroiditis , but in case of Hasimoto's the TPO antibodies will be more then 10, the other two types I posted above are not autoimmune, so they are not as destructive.

[mommy2two2008]

Does anyone know what the TPO ab of <10 means?  Need a breakdown from the "thyroid answers for dummies" at this point.  I am so clueless!  What if I don't have a T3 test result?

[mommy2two2008]

So - if not Hashi's, what are your thoughts on what could cause the sudden thyroiditis?

[898]

Some additional info: it is very common for thyroiditis to produce pain that radiates to the ear;
The heterogeneous structure (it looks like Swiss cheese on the ultrasound)-is also common sign of thyroid inflammation.

[mommy2two2008]

Thank you so much for your post!  I did see something about Hashi / Silent in my relentless searching but still am not sure.  This is so scary.  My Uncle had thyroid problems and took the RAI then he had milignant melanoma.  My father died of cancer and have several other cancer relatives on that side of the family.  My mother-in-law just got diagnosed in Feb. with Cholangiocarcinoma so if I had to tell my husband I had cancer, I think he would jump off the nearest bridge.  No one has seemed troubled by the ultrasound results, but if you type in heterogeneous - the only definition I can find is abnormal.  I have palpatations 2-3 times a month and have had them for a long time, never thinking I had / have a thyroid problem.  The swollen glands along with this all has freaked me out.  I have always gotten them with the ear feelings, but I have never had such headaches and neck symptoms.  Just really worried, probably for nothing, but I just feel like something is very wrong with me.  Will post after thurs' dr. appt with his report.  Thanks again - I really appreciate it!

[898]

The heterogeneous gland structure is usually the sign of thyroiditis.
As the antybodies are low, one of the following conditions may apply:
De Quervain's Thyroiditis. De Quervain's Thyroiditis (also called subacute or granulomatous thyroiditis) was first described in 1904 and is much less common than Hashimoto's Thyroiditis. The thyroid gland generally swells rapidly and is very painful and tender. The gland discharges thyroid hormone into the blood and the patients become hyperthyroid; however the gland quits taking up iodine (radioactive iodine uptake is very low) and the hyperthyroidism generally resolves over the next several weeks.

Patients frequently become ill with fever and prefer to be in bed.

Thyroid antibodies are not present in the blood, but the sedimentation rate, which measures inflammation, is very high.

Although this type of thyroiditis resembles an infection within the thyroid gland, no infectious agent has ever been identified and antibiotics are of no use.

Treatment is usually bed rest and aspirin to reduce inflammation.

Occasionally cortisone (steroids) (to reduce inflammation) and thyroid hormone (to "rest" the thyroid gland) may be used in prolonged cases.

Nearly all patients recover and the thyroid gland returns to normal after several weeks or months.

A few patients will become hypothyroid once the inflammation settles down and therefore will need to stay on thyroid hormone replacement indefinitely.

Recurrences are uncommon.



Silent Thyroiditis. Silent Thyroiditis is the third and least common type of thyroiditis. It was not recognized until the 1970's although it probably existed and was treated as Graves' Disease before that. This type of thyroiditis resembles in part Hashimoto's Thyroiditis and in part De Quervain's Thyroiditis. The blood thyroid test are high and the radioactive iodine uptake is low (like De Quervain's Thyroiditis), but there is no pain and needle biopsy resembles Hashimoto's Thyroiditis. The majority of patients have been young women following pregnancy. The disease usually needs no treatment and 80% of patients show complete recovery and return of the thyroid gland to normal after three months. Symptoms are similar to Graves' Disease except milder. The thyroid gland is only slightly enlarged and exophthalmos (development of "bug eyes") does not occur. Treatment is usually bed rest with beta blockers to control palpitations (drugs to prevent rapid heart rates). Radioactive iodine, surgery, or antithyroid medication is never needed. A few patients have become permanently hypothyroid and needed to be placed on thyroid hormone.