Help me “translate” Thyroid U/S report

[OudMood]

Hi everyone!

I finally had the much attended Thyroid U/S and I guess I should rejoice.. I was initially confused as the technician said my Thyroid appeared absolutely normal and she hasn’t seen anything that would suggest Thyroiditis and commented that “if you do have it, it is in very very very early stage as I can’t see anything”.

I tried to glance at the Us and saw the measurements and they did look normal ish the Ismus was 4.1mm and I think up to 3-4mm is normal?

I thought I saw some “geographic” or patchy areas when sideways but she hasn’t commented, whereas the middle area looked very smooth. 🤷🏼‍♀️🤷🏼‍♀️

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UPDATE

Had a GP review today and this is what the U/S report (slightly redacted) said:

[…] Had raised TSH and thyroglobulin levels. normal examination. [..]

The thyroid appears normal in size and shape measuring: Isthmus: 4.1mm

AP; Right lobe: 14 × 15 × 47mm; Left lobe: 14 × 17 ×46mm.

•The thyroid parenchyma is slightly heterogeneous, however no thyroid nodules seen. •Reduced vascularity noted in the parenchyma ? chronic thyroid disease.

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Discussed to be reviewed to endocrinologist

Asking for a referral at St Bartholomew's Hospital

••• Can anyone make light of the bullet points and especially the meaning of - heterogeneous parenchyma (I read something about it’s not how it should be 🤷🏼‍♀️) - and - reduced vascularity- ? •••

Lastly.. can antibodies still attack my thyroid even if I’m on Levo or treatment in general? 😱

[OudMood]

anyone that could share their opinion please?

[tattybogle in reply to OudMood]

don't know much , but my gut instinct is that 2 (even 4) years is very 'short' in terms of thyroid destruction becoming evident (physically)

i think you are looking at 'decades' more than years ?

So i wouldn't say your US results rule it out entirely .

i never had an US , so i'm only basing this on knowing how utterly naff a slightly raised TSH of 6.8 can feel with Total T4 still @30% .. but i had thousands of TPOab .

But as you know, negative TPOab /TGab doesn't rule it out either . Some things i guess we never really know until the years have played out.. We just have to go with our best guess based on symptoms, trend in TFT results , and our response to thyroid hormone replacement.

[OudMood in reply to tattybogle]

thank you there.

I don’t know where I read it now but apparently it’s likely that damage for me started many years ago as I also have autoimmune T1 diabetes for 17yrs and apparently those antibodies may have looked for another victim as I haven’t eliminated my trigger (I have no idea what’s my trigger though).

Realistically symptom that I could attribute to thyroid (but at the time I attributed to other causes) really started about 10 yrs ago and counting that I’m in my late 20s that’s .. quite a while 😅.

I had a review with my GP and the tec was pulling things out of thin air (although she was right about size). The report clearly says I have chronic thyroid disease and they have now referred me to an Endo as they think this needs to be looked more at depth.

I’ll update the post in a bit.. as there’s lingo that I need translating as googling isn’t helping 🤣

[PurpleNails Administrator]

thyroid parenchyma is slightly heterogeneous

Parenchyma is thyroid tissue.  This can be as expected or more solid tissue, which can be from nodular or scarring.  Less dense from fluid filled cysts. 

Heterogeneous means greater echos and therefore denser. 

Reduced vascularity 

Increased Vascularity is seen in both Graves & hypothyroid, the thyroid is being stimulated & working harder in both conditions.

So reduced vascularity is unusual & there not much information about it.

Levothyroxine treats the missing level of hormone and therefore has no direct impact on the autoimmune issue or antibodies. 

Doctors do not treat the autoimmune aspect & there’s not always a correlation between autoimmune activity, thyroid levels & antibodies.  Which is why doctors don’t rely on antibodies but seek to replace hormones.  

All hypothyroid is treated same way.  

It’s your confused immune system attacking parts of your system.  The antibodies are clearing up the damage it leaves. So are a results not cause is issue.

  Having 1 autoimmune make you predisposed to others.  Antibodies signify the autoimmune activity is occurring but they don’t cause the issue or produce symptoms & they don’t chose which area to attack.  

[OudMood in reply to PurpleNails]

Thank you so so much for your answer it has given me some key information to decipher the results although I had to Google to even understand your answer 😅 but I’m not surprised as it’s a complex topic and it’s my first time too.

Thank you for the Antibody explanation as well.

So I take it that more damage in say 10yrs time for example is likely/possible.

the reduced vascularity part is curious and I could not find anything after almost 20mjns of googling!!

On another point after googling and reflecting about what you wrote, I wanted to speculate with you..

I have seen in a study that standard Thyroid size is usually 40-60mm long and 14-18mm ..wide?

I have noticed that mine seems to be right on the lower end of that and I was wandering if together with the reduced vascularity this might be because it’s shrinking? 🤔

Read something about atrophy?

Or am I completely ridiculous?

[PurpleNails Administrator in reply to OudMood]

No I think your right.  

I was wondering about this & was searching further.

The report has noted “chronic thyroid disease?”

Reduced vascularised thyroid can represent advance stage of atrophied (atrophic thyroiditis or chronic lymphatic thyroiditis.  This would account for shrinkage & smaller size.

As it is advanced you would expect a previous higher level of antibodies for a long time prior, but then again antibodies don’t always show up or correlate.

The other reference I read about decreased thyroid vascularity (which likely won’t apply) is the use of potassium iodide.  Which is used pre surgery to reduce bleeding from thyroid or to protect thyroid in cases of potential radiation exposure.  Natural sources are seafood.  Supplements are sold for short term use & should not be confused with iodine which is often sold as helpful for thyroid issues ( often iodine is unhelpful too)