Can anyone help with results please?

[shz1]

Hi can anyone tell me what these results mean please?

Thyroid ultrasound scan -

The thyroid is enlarged with a heterogenous echotexture, RT AP lobe diameter =17mm, LT =17mm

The RT lobe is diffusely heterogenous with no focal nodules.

There is a 8mm spongiform nodule within the LT side of the isthmus

The LT lobe contains 2 spongiform nodules within the lower pole measuring 8mm and 4mm, there is also a 5mm colloid nodule.

All of the above nodules have peripheral vascularity.

Reactive lymph nodes are seen bilaterally at submandibular level and within the carotid chains.

U2 classification.

Blood results -

Serum TSH 0.32 mu/L Range 0.3-4.5 mu/L

Serum free T3 4.9 pmol/L Range 3.1-6.8 pmol/L

Serum free T4 18.7 pmol/L Range 11.0-22.0 pmol/L

[PurpleNails Administrator]

The thyroid is larger with and more solid (heterogenous echotexture) than expected.

The right side is measured “AP” anterior posterior (front side to other side) both lobes are give measurement of 17mm.

Diffusely means it’s denser throughout without defined or “focal” nodules.

There is a 8mm spongiform nodule within the Left lobe side near isthmus. Which is bridge of tissue in centre connecting the 2 lobes.

Then report says LT again (so 1 may be wrong) The Left Thyroid lobe contains 2 spongiform nodules (with air (of fluid) sponge like) within the lower pole measuring 8mm and 4mm, there is also a 5mm colloid nodule - colloid is normal thyroid tissue but over growth.

All of the above nodules have peripheral vascularity. The edge has blood flow but not centre.

Reactive or swollen (inflamed) lymph nodes (glands) are seen bilaterally (both side) at submandibular (located near jaw) level and within the carotid chains. The chain of nodes. U2 classification. This is ultrasound grading U1 being normal U2 being minor concern, as abnormal. Up to 5 which is suspected cancer.

Blood results -

Serum TSH 0.32 mu/L Range 0.3-4.5 mu/L. Within range but quite low. Usually this is seen with high thyroid hormones.

Serum free T3 4.9 pmol/L Range 3.1-6.8 pmol/L 48%

Serum free T4 18.7 pmol/L Range 11.0-22.0 pmol/L 70%

Both are in range. It’s not uncommon to see higher % of FT4 but usually by a smaller margin. Your FT3 which converted from FT4 is poor.

Test nutrient, folate,ferritin, B12 & vitamin D. These can lower TSH and conversion. Have you had thyroid antibodies tested?

Are these the only set of thyroid results you have to compare? Do you take thyroid hormones?

If Doctor suspects over active thyroid or over medicated (Drs often go by TSH alone) ensure they account for FT4 & FT3 and not TSH.

[shz1 in reply to PurpleNails]

Thank you so much for your help, your explanation is so easy to understand, if only the GP explained things in the same way!

I am not on any medication.

The rest of the blood results -

Folate 17.8 nmol/L. No range given

Active b12. 70.3 pmol/L. 0-150

Ferritin. 34.1 ug/L. 15-150

Vit D 45 nmol/L. 50-125

TPOAb. 13.5 kiU/L. 0-34

TgAB. 19 kiU/L. 0-115

[PurpleNails Administrator in reply to shz1]

Folate ok by most nmol/L ranges I’ve seen.

B12 range range starts from 0, so suspect about that. Suspect 70.3 is below mid point & optimal would be above midrange. But not terrible.

Ferritin too low. GP should do iron panel.

Vitamin D very low. is doctor treating?

Antibodies are showing negative but levels can fluctuate greatly. Positive levels can confirm autoimmune thyroiditis (under active).

If this is your first thyroid test I would repeat thyroid function again no later than 3 months time. If the TSH were to drop below range this will be sub clinical hyperthyroid. The FT4 & FT3 were well range but should the FT4 & FT3 rise (which is seen with low TSH) there are other thyroid antibodies TRab & TSI which should then be tested and if positive would confirm autoimmune Graves.

Do you have symptoms suspecting a thyroid issue?

[shz1 in reply to PurpleNails]

Thank you so much, I have most of the symptoms of hypothryroid but with the low TSH the GP said it was impossible but tested me anyway. I will go back to the GP and ask for the iron panel test.

[PurpleNails Administrator in reply to shz1]

It’s said the TSH doesn’t cause symptoms it’s a pituitary hormone which signal the thyroid. It senses thyroid levels and reacts, telling the hypothyroid to increase or decrease production.

Your unbound (free) thyroid hormones which the body needs to run on are quite good & well within range.

Why was scan done?

[shz1 in reply to PurpleNails]

The scan was done because I can feel a lump in my throat all the time, GP examined my neck and said the thyroid felt enlarged so I was sent for a scan

[SlowDragon Administrator in reply to shz1]

Low vitamin D

GP should prescribe 1600iu vitamin D everyday for 6 months

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

GP will often only prescribe to bring vitamin D levels to 50nmol. Some CCG areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with thyroid issues , improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7. One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need,

Vitamin D and thyroid disease

grassrootshealth.net/blog/t...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Great article by Dr Malcolm Kendrick on magnesium

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[shz1 in reply to SlowDragon]

Thank you, I will read all that this evening 👍

[SlowDragon Administrator]

Low ferritin

cks.nice.org.uk/topics/anae...

In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Never supplement iron without doing full iron panel test for anaemia first..ideally via GP

Medichecks iron panel test

medichecks.com/products/iro...

Iron and thyroid link

healthunlocked.com/thyroidu...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

[shz1 in reply to SlowDragon]

Thank you very much 😀