[Upquark]

I am new here. My name is Mary. I had a partial thyroidectomy back in 1991 because of a large nodule. It turned out to be benign. My doctor recently ordered an ultrasound and it seems I may have up to 4 new nodules. I have a large spongiform one at 3.8 cms in my left lobe that is TI-RADS 2 and up to three in my right lobe. The ones in the right lobe are discrete and difficult to visualize. The biggest one at 1.1 cm is at the mid gland, echogenic and TI-RADS 3. Another one is subtle possible isoechoic at the superior lobe. Here where it gets concerning. Apparently my thyroid is diffusely heterogenous with increased vascularity, nonspecific, can be seen with thyroiditis. I recently had TSH and free T4 tests and they came back normal, so I was surprised with the ultrasound findings.
TSH was 2.060 ulU/ml
T4, free 1.25 ng/dL
A little background history, I have autoimmune issues and already suffer from Sjogrnen's an autoimmune disease. It appears that thyroiditis might be Hashimoto's?
To make matter worse the PCP that ordered the ultrasound leaves on a sabbatical and I cannot see her until February. I am not sure what to do, look for another PCP or try to see a specialist. It takes a really long wait to see a new PCP where I live. I waited 2.5 months to see this one and she is leaving.
Anyone have any advice, insight or have been there done that and can comment? Will be much appreciated!

 

[GOLGO13]

Welcome again. Best to include ranges for your labs. They look fairly normal. To check for hashimotos ask them to run TPO and TG antibodies.

When someone has multiple autoimmune diseases I think it's worth considering some alternative ways of addressing autoimmune issues. Not really something doctors would recommend, but can be helpful. Some examples would be drinking highly filtered water (Berkey, reverse osmosis, bottled, etc). Lowering chemicals in health products like toothpaste, deodorant, soap, etc. Eating grass fed, pastured, organic foods. Eating less processed foods and considering going gluten free. At least a trial of full gluten free. It's not easy though, so keep that in mind. Using olive, avocado, or coconut oils instead of the other kinds. Lowering stress as much as possible. Yoga, meditation, warm baths. Walking 30 min a day if possible. All of these can be helpful. There are further diet things to try if needed. Elimination diets to try to get rid of foods causing trouble. Or food sensitivity testing. Again, many of these are alternative methods but I do believe in them and have used these myself and saw results. But they are not all easy.

Lovlkn can help with the thyroidectomy items. I am not familiar with those items. Wait a day or two and she will reply likely.

Good luck toward getting things under control.

 

[GOLGO13]

If you do have hashimotos, you are very early in that and probably do not have hypothyroidism quite yet. Often implementing some of those alternative techniques can get the thyroid back to normal for people very early in the process. Hashimotos and some you listed are more associated with each other.

 

[Upquark]

Welcome again. Best to include ranges for your labs. They look fairly normal. To check for hashimotos ask them to run TPO and TG antibodies.

When someone has multiple autoimmune diseases I think it's worth considering some alternative ways of addressing autoimmune issues. Not really something doctors would recommend, but can be helpful. Some examples would be drinking highly filtered water (Berkey, reverse osmosis, bottled, etc). Lowering chemicals in health products like toothpaste, deodorant, soap, etc. Eating grass fed, pastured, organic foods. Eating less processed foods and considering going gluten free. At least a trial of full gluten free. It's not easy though, so keep that in mind. Using olive, avocado, or coconut oils instead of the other kinds. Lowering stress as much as possible. Yoga, meditation, warm baths. Walking 30 min a day if possible. All of these can be helpful. There are further diet things to try if needed. Elimination diets to try to get rid of foods causing trouble. Or food sensitivity testing. Again, many of these are alternative methods but I do believe in them and have used these myself and saw results. But they are not all easy.

Lovlkn can help with the thyroidectomy items. I am not familiar with those items. Wait a day or two and she will reply likely.

Good luck toward getting things under control.

Thanks again for your response. I do all these things already. The only medicine available for Sjogren's caused side effects, so desperate for relief, I turned to alternative methods too. I follow an elimination diet called AIP, autoimmune protocol, or autoimmune paleo. It is very hard, I have been doing it since 2016, I know. I eat only organic meat, fruits, vegetables, healthy fats and a little bit of dairy. I drink spring water. At the beginning of the pandemic and then again earlier this year due to an unrelated health issue, I did get off my diet for a while. But eventually I get back to it, because it really helps with a lot of autoimmune issues.
Due to the effect of Sjogren's to teeth, I do use prescription strength fluoride toothpaste but there is not much I can do about it. Maybe I should also change soaps and deodorants. I wish I could go for walks, but it is very hot where I live and autoimmunity does not like heat or sun. I am not really sure what else to do.

 

[Upquark]

I am new here. My name is Mary. I had a partial thyroidectomy back in 1991 because of a large nodule. It turned out to be benign. My doctor recently ordered an ultrasound and it seems I may have up to 4 new nodules. I have a large spongiform one at 3.8 cms in my left lobe that is TI-RADS 2 and up to three in my right lobe. The ones in the right lobe are discrete and difficult to visualize. The biggest one at 1.1 cm is at the mid gland, echogenic and TI-RADS 3. Another one is subtle possible isoechoic at the superior lobe. Here where it gets concerning. Apparently my thyroid is diffusely heterogenous with increased vascularity, nonspecific, can be seen with thyroiditis. I recently had TSH and free T4 tests and they came back normal, so I was surprised with the ultrasound findings.
TSH was 2.060 ulU/ml
T4, free 1.25 ng/dL
A little background history, I have autoimmune issues and already suffer from Sjogrnen's an autoimmune disease. It appears that thyroiditis might be Hashimoto's?
To make matter worse the PCP that ordered the ultrasound leaves on a sabbatical and I cannot see her until February. I am not sure what to do, look for another PCP or try to see a specialist. It takes a really long wait to see a new PCP where I live. I waited 2.5 months to see this one and she is leaving.
Anyone have any advice, insight or have been there done that and can comment? Will be much appreciated!

