due an ultrasound

[UndiagnosedR]

my thyroid blood tests came back normal, however over the last 18months I have lost 20% of my body weight (was a size10) and have flaking. brittle nails and brittle hair plus fatigue. I have recently notice a lump on my throat and went to GP who said it was moving with my thyroid and booked me for urgent ultrasound at the go surgery. Has anyone had the experience of normal blood tests and had a thyroid lump? What generally happens? To note this lump is quite noticeable and there isn’t swelling in my neck it’s like a large grape one side and is hard.

[Jaydee1507 Administrator]

Welcome to the group.

When you say you had normal thyroid blood results do you know what they were? Ask GP's receptionist for a printed copy or get the NHS app and again ask GP receptionist to access to blood results. Often when GP says results are normal for thyroid they can show signs of struggling thyroid function.

Have you had thyroid antibodies tested?

With the scan they will be looking for nodules or a goitre on your thyroid.

[UndiagnosedR in reply to Jaydee1507]

hi, I’ve had the thyroid antibody and function tests apparently they said in normal range

[Jaydee1507 Administrator in reply to UndiagnosedR]

Do you have the actual numbers though? Noone here can tell you much without them.

[UndiagnosedR in reply to Jaydee1507]

ok so TF T4 20.5, TSH 0.03, SC thyroid peroxide something is 17 and said the thyroid function test was stable. I have no idea what any of that means. I should also say that my voice has changed too

[Jaydee1507 Administrator in reply to UndiagnosedR]

Unfortunately they haven't tested FT3 which is the active hormone. I'm surprised at that if your TSH is 0.03. Did you get the decimal point correctly there?

What are the ranges - numbers in brackets by each test?

If your TSH is 0.03 then that is a hyperthyroid result and they should have tested FT3.

[UndiagnosedR]

definitely 0.03

[UndiagnosedR]

when I called and asked for the results this is what they told me. They didn’t give ranges just these numbers. I have ultrasound tomorrow on my neck so I’m hoping they are just going to refer to endocrinology

[UndiagnosedR]

just checked the record it is saying abnormal but GP are saying no further action and the range should be 0.27-4.5

[Jaydee1507 Administrator in reply to UndiagnosedR]

Well that is a hypERthyroid result. I would push for the Endo referral and question GP why they think that TSH is normal, particularly as you have weight loss as a symptom.

Try and get GP to also test key vitamins which can also cause fatigue and vague symptoms - ferritin, folate, B12 & D3.

[tattybogle in reply to Jaydee1507]

i suspect what has happened here is that :

"F T4 20.5, TSH 0.03, SC ..." is probably for 'sub -clinical' , ( meaning 'TSH out of range but fT4 still in range' )

so they are aware TSH is under range (hence the record saying abnormal) but fT4 is in range .. , would explains why the lab has not run fT3 ... (fT3 won't be done if fT4 is not over range)

So it's a "Sub-Clinical Hyperthyroid" result .. not a "Hyperthyroid" result.

and the guidelines for sub clinical are different.

[Jaydee1507 Administrator in reply to tattybogle]

I'm not that well up on hyper or SC hyperthyroidism. Pretty misleading though to say the test was normal when at least they should be monitoring, also doing FT3.

[tattybogle in reply to Jaydee1507]

fT3 is not done ROUTINELY by lab unless TSH is under range and fT4 is over range . ( protocol called "TSH (with) reflex (to) T4" )

And lab may not agree it is necessary when fT4 is in range, even if GP asks for it, but it will be done if an endo requests it later on .

Receptionists are trained to say 'normal' over the phone if doctor has written 'no further action' . That does not mean there will be no further monitoring or follow up at all , but it does mean the non medical receptionist is not in a position to make the patient aware of every mildly abnormal result at that point over the phone .. remember they are dealing with the whole population not just people who can interpret blood results thoughtfully and without panicking .

The GP has ordered an ultrasound and is awaiting the result . so obviously in this case "no further action" does not mean "we are not doing anything about it at all"

[UndiagnosedR in reply to tattybogle]

ok, so does that mean a referral to endocrinology is less likely?

[tattybogle in reply to UndiagnosedR]

they said ' normal ' verbally ' (was this the receptionist ?) because the GP has seen the result and written no further action at present , receptionists are probably trained to say 'normal' under those circumstances ,

Discuss this subclinical result further with GP once they've got the ultrasound report to find out what follow up monitoring / action they have planned .

EDIT ...Mention the unexplained weight loss again , to make sure GP has taken it into account .. and request they try to get the lab to run an fT3 to see if it might be over rang even though fT4 is not , (they may or may not agree .. and it they do, the lab may or may not agree to do it . But It will definitely be done if an Endo orders it.

Referral to endo will partly depend on ultrasound findings , so don't worry about not being referred until you know what they can see on that.

[Jaydee1507 Administrator in reply to UndiagnosedR]

When you want to reply, hit the reply button under the message you are replying to as this conversation is now getting a bit jumbled. 🙂

With a raised TSH it could be one of several things:

Hashimoto's disease starts sometimes with a spurt of extra hormones being put out and then eventually thyroid tissue is lost and you become hypOthyroid.

Graves Disease where your thyroid goes into overdrive and too much thyroid hormone is put out.

Nodules where a nodule puts out too much thyoid hormone.

Rechecking thyroid function tests (TFTs) 3 months after the initial result to exclude other causes of a transiently suppressed TSH, if subclinical hyperthyroidism is suspected.

So your GP should monitor you every 3 months but will also depend on what the ultrasound results are. Come back and post when you have them.

[tattybogle in reply to Jaydee1507]

typo alert Jaydee.. did you mean to write "with a lowered TSH, it could be... " rather than "with a raised TSH... " ?

[Jaydee1507 Administrator in reply to tattybogle]

Yup. brainfog.

[UndiagnosedR]

thank you, I will do. as it is I’m now in underweight cat anyway. Annoyed why they said it was normal. I have had those tests and they are all normal I’ve seen on my record. My Selum folate is low (4) (2-18.7 range) but within range.

[Jaydee1507 Administrator in reply to UndiagnosedR]

What were the other results numbers with ranges please?

[PurpleNails Administrator]

I have one sided enlargement to my neck which moved with thyroid.  

I had ultrasound & fine needle aspiration as swelling is large over 5cm, which showed benign nodule - but the high levels were missed. 

It can be the case the with hyper nodule/s the TSH drops first, then FT3 rise at higher rate than FT4  -   My FT4 was borderline high when diagnosed. The levels can rise very slowly. With autoimmune it is often occurs quickly.

 The ultra sound will be able to detect if thyroid nodule but won’t be able to determine function of it.

More on my profile. 

[UndiagnosedR in reply to PurpleNails]

thank you 😊 will post the outcome

[Batty1]

You really need a fine needle biopsy first.