Confusing results and Nodule

[CarolineCaroline]

This is the response from Endocrinologist'.

I don’t feel great. I have low energy levels compared to normal, I’m so tired , always cold or temperature sensitive.

Reading this response, it doesn’t sound that they plan to offer to medicate me. But the thought of feeling like this indefinitely fills me with dread.

I’ve now started keeping a copy of all my results and hospital consultation letters, as I think I may need to seek opinions privately.

Any advice greatly appreciated 😊

This is the response from my Endocrinologist

This is with regards to the results from the tests and investigations arranged from the endocrine clinic. I can see that you had your thyroid function tests done on the 2nd November 2023. Your TSH receptor antibodies are >1 and this is negative. Your thyroid function tests show a TSH of 4.73 with a Free T4 of 8.8 and a Free T3 of 5.1. This suggests a new picture of subclinical hypothyroidism which is exactly the opposite of what it had been before. This is indicative of borderline underactive test result.

Your TPO antibodies were raised at 633. This suggests this could be possibly autoimmune where the immune system works against your thyroid gland.

Your 25-hydroxy vitamin D levels are 74 which is reassuring. This is normal and in this regard I will arrange a bone density scan to screen for osteoporosis.

I can see that you have also had the ultrasound of your thyroid which suggests well-defined isoechoic nodule with hypochoic halo seen in the left lobe measuring about 1cm which was graded as BTAU3. It appears wider than taller with no cystic degeneration of calcification and no increased vascularity. In conclusion, you have a nodule on the left side of the thyroid lobe which is graded as U3 and in this regard I will refer you to ENT as you may need a pinch of tissue taken and sent for testing for this to rule out any other sinister causes.

[PurpleNails Administrator]

Borderline hypothyroid with Positive TPO. Why haven’t doctors started replacement.

[PurpleNails Administrator]

well-defined isoechoic nodule mean the nodule looks like normal density to rest of thyroid.

hypochoic halo - means the nodule edge is darker & dense.

Under 1cm without concerning features are considered insignificant. Over 1 cm are monitored or a FNA fine needle aspiration is done to test the cells. It’s a minimally invasive test. With ultrasound & local anaesthetic. “A pinch of tissue” is a terrible description. I had a tiny round plaster over area & went to work a busy shift after test.

Wider than taller nodules is more concerning than round. Likely why you’re being referred to ENT.

No cystic degeneration refers to areas when the thyroid cells break down & leave fluid filled cysts.

calcification refers to formation of calcium deposits. If present Micro under 1mm macro over.

vascularity mean Normal blood flow.

[SlowDragon Administrator]

previous post with results

healthunlocked.com/thyroidu...

So exactly as predicted those results were early stage HASHIMOTO’s ……that’s autoimmune HYPO thyroid

Before starting on replacement thyroid hormones (levothyroxine) …which is usually a lifetime necessity

You technically need 2 separate tests with TSH over 5

Was this test done early morning, ideally before 9am and only drinking water between waking and test

this gives highest TSH

So you need a further thyroid blood test in another 6-8 weeks

Test as recommended …..

Meanwhile get B12, folate, full iron panel including ferritin

Low vitamin levels are extremely common with autoimmune diseases

and coeliac blood test as per NICE guidelines…..done via GP

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]

Your thyroid function tests show a

TSH of 4.73

Free T4 of 8.8

Free T3 of 5.1.

You need ranges on these results

Ft4 could be below range