Goitre, normal TSH, ENT

[dinahdough]

I recently discovered a lump on my thyroid which I now know to be a goitre and on checking online discovered I have most of the common symptoms of hypothyroidism and a lot of less common ones too. GP did a TSH test but result came back 0.87 which I believe to be well within normal range but I know from reading some of the posts on your forum that a TSH test alone does not necessarily diagnose a problem. GP is now sending me to ENT and I am unsure what to expect - will they look at the lump in isolation or are they pretty clued up on thyroid issues? Any advice/suggestions/opinions would be gratefully received.

[J972]

Did you have any other thyroid function tests done? TSH in isolation is completely inadequate. You need your FT4 and FT3 tested. Antibodies, too.

What time of day was test done?

[dinahdough in reply to J972]

Test was done 9am. Nothing else was tested although I know now that it should be.

[mistydog in reply to dinahdough]

Had you eaten or drunk anything because this makes a big difference

[PurpleNails Administrator]

ENT tend to only look at psyical issues.

Usually from a “does this need surgery” viewpoint.

ENT cleared my thyroid swelling after a fine needle aspiration but I did turn out to have a function issues which were missed. ENT had trusted GP would check, GP had ordered function but results never came back from lab.

TSH isn’t sufficient. FT4, FT4 & thyroid antibodies should be tested to rule out thyroid issues.

There are private options - Order a kit online and sample can be taken by fingerprick test, (extra fee for clinic visit / home visit venous draw) sample posted back & results available online often very quickly.

Sample recommended to be taken at 09.00, fast overnight, avoid biotin 3 days before test.

See link for private companies with discounts with many packages & options.

thyroiduk.org/testing/priva...

[dinahdough in reply to PurpleNails]

Thanks for your reply. I'm interested to know your swelling was cleared, I had assumed it was lump removal or nothing so that's good to know that might be an option. My appointment is next week so if they don't do blood tests I will do some private testing.

[PurpleNails Administrator in reply to dinahdough]

If the swelling or nodule is benign & and not affecting you physically eg causing painful compression / growing downwards, causing breathing, swallowing or voice issues it will not be treated. So unless harmful it will be left as would be classed as cosmetic issue.

My nodule is categorised as large as over 5cm but ENT discharged me. It is quite noticeable if pointed out as it’s one sided.

Mine hyper functions & is not autoimmune. It’s is now treated with anti thyroid medication.

Surgery wasn’t offered as other treatments are standard. Specifically radioactive iodine it used for enlarged hyper thyroid. I wasn’t keen. I could push for surgery, & a ENT surgeon said he would remove thyroid lobe with nodule. It’s usually an entire side or the whole thyroid not parts from it. Thyroid is too vascular to take out selective parts.

[SlowDragon Administrator]

very important to also test vitamin D, folate, ferritin and B12

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

Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune

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 BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG 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

[dinahdough in reply to SlowDragon]

Thank you so much for all the info. There's clearly a lot more to it all than I had ever imagined. I'm seeing ENT next week after which I will definitely look at private testing depending on outcome of visit.

[annnsandell]

ENT should certainly know what they are doing Thyroid wise. You say symptoms of hypothyroidism which obviously need checking out with additional tests but you can also have a goitre with a thyroid that is working perfectly hence ENT. Good luck and hopefully you won't have to wait very long.

[dinahdough in reply to annnsandell]

Thank you. My appointment came through within two weeks which, given what we are continually being told about NHS waiting times was rather alarming. I hope it's not because the GP thinks it's something bad!