At my wits end. Whats happening?

[Horsepoor]

ANOTHER Thyoidand parathyroid ultrasound?
HELP!
These have been my test results.
33mm x17mm x17mm mass left lobe,5mmx7mm  on isthmus, another nodule in right lobe. FNA results benign abundant  follicular epithelium, macrophages, blood, acute inflammation, hurthle cells.
MRI: Advanced bone degeneration
Blood work: TSH .48, free t4 ..73,Free t3 1.0 Deficient vitamin d 17, high normal calcium9.1 , below normal protein, below normal ast (sgot), below normal c reactive protein, high ldl cholesterol. I am a 43 yr old very active woman I work outdoors, healthy diet. History of chronic lymes that is now negative. Chronic pain and other autoimmune symptoms
Whats happening? Being sent for another ultrasound, have not seen an endocrinologist and big mass is pressing on a lot of stuff. Very uncomfortable

[goolarra]

Good for you.  I'm so happy to hear this isn't discouraging you.  

With your low TSH, pituitary dysfunction is a distinct possibility.  Not all pituitary dysfunction shows up on a scan.

Keep us posted...  

[Horsepoor]

Yes I was tested for thyroid autoimmune and it came back negative. I am making an appointment with another endo that my nurse practitioner really likes, even though she is booked through May. In the meanwhile I have an out of state family friend who is in the medical field look for someone they might recommend at Vanderbilt in Nashville. I'm not letting Dr. 'You ride horses what do you expect' knock me down on this. Since a cameras crew didn't walk in and say I was getting punked, I reckon he meant every word of what he said and I'm happy to put that experience behind me. My NP is leaning towards pituitary dysfunction and would like the neurologist to take a closer look at my pituitary to see if there is anything he may have overlooked on the brain scan he did.

[goolarra]

Well, I won't slap you, but I'd like to be close enough to slap HIM!  LOL

Nodules are very common.  They're also a hallmark of Hashi's.  If they're small and don't look suspicious on U/S, they're usually just watched for changes.

However, he should not have ignored your TT3 and FT4.  Those are much too low.  My guess is that he looks at TSH, and then his eyes glaze over, and he just can't quite make out those T3 and T4 results.  

I'm sorry he was such a bust.  I know you're in a rural area and have limited options.  Remind me, were antibodies tested?  Can you do some research on doctors (interview them over the phone) and start over?  

[Horsepoor]

Wow. Somebody slap me. Met with Endo who absolutely ignored my bloodwork. Said my low parathyroid was 'incidental' (ummm incidental to what?!) asked if I had trouble swallowing Blah blah blah. Yes to all. Looked at my low thyroid function, low t4, low t3 read all of my symptoms. Knows I have 5 nodules one of which is hypoechoic symptoms pain and very little blood flow, stenosis of my vital neck parts etc. Said well, you train horses. Your not going to feel at 43 like you would at 20. If he took 10 people off the street 5 would have a nodule. Said follow up in 6-12 months with an ultrasound and we'll see if it grows. He kind of chuckled and said don't lose sleep over it. (I felt like he thought I was an over reactive female, not for anything I do a mans job and I'm touch as grit, not a whiny baby) , no bloodwork, no ct scan etc. nothing. I gave him a 50 dollar copay after an hours drive and he said...basically,,, I'm just old and achy.

[Horsepoor]

Had an ultrasound done again today, there are now 5 masses. 3 consume the entire left side one on isthmus and one in right lobe.  Appt with Endo on Tuesday. The plot thickens....

[goolarra]

Hang in there.  The waiting's the worst part.  Best of luck with your U/S.  Hope the endo gets back to you today.

[Horsepoor]

They faxed my file to an endo Friday evening (no news yet). They scheduled an ultrasound for Thursday and they said that has to be done before my insurance company will pay for the CT scan they want done. In addition to everything mentioned my RDW is low (not deficient) creatinine low. My calcium level was normal 9.1 (8.5-10.3 range) or course my vitamin D was very low. Maybe the endo will contact me tomorrow. I will let you know what they say.

[goolarra]

I don't know a lot about parathyroid.  It regulates the calcium and magnesium levels in the blood.  It was probably PTH that they tested.  When PTH is low, it's because serum calcium levels are too high.  The only relationship of thyroid to parathyroid is its proximity in the body.  

