Please help me understand thyroid ultrasound test results.

[naturegirl3434]

Hi there! I thought that thyrotoxicosis was something that people with Graves disease got? I have Hashimoto's. Can anyone kind of interpret the results of this test me? I haven't had much luck looking stuff up on the computer. I am just getting more and more confused. Thanks.

Study Result of Thyroid Ultrasound scan

Impression

IMPRESSION: Heterogeneous thyroid echotexture and bilateral atrophy, but no

masses or cysts.

Narrative

US HEAD NECK SOFT TISSUE 10/4/2019 1:42 PM

PROVIDED CLINICAL INDICATIONS: Thyrotoxicosis without thyroid storm,

unspecified thyrotoxicosis type Thyrotoxicosis, unspecified without thyrotoxic

crisis or storm

ADDITIONAL CLINICAL HISTORY: None.

COMPARISON: None.

FINDINGS: Real-time grayscale imaging as well as color Doppler imaging was

used to evaluate both thyroid lobes.

The right lobe is 2.5 x 1.2 x 0.7 cm.

The left lobe is 2.5x 0.7x 0.1cm.

Both lobes have heterogeneous echotexture with normal Doppler flow.

[greygoose]

I think what they're saying is that your lab results are high, but not high enough to be thyrotoxic. Your doctor just suspected it. I think. Trouble is, doctors think that anything over range is thyrotoxic!

If you have Hashi's, you will have swings between hypo levels and 'hyper'-like levels - but not high enough to be Grave's. Doctors just don't know the difference, nor how Hashi's works.

The high levels come about because when the immune system attacks the thyroid, the dying cells dump their store of hormone into the blood, causing frees to rise steeply and the TSH to drop. But, that doesn't mean that your thyroid is over-active, as in Grave's. The levels will go down by themselves, eventually.

That's my interpretation, anyway.

[naturegirl3434 in reply to greygoose]

Thank you so much! I appreciate it!

[greygoose in reply to naturegirl3434]

You're welcome.

[MaisieGray]

Thyrotoxicosis is simply the state of having too great a level of thyroid hormone in the system, and whilst hyperthyroidism/Graves' is responsible for the majority of cases, it isn't the only cause. It can be caused by Hashimoto's, postpartum/post-viral/post-bacterial thyroiditis, drug-induced thyroiditis eg, amiodarone, interferon-α, lithium etc, destruction of thyroid follicles, acute infectious thyroiditis, bacterial or fungal infection, radiation thyroiditis, thyroid cellular destruction and release of stored thyroid hormone, thyroid adenoma infarction, and of course can be of extrathyroidal origin ie the ingestion of exogenous thyroid hormone .........

So your thyroid shows evidence of having suffered the consequences - heterogeneous thyroid echotexture and bilateral atrophy - of something, typically but not exclusively, Graves' or Hashimoto's. A normal healthy thyroid would be homogeneously/uniformly hyperechoic and brighter than the surrounding muscles whereas yours has heterogenous/mixed echotexture with some atrophy (wasting/shrinkage) in both lobes. So basically it is showing the expected 'wear and tear' caused by your Hashimoto's. My hypothyroidism is non-autoimmune but when scanned after 30 yrs of being hypo, my thyroid had atrophied to the point of being smaller than a young child's, for instance, with one lobe having deteriorated more than the other, as in your case.

[naturegirl3434 in reply to MaisieGray]

Wow! Now I completely understand. I really appreciate you taking the time to explain. I was kind of worried. Thanks so much.