Blue horizon results - advice please

Blue horizon results - advice please

Hi. I was diagnosed with a large nodule on my thyroid after suffering with swallowing and breathing problems and hypothyroid symptoms. Was told at the time that my blood tests were normal. I'm waiting to see thyroid surgeon. The appointment came through today. 6th June :( had blue horizon tests done whilst I was waiting as GP not helpful and dismissive of symptoms. Any advice on thyroid nodules/thyroid removal/blood results gratefully received as ion feeling a bit overwhelmed. 

22 Replies

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  • Betty41,

    Your thyroid results are euthyroid (normal).  They're actually very good as TSH is low in range, FT4 close to top of range and FT3 mid-range.  Thyroid antibodies are negative for autoimmune thyroid disease (Hashimoto's).

    B12 is low, PA Society recommend 1,000 as optimal.  Supplement 1,000mcg methylcobalamin with a B Complex vitamin.

    Folate and ferritin are good.

    CRP is a marker of non-specific inflammation somewhere in the body.

    If the thyroid nodule is >2cm a fine needle aspiration biopsy is often done to see whether the nodule is benign or malignant.  A local anaesthetic is given and the procedure is a bit uncomfortable but not painful.  There may be some bruising and pain for a few days after.

    I had a large nodule removed to ease breathing and swallowing as it was compressing my trachea.  Hemilobectomy is usually performed as day surgery and you are normally kept in overnight for observation.  I had a drain inserted into the wound to reduce post op  swelling and bruising.  It was removed before I was discharged.  I had very little pain and discomfort afterwards and needed very little of the copious pain relief available in hospital and provided to take home.  I had no trouble swallowing when eating and drinking after the op but it's advisable to have soft foods, soups and drinks available at home in case your throat is sore or painful. The long running stitch I had was removed 7-10 days later.  The wound healed well and the scar is a fine white line a couple of cms long in the hollow of my throat.  You'll be advised not to drive until you can move your neck without discomfort.

    It is assumed that your remaining thyroid lobe will pick up the slack and produce the hormone required so you won't be given Levothyroxine unless your thyroid levels drop and you become hypothyroid.  Ask your thyroid surgeon whether, and when, a thyroid function test should be done after hemilobectomy.

    _______________________________________________________________________________________

    I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

     

  • Thanks for your reply.  I just feel really confused. If my results are ok why do I have a large lump on my thyroid? I feel tired all the time, have put on weight, dry skin, dry eyes, memory problems, pins and needles in hands, feel cold all the time and depressed to the point I struggle to leave the house. Why do I feel like this if it's not my thyroid? I was hoping I was on the way to getting sorted but now I'm not sure what to think :(

  • Betty41,

    Nodules, other than toxic nodules, rarely affect thyroid levels.  I'd been feeling rubbish, mostly hyper, for about a year but when my thyroid levels were tested they were also euthyroid.  I fairly sure my symptoms were due to Hashimoto's as I had positive antibodies but my surgeon said they were non-thyroidal because I was euthyroid.  Hashi symptoms ceased after I had completion thyroidectomy so I'm sure he was wrong.

    Low B12 can cause pins and needles in hands and feet.  The B12 supplement I recommended will help with that and may improve energy and mood.

    Ask your GP to check vitamin D level as vitD deficiency can make you feel very unwell.

    _______________________________________________________________________________

    I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

     

  • Thanks. I will ask GP to check vitamin D and try the B12 supplements

  • Cindy21,

    Betty41's FT4 and FT3 are within range so she isn't hyperthyroid and unlikely to have a toxic nodule.

    __________________________________________________________

    I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

  • Thanks. What do you mean by a toxic nodule?

  • Cindy21,

    Hypersecreting nodule.

  • Thanks for your reply Clutter.

    My tsh was 0.16 T4 16.5. TPOAS  less than 33. I have several nodules on the goitre. I have been diagnosed by a consultant endo with subclinical hyperthyroidism.

    Carbimazole is contraindicated due to cardiac arrhythmia and Long qt syndrome. RAI has been suggested. I am unabe to tolerate th horrific signs and symptoms of hyper/hypo much longer and am temptd to plump for RAI.

  • Cindy21,

     

    Can you copy and paste your question in your own post by clicking on Write a post.   Please include the FT4 range and say whether FT3 was tested.