Did you get an appointment with the endo?

[Horsepoor]

My parathyroid test came back today, they called and said they wanted me into an Endo ASAP. They are making calls. They said the test was low. I haven't seen the paperwork but I THINK they said the lab range started at 14 and I was below that. Don't know the number. I just felt urgency in her voice.  so confused.

[goolarra]

There's no hurry to have antibody tests.  Lots of times, they explain a lot of what's going on, but perhaps they'll be more likely to do them after the current tests, or the specialist will.

[Horsepoor]

They just called back and said they didn't think they needed to do those tests at this time. They would see what the parathyroid test showed and leave any additional  testing up to the 'specialist' (who I've been waiting a week to get a referral to and it isn't likely I will get in t see them before May)

[Horsepoor]

I just called to see if they could add those tests to the parathyroid test. They will get back to me and let me know.
Thanks so much! This is all greek, to me!

[Horsepoor]

I have never had any tests for Hashimoto's

[goolarra]

I just saw 898_1's response.  Since autoimmune is suggested, has anyone ever tested your thyroid antibodies to see if you have Hashimoto's thyroiditis?  TPOab (thyroid peroxidase antibodies) and TGab (thyroglobulin antibodies) must both be tested since some of us are positive for one, some the other and some both.

Thyroid meds can also help shrink some types of nodules.

[goolarra]

Your FT4 is at 14% of range.  For a number of reasons, thyroid reference ranges are very flawed.  Many of us find that we feel hypo until FT4 is around 50% of range.  Your FT4 is also at 14% of range, and the guideline for FT3 is 50+%.  Both indicate that you are hypo.

TSH disagrees.  It's on the low (hyper) side.  Although many doctors think TSH is the be all and end all in thyroid testing, it's really the least important of the tests.  A low TSH with accompanying low FT3 and FT4 can indicate secondary hypothyroidism.  Secondary is actually a pituitary dysfunction.  The pituitary doesn't put out enough TSH to stimulate the thyroid to produce hormone.  However, the result (hypo symptoms) and the treatment are the same whether primary or secondary.

I know what you mean, the middle of nowhere is just up the road from us!  LOL

You might have been deficient in D for years.  D is also necessary for the synthesis of thyroid hormones in the thyroid and must be present in cells for thyroid hormone to be able to get into the nucleus and do its job.  

[898_1]

The large nodule is MOST likely benign (has lot of colloid) Macrophages (white blood cells) suggest inflammation with hemorrhage (filed nodule is filled with blood).
Random occasional Hurtle cells suggest autoimmune process.
In this case the doctor may suggest anti-inflammatory drugs; this may make nodule ”softer “ and relive pressure symptoms; the nodule may also shrink. This therapy can be combined with applying cold to the area and limiting tension to the neck muscles and talking so bleeding into the nodule will not happen again.

[Horsepoor]

TSH 0.48 lab range is 0.34-5.60 mU/L
Total T3 1.00 lab range is 0.87-1.78 ng/ml
Thyroxine Free (free t4) 0.73 lab range is 0.58-1.64
They are running a parathyroid test today
also forgot to mention the biopsy showed colloid as well (don't know if that matters)

The only meds I am on is 50,000U of Vitamin D 1x per week, 1000mg of Calcium/Vitamin D daily (only began this 3 days ago), also gabapentin for chronic body pain.

I am NOT on ANY thyroid meds and have never been to an endocrinologist. The large mass is pushing on my major veins and my trachea.

Any help is appreciated, I live in a small town in between the boondocks and the sticks. Limited care options here.

I have been having pain, fatigue,  headaches, muscle weakness, confusion, heart rate issues and insomnia for years and finally was sent to a neurologist who accidentally found the nodules, that  were all present on an MRI done a year and a half ago but no one picked up on it. (I have two bad cervical discs) Neurologist also mentioned that I have advanced bone degeneration. Connection? Can someone have low D for years and not know it. My previous Dr (8 years) never tested me for it despite my symptoms.

[goolarra]

Please post the reference ranges for your T3 and T4.  Ranges vary lab to lab, so they have to come from your own lab report.  Also, do they say they are FREE T3 and FREE T4?

Is your doctor addressing your severe D deficiency?

Are you taking thyroid meds?  If so, which and how much?

I'm no imaging expert...hopefully someone else will chime in soon on that part of your question.