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Old 04-06-2009, 07:58 PM   #1
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What is Thyromegaly? and how does one treat it?

Results of an ultrasound done on my thyroid this week:

Thyromegaly is present, with the right lobe measuring 4.7 x 2.3 x 1.7 and the left lobe measuring 5.6 x 2.3 x 2.2 cm. Extensive bilateral sample and complex cystic nodules are present, with the largest cystic nodule located within the central aspect of the right thyroid lobe. Measuring 1.4 x 1.0 x 1.2 cm; a dominant heterogeneous solid nodule is present within the lower pole of the left thyroid lobe, measuring 4.0 x 2.2 x 2.2 cm (no typ-o's here, they highlighted and underlined centimeter several times).

EXPRESSION: DIFFUSE GOITROUS CHANGES; ACCOMPANIED BY A DOMINANT 4-CENTIMETER HETEROGENEOUS SOLID NODULE IN THE LEFT LOBE; PERCUTANEOUS FINE NEEDLE ASPIRATION IS RECOMMENDED; ALONG WITH CORRELATION WITH THE SERUM TSH LEVEL. (they also underlined all the capitalization) above.

After finally getting in to see my GP (an internist) this evening, she remained uncommittal and said it was nothing to worry about, first she said she wanted to refer me to an Endo, then said she could also just order the tests herself (to get a FNB (ultrasound guided) aspiration and biopsy done (but I kinda had to push her to do that). It was only when I told her its getting VERY uncomfortable that she relented. I'm also fighting dental infections along with a sinus infection (caused by a pulled tooth) so I'm pretty much in discomfort most all the time.

I also talked her into getting some labs to rule out Hashimotos, she wrote a TY TS TSH antimocrosomal antibodies, and said to wait it out. No meds, no nothing. Mind you, I'm not having any of the truly classic symptoms of hypo or hyper, more thyroiditis type symptoms off and on. Also have been diagnosed with adrenal dysfunction but of unknown level. Have been treating that with VIt B and C.

Its only April but I've already taken probably 3 weeks of vacation and personal days just trying to deal with all this.... and not sure how to go from here. Just awfully frustrated, sick, tired, and looking for help.

I'm 55, (5 years into menopause) and basically living on Xanax for the continual bouts of anxiety, in between doses of vitamins, minerals, lots of water, and as much sleep I can muster.

Oh also have low ferritin (35 on scale of 10-210) which means I cant go on Armour even if I could get it, nice) but am supplementing daily to try and bring it up.

Sorry for the long rant, any words of wisdom or advise, would sure be welcomed, thank you,

Blessings,
Macy
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Old 04-07-2009, 06:28 AM   #2
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Low ferritin doesn't mean one cannot have Armour. Neither does low adrenals...you just have to take your RX'd iron and usually have more Armour added...keep testing FT's and 4x salivary cortisol.

Thyromegaly is what happens when the thyroid enlarges. The thyroid enlarges due to disease (generally hypothyroidism). When the patient is treated (FT4, fT3 ranges) with incoming replacment hormone, the thyroid quiets down. Vitamins don't generally 'fix' adrenals.

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Old 04-07-2009, 08:25 AM   #3
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Maycee--

If you have FNA on your nodules, the pathologist will diagnose Hashimoto's if you have it. Mine was diagnosed from the biopsy, but when my endo checked my antibodies, he told me that they were low, and simply based on the blood tests he would not have diagnosed Hashimoto's, but the biopsy is considered conclusive.
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Old 04-07-2009, 05:36 PM   #4
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Thanks so much... so what would the pathologists report say to confirm Hashimotos without the blood work confirmation? From all I've read, I have heard you can have Hashimotos without the antibodies being high (at first). But my doctor has been calling it euthyroid all along, tho its getting bigger and more painful, hard to turn my neck, swallow, etc
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Old 04-09-2009, 07:57 AM   #5
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And notice that it reads 'correlation of serum TSH'. In other words, you are called 'euthyroid' based on your TSH....your pituitary. Not a good thing. Euthyroid means that your thyroid is 'normal'...and you need to go by FT's for that.

Actually, it's calling for a FNB to rule out follicular cancer, not to find Hashimoto's.