  • Cindy21,

    It's a commonly held view by GPs and endocrinologists that Hashimoto's doesn't cause symptoms when bloods are euthyroid.  My own experience, the experiences others report, and some research leads me to think otherwise.  There was no improvement after hemilobectomy but Hashi symptoms resolved after completion thyroidectomy.

    I had a hemilobectomy to remove a large nodule compressing my trachea.  The nodule was malignant so I had completion thyroidectomy 3 months later. The surgeon was a maxillofacial head and neck specialist. A 40-strong multi-disciplinary team including oncologists, pathologists, radiographers and endocrinologists from 4 hospitals reviewed my results and was involved in treatment recommendations.  The surgeon referred me to endocrinology after I had RAI.

  • Dear Clutter

    Thanks for your response.

    I am sorry to hear this.

    I agree with your comments about the commonly held view of drs even endos.

    They don't know what they are at.

    I wish you all the best.

     

  • I suspect there is reason to think otherwise as well, and that euthyroid blood tests with Hashis can still have symptoms. The question is though, is surgery the only option? Also, is it possible to have Hashis but sometimes have normal antibody levels? 

  • Allyson1,

    Surgery is rarely an option unless there are nodules, cysts, or goitre which have to be removed.  Some patients are diagnosed with Hashi's when an ultrasound scan shows damage to the thyroid typical of Hashimoto's even though antibodies are negative.

  • Thanks Clutter. Betty41 mentions a nodule and is symptomatic despite good tests. I'm in a similar boat- painful nodules, inflammation, hypo (sometimes hyper) symptoms, but also a Hashimoto's diagnosis. I'm also symptomatic and don't feel well. Yet my tests are euthyroid. 

    As you say your Hashimoto's symptoms only resolved with complete removal of the thyroid. Is that the only way to truly get relief with this sort of situation? 

    It seems like this situation is not uncommon. 

  • Allyson1,

    It would be better if you ask your question in a new post and include thyroid and antibodies results and ranges to help me and other members reply.

  • I'm not meaning to derail the post, but I'm wondering how Betty41 could be feeling hypo but have euthyroid tests? This seems to be a common complaint. 

  • Allyson1,

    Betty41's results are unequivocally euthyroid and she doesn't have Hashimoto's so I don't know why she is symptomatic.  It's possible that her symptoms are non-thyroidal and are due to something else entirely.  Or, it may be, that symptoms can precede abnormal bloods by years. I don't have a link to substantiate that last comment unfortunately.

  • It could be your B12, don't go by your test results as B12 serum test not accurate. Mine was 400-500 yet I have Pernicious anaemia, confirmed by gastric parietal and intrinsic factor antibodies and I had all the symptoms. There are other blood tests your can have re b12 or you could try supplements though be aware that if you take supplements it could then affect blood tests for a while. Look at pernicious anaemia website, or b12d.org or b12deficiency.info/ for much more info so you can decide what to do. Have you had your iron (ferritin) checked. I was told by Dr Chandy mine should be around 200 (it was always low 20's).

  • By ultrasound.

  • Hi Betty

    Please can you tell me how the diagnosis of a thyroid nodule was made? 

    Were you having any signs and symptoms that made your dr suspect that you had thyroid disease?

    My consultant wrote a medical report saying T3 and T4.that nodules can hypersecret T3 and T4.My nodules are non cancerous.

  • Your thyroid blood test results are good.  T3 is the active hormone which controls your metabolism so the Free T3 result is the most important.  T4 is a storage hormone and needs to be converted to T3 to become active, so the T4 result is less important.

    It is unusual that you have hypothyroid symptoms with your free T3 levels, but they could be caused by thyroid hormone resistance (impaired sensitivity to thyroid hormone).  This is a genetic condition which means that the body needs high levels of T3 to function normally.  If this is the case the enlarged thyroid gland is caused by it working so hard to try to provide the necessary level of hormones.

    The enlarged thyroid gland could possibly be shrunk by taking thyroid hormones, thus reducing the workload on the thyroid gland.  It is normal to use a full replacement dose of T3 to do this in thyroid cancer patients.  This should be tried to avoid the need for surgery.

    To treat your hypothyroid symptoms will also require a high dose of T3. Finding a doctor to do this will be difficult.

    I can point you to a book on this if interested.  

  • Thanks for your reply Sandy12. I've not heard of thyroid hormone resistance before. I'm frustrated that I have to wait so long to see the consultant. As far as I know the only option he will give me is surgery to remove the nodule. I think I would have to go down the self medicating route for T3 which I'm not sure about. Please could you send me details of the book you mentioned. Thanks

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