So the ranges for the
TSH 0.45-4.50 ulU/ml
T4, free 0.82-1.77 ng/dL

 

[GOLGO13]

Thyroid labs are not too bad. Get FT3 if you can. Probably not an issue at this point.

I didn't want to mention AIP (cause it is hard) but I was thinking it. AIP is a temporary diet though so I hope you did reintroductions. Otherwise you may not be getting enough food and variety. That can result in nutrient deficiency and low calories. I suggest using a tool like cronometer (website or app) to track your calories and macros for a month. Don't obsess over it, but track them.

Low calorie diets are bad for Thyroid.

Also, make sure you are getting some Iodine, but not too much. Seaweed or ionized salt. Some people avoid Iodine too much and it can affect the Thyroid.

Maybe some sort of exercise indoors like a bike or treadmill.

Long term AIP without reintroduction can cause your gut to forget how to deal with foods. If this cause sensitivity to too many foods consider slow reintroduction and maybe the help of an open minded nutritionist. I'm not anti AIP (I did it myself), but it's something that needs to be done very carefully. I found it extremely hard to get enough calories and that caused me some issues with it.

 

[GOLGO13]

I think I have some sort of IBS. Foods I eliminated from doing AIP are legumes and dairy. I also seem very sensitive to spicy peppers which really stinks. Most gluten free restaurants are Thai food which are all spicy flavored. I have thought about doing food sensitivity testing just in case I missed something with my reintroductions. Food is very difficult nowadays and that can be stressful. Stress is the biggest factor from my experience with hashimotos. At least for me that has the biggest impact.

I do have special gluten free oats (Montana Gluten free) and muesli to get whole grains. And gluten free pasta (jovial) and bread (canyon bakehouse). It's low fodmap but would need reintroduction on AIP. These helped me get calories back. And pecans here and there.

But yes, with multiple autoimmune AIP is helpful but tricky.

 

[Lovlkn]

Upquark,

"My doctor recently ordered an ultrasound and it seems I may have up to 4 new nodules. I have a large spongiform one at 3.8 cms in my left lobe that is TI-RADS 2 and up to three in my right lobe. The ones in the right lobe are discrete and difficult to visualize. The biggest one at 1.1 cm is at the mid gland, echogenic and TI-RADS 3. Another one is subtle possible isoechoic at the superior lobe. Here where it gets concerning. Apparently my thyroid is diffusely heterogenous with increased vascularity, nonspecific, can be seen with thyroiditis. I recently had TSH and free T4 tests and they came back normal, so I was surprised with the ultrasound findings.
TSH was 2.060 ulU/ml
T4, free 1.25 ng/dL "

Based on the size of the nodules alone - your doc will likely suggest another Surgery to remove the remaining 1/2. Vascularity is the other issue

As far as your labs - can you edit and post ranges? Based on my range for FT-4 you would be hypo. DOes your doc ever run FT-3?

 

[GOLGO13]

Lovlkn, her range for FT4 was .82 to 1.77. So her value of 1.25 is almost exactly in the middle of the range. TSH of 2 is pretty reasonable also for someone not on medication. FT3 would be nice to get next time.

She should definitely check for hashimotos though. And I would keep an eye on the thyroid labs every 6 months... especially if hashimotos comes back positive.

 

[Lovlkn]

Being in the middle of range - without knowing FT-03 levels can definitely result in an elevated TSH result. Nodules impact thyroid hormone function and she has several documented. If you are concerned see a surgeon who will give an honest opinion whether they think it should come out or a PCP if you would like thyroid hormones. A naturopathic might be a better decision as they will look into FT-3 results to determine whats going on.

 

[Upquark]

I am sorry I didn’t post earlier. I didn’t realize I had more responses. So, as I was researching the lab results, I found out that taking biotin may alter the results. So, I had another blood test and this time they did the whole thyroid panel.
So here are my results
TSH 2.570 .450-4.5
Free T4 1.21 .82-1.77
Free T3 2.8 2.0-4.4
TPO <8 0-34
Thyroglobulin antibody <1 0.0-0.9
I was within the range in everything, but I read that a TSH above 2.5 is actually considered high by some doctors and it is considered a sign for future hypothyroidism. Anyone has been there?

 

[Upquark]

Upquark,

Based on the size of the nodules alone - your doc will likely suggest another Surgery to remove the remaining 1/2. Vascularity is the other issue

Lovlkn,
can you provide any more info about vascularity? What are the implications? I also had a recent development, I now have a couple of swollen, small lymph nodes in the right side of my neck. I am still waiting to see an endo. My PCP’s office sent a referral to one. They took almost 2 weeks to process my referral and in the end they told me they had no availability. I need to find another endo.[/QUOTE]

 

[Lovlkn]

Is vascular flow a predictor of malignant thyroid nodules? A meta-analysis I've been on Thyroid boards over 20 years and a vascular thyroid is usually reason for concern in many posts I have read.

 

[GodlovesAnna]

I am new to this whole thing..I just found out I have several nodules and one of them is on my isthmus, which apparently is a concern as if there is malignancy, it can spread outside of the thyroid. I read my US report and it did say 2 of the 7 have blood flow or or vascular. I did also read that that doesnt necessarily mean its malignant.