Treatment on Hypothyroidism and Nodules

[Sheila73]

I was recently diagnosed Hypothyroidism with nodules. My FT3 and FT4 are normal, nodules are multiple with the big one at 7mmx6mm. I'm currently on Levothyroxine 25mg a day, but don't want to take it for the rest of the life. The symptoms are not very obvious yet, just tiredness. I want to get the nodules removed, any good hospital in the UK to treat it? This is an unfamiliar journey for me. Any advise will be much appreciated.

[greygoose]

Well, I'm not an expert on these things, but I can tell you that there is no such thing as 'normal'. Your FT4 and FT3 may be in-range, but that's not the same as optimal. And, your doctor must have considered you to be hypo or he wouldn't have prescribed levo. And, in 99.9% of case, hypo/levo is for life.

Being hypo is not caused by your nodules, and removing them - and I don't even know if that's possible, don't think so - will not stop you being hypo. To get rid of the nodules, I'm pretty sure you have to remove the whole thyroid with them, so they you will still have to take levo for life. I really don't think there's any way round that. If you find one, let us know.

You'd probably get more helpful comments if you post your exact results - numbers and ranges - TSH, FT4 and FT3, and antibodies if you've had them tested. Nodules and antibodies often go together.

[Sheila73 in reply to greygoose]

Thank you for your reply, this is a learning curve for me and I'm so glad to find this group. I haven't had my antibodies tested yet. Can I ask my GP for this? My FT3 is 4.43, FT4 is 12.27; TSH is 15.765.

[Clutter in reply to Sheila73]

Sheila73,

Your largest nodule 7mm x 6mm is very small. It is unlikely surgery will be recommended unless the multi nodule goitre is compressing your windpipe or impacting nearby organs. Levothyroxine will sometimes shrink nodules and goitres but won't eradicate them. Removing nodules involves removing the thyroid lobe on which they are situated and in the case of a multi nodule goitre that usually means total thyroidectomy.

TSH 15.765 means you are hypothyroid and will need Levothyroxine replacement for life. 25mcg is the lowest dose and unless you are > 50 years of age or have heart disease it would have been more appropriate to start you on 50-75mcg.

The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.4 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in thyroiduk.org.uk/tuk/about_...

For maximum absorption Levothyroxine should be taken with water 1 hour before, or 2 hours after, food and drink, 2 hours away from other medication and supplements, and 4 hours away from calcium, iron, vitamin D supplements, magnesium and oestrogen.

It takes 7-10 days for Levothyroxine to be absorbed before it starts working and it will take up to six weeks to feel the full impact of the dose. Symptoms may lag behind good biochemistry by several months.

You should have a follow up thyroid test 6-8 weeks after starting Levothyroxine. Arrange an early morning and fasting (water only) blood draw when TSH is highest, and take Levothyroxine after your blood draw.

thyroiduk.org.uk/tuk/about_...

[Sheila73 in reply to Clutter]

Thanks Clutter, very helpful information!

[Sheila73 in reply to greygoose]

Sorry, didn't quite understand the antibodies. I did have TRAB, TGAB, ANTI-TPO checked. TRAB and TGAB are in normal range. ANTI-TPO is larger than 600.

[Clutter in reply to Sheila73]

Sheila73,

TRAB negative means you do not have Graves Disease which causes hyperthyroidism.

Anti-TPO are positive for autoimmune thyroiditis (Hashimoto's) which causes 90% of hypothyroidism. There is no cure for Hashimoto's. Levothyroxine treatment is for the low thyroid levels it causes. Many people have found that 100% gluten-free diet is helpful in reducing Hashi flares, symptoms and eventually antibodies.

chriskresser.com/the-gluten...

thyroiduk.org.uk/tuk/about_...

[Sheila73 in reply to Clutter]

Will definitely try gluten-free. Many thanks indeed!

[Heloise]

Hi Sheila, this website is one of many good ones to search for answers. You should be treated with a TSH that high. These are the labs to have. You can also use the headings to look for information about nodules. None of this is your thyroid gland's fault. Something else is doing the damage. stopthethyroidmadness.com/l...

[Sheila73 in reply to Heloise]

Thanks, I will do some research and make appointment with GP.