ULTRASOUND RESULTS - THERE IS A NODULE WHICH IS PAINFUL - CAN ANYONE HELP?

[Redlester]

Hello everyone

Apologies at the outset because this is long but I am very worried and would be very grateful to anyone who reads this and can advise me.

I had an ultrasound scan of my thyroid gland last Tuesday.

My thyroid antibodies have never been out of range - my last test in March this year showed that they were :

Thyroglobulin Antibodies 21.7 kIU/L (Range: < 115)

Thyroid Peroxidase Antibodies 9.53 kIU/L (Range: < 34)

After the scan the NHS endo sent a report back to my GP which he copied to me in which he said:

""The thyroid gland is mildly prominent with a slightly coarsened echo texture. there is no hypervascularity. A single benign nodule was noted to the left of the isthmus measuring 8mm in diameter (U2/TR2).

The thyroid imaging appearance could reflect a previous thyroiditis but show no evidence of active disease.

This is good news. No further action is required other than to continue an annual check on thyroid function. "

I am concerned about the "no further action" recommendation on 3 grounds.

1. On the day of the scan the radiographer showed me the image and said that my thyroid appeared to have a coarse or granulated texture which could be consistent with Hashimoto's Thyroiditis. There is Hashimoto's disease within my immediate family [my sister and possibly my mum] , and an extensive history of hypothyroidism in my extended family. Based on endo's advice to my GP - where does this leave me? do I have hashi's or not? do I just proceed on basis that I DO have hashis? Some would say it is irrelevant, but considering there are things like Low dose Naltrexone which can help people with hashis it is important to know.

2. I have had severe hypothyroid symptoms for a long time now, which became markedly worse in the early months of this year and in March I did a medichecks test which produced the following results:

CRP HS 1.07 mg/L (Range: < 5)

Ferritin 16.4 ug/L (Range: 13 - 150)

Vitamin B12 - Active >150 pmol/L (Range: 37.5 – 187.5)

Vitamin D 86.2 (Range 50-175 nmol/L )

Thyroid Hormones

TSH 9.05 mIU/L (Range: 0.27 - 4.2)

Free T3 3.75 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine 11.3 pmol/L (Range: 12 - 22)

Thyroglobulin Antibodies 21.7 kIU/L (Range: < 115)

Thyroid Peroxidase Antibodies 9.53 kIU/L (Range: < 34)

The medichecks doctor commented that the free T3 is low and the free T4 is now below the bottom of the range, while my TSH has increased, suggesting that my thyroid is becoming underactive and that I may require thyroid medication. I had an online consult with a functional medicine doctor a couple of weeks later who prescribed T4 and T3. I am currently taking 50mcg T4 and 50mcg T3 as per his prescription and am taking ACE for hypocortisolism - this is a very far cry from "no further action is required".

3. I can feel the thyroid nodule and am currently experiencing severe pain on the right side of my neck which radiates into my jaw, teeth, ear and up the back of my head, accompanied by a sore throat and hoarseness. I have had this pain in a duller form since early February this year and the pain has been severe since the beginning of March and the intensity of it has increased since then to the point where it is now excruciating and sleeping is very difficult and I am quite concerned about what is going on.

It is difficult to avoid the conclusion that the nodule is causing the pain. Getting in touch with GP is nigh on impossible at the moment and would be a waste of time as she would simply defer to endo. Endo is quite sympathetic, albeit open about the fact he is constrained by the NHS guidance about not treating hypos unless TSH is over 10. I have his email address and he does respond to emails - I wonder should I let him know about the blood test results and the nodule pain.

[SeasideSusie Remembering]

Redlester

Did you discuss your Medichecks results with your GP, with a TSH so close to 10 with FT4 below range there would have be no reason not to give you a prescription for Levo. That would have been better than the FMD putting you straight onto a combination therapy. You should have taken enough Levo to get your TSH down to 1 or lower, which would take your FT4 as high as possible then you could see what your conversion of T4 to T3 was like and then would have been the time to consider adding T3 if conversion was poor.

What's happened about your dire ferritin result, a level below 30 gives a diagnosis of iron deficiency so this should have been discussed with your GP, any further testing carried out (iron panel) and a prescription for iron tablets if appropriate along with regular monitoring.

[Redlester in reply to SeasideSusie]

Thanks SeasideSusie.

These test results came during pandemic and lockdown - getting access to GP was nigh on impossible, and even if possible, based on previous experience, would have been waste of time as they are very poor when it comes to thyroid testing adhere strongly to the TSH over 10 policy. I was [and had been for a very long time] desperate by that stage with pronounced hypo symptoms and was glad to have consult with FMD which I found helpful.

He recommended ACE for hypocortisolism which really needs to be treated before introducing thyroid hormones for them to work successfully, although he was content for me to use T3 at low levels in the early stages. I take your point about conversion of T4 but FMD prescribed 50mcg T4 and indicated that he doesn't intend me to go higher than that, based on symptoms and blood work, and feels that T3 would be more helpful, which I was content to proceed with. In any event with my low cortisol and low iron, conversion of T4 would likely have been problematic for me when I consulted with him, and since then I have worked on trying to boost ferritin with iron rich food and have followed his ACE dosing schedule. I have added in the 50mcg T4 this week and so far am not having a problem with it - this may not have been the case if I had taken it from the get go when he had prescribed it.

I was originally multidosing the T3, but greygoose suggested I might get better results from taking it in one dose as per John Lowe's regimen. Following her advice I switched to that and have found it to be far better, so I now take both the T4 and the T3 during the night.

As for iron - I did try to supplement with better you spray for a very short time only but found this made me even more groggy and exhausted than I was without taking it, so I stopped it and am just going with iron rich foods. I am due to test everything shortly, so will know then what has happened to my ferritin level.

My big concern at the moment is the nodule and the pain it is causing.