Should i get a second opinion??

[Thyroid_nodules]

Hi there, I had an ultrasound of my thyroid in which they discovered I had a number of thyroid nodules ranging from 2mm to 14mm in size. My doctor re-tested my thyroid bloods. Two results came back normal, and my T3 was elevated. It was slightly above the normal range. I should note here that I have OCD, and had been feeling alot more anxious of late, so she referred me on to an endocrinologist for a review, because she was concerned my thyroid might be overactive. So, i met with the endocrinologist, and he looked at my results, and told me it wasn't overactive, and i was to come back in 6 months for an ultrasound of my thyroid to examine my nodules. However, I feel alot more hormonal lately (e.g fibrocystic breasts) and i don't understand how an abnormal T3 level can be just dismissed? What do you think? Thanks in advance

[greygoose]

Hi Thyroid_nodules, welcome to the forum.

You don't say if you have any sort of thyroid diagnosis or if you're taking any medication for thyroid. Why did you have the ultrasound?

It would be a lot more helpful - helping us to help you - if you put your actual results and the ranges. Just saying 'normal'/'abnormal' tells us nothing - in fact, there's no such thing as 'normal', it's just an opinion and just means that your levels are somewhere in the range. Being in-range is not the same as being optimal. So, until we know the exact numbers, there's not much anyone can say.

But, I think I can safely say that if your TSH and FT4 were in-range, then your thyroid is not over-active. If you were, the FT4 would also be over-range, and the TSH suppressed.

[Valarian in reply to greygoose]

In hyper patients FT3 may well be the first thyroid level to be elevated and the last to drop. However, you would expect TSH to be at least low if not below range.

[Lora7again]

I have a multinodular goitre, is that what you have? My goitre does cause me symptoms but I have no intention of having RAI or getting it removed because is not cancerous. Also we need to see your thyroid blood results especially your T3 with ranges and did they test your antibodies?

[SlowDragon Administrator]

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

With Hashimoto’s thyroid nodules are very common.

Ask GP to test vitamin levels and thyroid antibodies

You may need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Presumably you are NOT on levothyroxine...

But if you are ...Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or vitamins

thyroiduk.org.uk/tuk/testin...

For thyroid including antibodies and vitamins

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3 £29 (via NHS private service )

monitormyhealth.org.uk/thyr...

If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all primary hypothyroidism in Uk is due to Hashimoto's.

Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten.

So it's important to get TPO and TG thyroid antibodies tested at least once .

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Link about antibodies and Hashimoto's

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

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

List of hypothyroid symptoms

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

come back with new post once you get results

[Brookesy1 in reply to SlowDragon]

Hi I have hashimotos. I've not been scanned for about 4 years but was scanned every year for 4 years when first diagnosed cause my lymph nodes were little bit bigger than average 1.1cm everything was fine. My left side is slightly swollen on my thyroid but there were no nodules. I've had bloods are they are all normal so no medicine. Should I get my thyroid checked? I have regular bloods every 6 months and they are all fine. My dr says I dont need to see an endocrinologist. Should I be ok with this?

[SlowDragon Administrator in reply to Brookesy1]

ALWAYS get the actual results and ranges on all tests

Frequently only TSH and Ft4 tested, which is completely inadequate

Essential to test, Ft3, both TPO and TG antibodies and all four vitamins too

[Brookesy1 in reply to SlowDragon]

Ok I'll get my latest results and post

[Thyroid_nodules]

Firstly, thanks to everyone who replied, much appreciated

For about a week or so, I noticed that my thyroid area had been feeling quiet tender to touch, so i mentioned this to my gp, and she suggested that i should have an ultrasound. So I went for the ultrasound, and then i was told i had a number of thyroid nodules ranging in size, and they advised me to have a follow up in 6-12 months. I wasn't diagnosed with anything. I was just told i had thyroid nodules and come back again to check. However, because my anxiety had gotten notably worse over the past year, my gp was concerned that maybe my thyroid was the cause of this, so she re-tested my thyroid and advised me to see an endocrinologist. Here are my results:

T4 Free: 12

TSH:1.24

T3 FREE: 4.94

Hope this makes sense!

[LAHs in reply to Thyroid_nodules]

It is quite possible that the nodules are benign. I would suggest you ask your doc if you could have a fine needle analysis (an FNA) on the largest one, (the 4mm one). An FNA sounds scary but it is OK, I had one and I am the biggest chicken when it comes to medical stuff. This way you will know for sure the nodules are either benign or cancerous. Probably the former, so you can relax and take it off your mind.

[Valarian in reply to Thyroid_nodules]

Were the ranges for FT3 and FT4 shown in brackets after the results ? These vary from one lab to another, so the results don't make much sense without them.

However, with regard to your concerns about the FT3 being over range, it's unlikely that it will be much over the range with TSH of 1.24. TSH is a signal from the pituitary gland telling the thyroid to make more thyroid hormone: if the thyroid is overactive, the signal isn't needed, Many people who are hyper have TSH of less than one, perhaps even to the point where it can't effectively be measured.

[Thyroid_nodules in reply to Valarian]

Sample type: Serum

T4 Free: 12........ Pmol/L (8 - 22)

TSH:1.24.......... mlU/L (0.35 - 4.94)

T3 FREE: 4.94....... Pmol/L (2.89 - 4.88)

Prolactin: 398..... mIU/L (109 - 557)

Hope this makes sense. Thanks for your help

[Valarian in reply to Thyroid_nodules]

Anti-thyroid medication would reduce production of both FT3 and FT4, and you might very soon find yourself below range. Your FT3 isn't much above range (people who are definitely diagnosed as hyper often have thyroid levels double the reference range) and if anything, your FT4 is on the low side.

Your original question was whether you should seek a second opinion because your FT3 had been over range. I doubt if any endo would prescribe anti-thyroid medication with those results. The important thing now is to have the nodules investigated, and find out whether any treatment is needed for those. In the meantime, if you are having any symptoms (breathlessness, rapid heart rate, tremor), you could discuss these with your GP.

[Valarian]

Hi

Here is a link to some information about thyroid nodules:

btf-thyroid.org/thyroid-nod...

Thyroid nodules are extremely common (by the time we are 60, more than 50% of us have them, although often we aren't even aware of them). Most need no treatment at all, others perhaps just monitoring. The key thing is, they are going to monitor/investigate.

Thyroid levels fluctuate to an extent naturally, although your 'slightly elevated' FT3 result could be caused by the nodules. All treatments for hyperthyroidism have their drawbacks, so not something to rush into if there is no need.

You could ask whether you are due to have another set of thyroid function tests prior to your next endo appointment (try calling the endo's secretary). If not, you could discuss your concerns with your GP, and see if they would agree to another set of tests, perhaps in three month's time, to help set your mind at rest (especially in view of your OCD, as elevated thyroid levels can themselves cause anxiety, so you could end up with a bit of a viscious circle). If the GP won't go along with this (or doesn't feel they can as you are now seeing an endo) you could go for private tests. I don't know much about these myself, but I see that SlowDragon has posted about them above.

Like greygoose , I'm also interested to know what prompted the original scan ?