Heterogeneous thyroid.

[Ticman]

Hello everyone again.Sorry but I've got another question.

On my latest ultrasound of my thyroid it reported that both lobes of my thyroid were heterogeneous and thyroiditis was a possibility.

What does that actually mean in plain English?

Thanks 😁

[Charlie-Farley]

I’ve just done a belt and braces to check my understanding

Found this

“What Is a Heterogeneous Thyroid? This is often a difficult term for patients to understand, but very simply, a heterogeneous thyroid is an irregular type of thyroid gland. It's brought on by autoimmune thyroiditis, in which your body's immune system can't differentiate between your own cells and foreign cells.”

I’ve always used the term heterogeneous in terms of soil 😂. Bit of a departure! So if you have this heterogeneity in both lobes it is probably discernible changes in the thyroid tissue as a result of Hashimoto’s. I’m guessing that you have a had a recent diagnosis or been sent for a confirmatory scan?

this feels a bit hitchhiker’s guide to the galaxy but if you are newly diagnosed don’t panic. We can arm you with knowledge to ensure if come up against any problems you can effectively self advocate.

[Ticman in reply to Charlie-Farley]

Thanks for reply.Ive not been diagnosed with anything yet.

TPO antibodies were positive so doctor is monitoring me with thyroid tests every three months.

[Charlie-Farley in reply to Ticman]

When I was diagnosed I was a borderline case in terms of bloods but very symptomatic. The scan swung it for me. I think the doctor was hoping for a negative so she could send me away with a “there you are silly thing nothing wrong“ but the scan showed changes.

If you want you can read my bio - I wrote it as a case study. I’ve written self advocacy posts as well. Be kind be firm- don’t let them muck you about. I’ve read the guidelines and I’m in process of reading the medical literature underpinning. Really flaky! 🙄

[SlowDragon Administrator]

TPO antibodies were positive so doctor is monitoring me with thyroid tests every three months.

What were your last test results

How do you feel

Any symptoms

Are you taking any vitamin supplements

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/testing/thyro...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

[SlowDragon Administrator]

your previous post

healthunlocked.com/thyroidu...

TSH 5.1

FT4: 11.8 pmol/l (Range 10 - 20)

Ft4 very low at only 18.00% through range

T3 5.4 (3.5-6.5)

TPO 105

So with abnormal test you need retest in 8 weeks

Get vitamin D, folate, ferritin and B12 tested by GP now

And coeliac blood test too

nice.org.uk/guidance/ng20/c...

1.1 Recognition of coeliac disease

1.1.1 Offer serological testing for coeliac disease to:

people with any of the following:

persistent unexplained abdominal or gastrointestinal symptoms

faltering growth

prolonged fatigue

unexpected weight loss

severe or persistent mouth ulcers

unexplained iron, vitamin B12 or folate deficiency

type 1 diabetes, at diagnosis

autoimmune thyroid disease, at diagnosis

irritable bowel syndrome (in adults)

first‑degree relatives of people with coeliac disease.

[SlowDragon Administrator]

Starting levothyroxine - flow chart

gps.northcentrallondonccg.n...

guidelines on dose levothyroxine by weight

Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

[Ticman in reply to SlowDragon]

Thank you very much for all the information.It is appreciated.

[helvella Administrator]

One of the best sites for anything to do with imaging (X-ray, ultrasound or pretty much any other sort) has many pages concerning thyroid ultrasound.

This is a search of the site for "thyroid ultrasound":

radiopaedia.org/search?q=th...

and you can search repeatedly for anything - like "thyroid heterogenous":

radiopaedia.org/search?scop...

I don't know enough to even point you at the best articles/pages.

[Ticman in reply to helvella]

Thank you

[Bearo]

Hetero…..= different/varied

Homo……= the same

If that helps?