Pam
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Old 04-09-2009, 08:49 PM   #6
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Well, I"ve scheduled the FNA for this Monday... a little scared, since this is the second ultrasound I've had done in 5 years on the same side. The first (ultrasound) showed no dominant nodule, but (the FNA) did suggest I have further testing done, because of some "focal Hurthle cell cytoplasmic change - in a background of scattered histiocytes and colloid " that the doc at the time poo-pooed, and said just to "keep an eye on".

I was reading how it says that 95% of dominant nodules are benign, but in other places it says follicular cancers of the thyroid cannot be detected by aspiration.... ? and it says the larger it gets (and the older you get) the more worrisome it is, especially when its considered to be solid instead of cystic.

I guess I still don't get how the "correlation with the serum TSH level" applies to euthyroid and then possible cancer. Sorry to be so thick... feeling very muddle headed tonite.

Thank you very much for your help!

Maycee
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Old 04-10-2009, 08:12 AM   #7
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You do an FNA to rule OUT cancer most of the time (not to find Hashi's), that's what I was getting at. And going by TSH ONLY is just....um...ignorant as all get out. The doc is 'poo-pooing' cuz he's only looking at TSH. That's not right. We all know that. If you aren't converting T4 to T3, if you aren't making ENOUGH, than that's when you get thyromegaly.

Bottom line: If you NEED thyroid hormone, (and you look at FT's to know that) and you don't get it...thyromegaly results most of the time. If the patient with large thyroid only gets T4 and can't convert you get thyromegaly. If you get enough T3 with your T4, it can actually make the thyroid swelling subside, and it takes time. So, while the doc was poo-pooing all that, he could have been giving you proper amounts of T4/T3 and circumventing the growth.

FNA is almost never to find Hashi's...cuz if your FT's are low enough to warrant treatment, it's the same treatment for Hashi's anyway and keeps the thyroid from enlarging (goitering). FNA is a diagnostic tool. The doctor is supposed to treat, not 'look at it grow' IMHO.

Pam

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Old 04-15-2009, 09:55 PM   #8
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Bottom line: If you NEED thyroid hormone, (and you look at FT's to know that) and you don't get it...thyromegaly results most of the time. If the patient with large thyroid only gets T4 and can't convert you get thyromegaly. If you get enough T3 with your T4, it can actually make the thyroid swelling subside, and it takes time. So, while the doc was poo-pooing all that, he could have been giving you proper amounts of T4/T3 and circumventing the growth.

Pam, Thank you for the clarification! It was like pulling hens teeth to get my Doc to order these (she said she did it just for me) but I finally got the prized order for Free T's plus the antimicrosomal bodies added. I'm off to Quest tomorrow to get them done. Is there any specific time of day that is better then any other? I'm not on any thyroid med currently. Just had the biopsy done Monday and am still awaiting results. I've been visiting STTM (stop the thyroid madness) too, and was reading up about iodine supplementation. Still on the fence about that. It seems like my thyroid and adrenals are playing tag with one another, one day my throat will be all swollen up, the next day I'm exhausted, tired but wired and have to take Xanax to calm down. BP is all over the road, as are my temps. I did get a kit from another dr about a year ago to have my saliva tested for adrenals, I'm thinking I better do this too, cuz I'm starting to hit the wall here. On vacation this week to have some teeth pulled, which is the only reason I'm feeling somewhat normal. Any stress just puts me back on the floor. I'm in lovely shape aren't I?

Thanks so very much, I"m really anxious to get these tests back to see what the results are, and to have them analyzed. I really do so want to feel well again....
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Old 04-21-2009, 08:06 PM   #9
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Still no blood results yet, but I did get pathologists report back. the non-chartable comment was: hypercellular aspirates, r/o a microfollicular lesion (4 cm dominant nodule). Follicular cells have bland nuclei with focal Hurtle cell change Hyperplastic vs neoplastic (etc). Dr thinks I should have it out, because of the compression alone, to make sure it is not cancerous. Said a lobectomy should do. I have not seen too much about lobectomies here tho. Could anyone say, it difficult to go thru, can it be done outpatient?? My mom was almost cut ear to ear, for her total thyroidectomy years ago. Appt with Surgeon for a review is this Thursday.
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Old 02-21-2013, 10:14 AM   #10
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Maycee - I don't see a way to message you privately, but I was wondering if you could recommend a good surgeon, etc. I have a large nodule I need biopsied and likely my thyroid removed and I'm in the Chicago area. Thanks!
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