Goitre question

[Apodemus]

Hi folks... I'm doing well (in summary no TRAbs, T4/T3 in range and TSH rising ...TED subsiding after a very difficult 6 months and just have one Retinal issue to resolve, on 5mg Carbmizole) however endo at the last appt said I had a goitre. I had my scan today and they said it was nodular and asymmetric and had gone below my collar bone but not noticeable to the eye . They took two biopsies but complained they were bloody. So my question is what is the relationship between a goitre and hyperthyroidism and should I be worried?

[PurpleNails Administrator]

Have TPO & TG been tested?

Nodules likely be hyper functioning (hot or toxic) causing the hyper - & this can occur with or without any autoimmune.

Most dr will say you can have TED outside of Graves / autoimmune but it not the case.

I have large hyper nodule which is visible, but not growing behind collar bone. Restosteral growth might increase complications in terms of surgery, if that were to become necessary later on, but try not to worry.

I wonder why they complained the samples were bloody? I think most nodules are non functioning & not as vascular as the hyper one are.

[Apodemus in reply to PurpleNails]

TPO and TG in normal range. I asked about hot nodules and he said it wasn't inflame. I got the impression histology didn't like bloody sample due to contamination but may be wrong.

[PurpleNails Administrator in reply to Apodemus]

I don’t think nodule are associated with inflammation unless autoimmune is involved too, Ive never had it mentioned in any reports., but that might not mean much. Makes sense re contaminating sample, but considering what the procedure involves to obtain sample, some blood can’t be that rare.

[Apodemus in reply to PurpleNails]

Yes I agree he just said they may need to do it again. But he was quite reassuring that it wasn't a big issue.

[PurpleNails Administrator in reply to Apodemus]

Obtain a copy of the scan & histology report. Bear in mind histology or ultra sound scan can’t identify the function level from nodule.

My nodule was clear pee as benign & I was discharged. I even asked twice, are you sure the levels are ok? Yes because they’d been marked no further action. Turned out the function hadn’t been tested but all the results which had come back were in range.

[Apodemus in reply to PurpleNails]

Thks. I have had my bloods tested for so many things for inflammation such as C Reactive. Erythrocyte sedimentation rate etc and they all come back within range so beginning to think this might be a red herring.

[pennyannie]

Hey there again :

As I understand things - these are 2 different health issues though both can cause hyperthyroidism-

If the goitre is caused by either hypothyroidism or hyperthyroidism it can usually be treated with medications - and if hyperthyroid an Anti Thyroid drug such as Carbimazole - that you have already been prescribed deemed the appropriate treatment.

If the goitre is pressing on the windpipe, causing choking or breathing issues and one's life incapacitated - surgery to remove part of the thyroid a logical next step.

If the hyperthyroidism caused by Graves with confirmed positive over range antibody readings - the thyroid hormones T3 and T4 to keep rising higher and higher which can put undue pressure on the heart and considered life threatening -

Graves is an Auto Immune disease, for which there is no cure and your immune system turns and attacks your body rather than defend it and with Graves the immune system attacks the thyroid and / or eyes.

Treatment is with an AT drug for around 15-18 months and if this does not resolve the situation - definitive treatment such as surgery or RAI thyroid ablation then suggested.

Most recent research if with Graves :- which you haven't got but may get suggested !!

pubmed.ncbi.nlm.nih.gov/338...

ncbi.nlm.nih.gov/pubmed/306...

[Apodemus in reply to pennyannie]

Thank you, it doesn't cause me any problems except with very soft bread and sausages which if I don't chew are hard to swallow! T4 went to 29 just and came back in range very quickly with meds. Thanks for the papers...zoology degree

[pennyannie in reply to Apodemus]

I think the most telling issue as someone with Graves and post RAI thyroid ablation 2005 is that treatment for primary hypothyroidism irrespective of how you got there - is all the same.

T4 -Levothyroxine is now the only treatment option now readily prescribed on the NHS -

both T3 and Natural Desiccated Thyroid having been withdrawn from the remit of primary care doctors - with ICB / CCG placing restrictions on prescribing - which has now created something of a post code lottery throughout the country.

Of course if you can afford to go Private there is a very different landscape - though it's still not a ' given ' and you need to see a sympathetic thyroid specialist.

In most other countries of the World all 3 treatment options are acknowledged - I'd just be happy to pay for my NDT if it were through the NHS and I then had a guaranteed source of supply rather than surfing (on the internet ) at age 77 !!