Hi all
Well the plot thickens. Was supposed to get thyroid US today but mix-up means I’m to wait another 2 weeks. However, a CT scan from a month ago showed a nodule. ENT doc thinks it’s on the isthmus and could be a toxic adenoma but needs US and FNA to confirm.
He’s scratching his head though - he said Hashimotos doesn’t usually present with a hyper functioning adenoma causing the hyper blood results and symptoms.
I’m confused… can anyone shed light please?
sorry you have been waiting a while for a reply. Not something I know about , but will tag PurpleNails to see If she knows anything related to your question or who to ask.
He’s scratching his head though - he said Hashimotos doesn’t usually present with a hyper functioning adenoma causing the hyper blood results and symptoms.
He’s not been following this forum then
We see significant numbers of Hashimoto’s patients who start with transient hyperthyroid results and symptoms before becoming increasingly hypothyroid
D’you think this is how the transient hyper results happen then? Does Hashimotos cause nodules and it’s these that then dump the extra T4? I guess I’ll know when I finally get the ultrasound whether my current hyperthyroidism (despite hashi antibodies) is from the nodule.
He admittedly is an ENT surgeon and said I need to see endocrinologist quickly as I’m still going through this unmedicated (propranolol didn’t agree with me).
thyroidcancer.com/hashimoto...
The inflammation of Hashimotos’ thyroiditis makes the thyroid look lumpy bumpy on ultrasound. Pseudo nodules are diagnosed when the apparent nodules disappears on follow up ultrasounds.
thyroidcancer.com/blog/top-...
Hashimoto's disease can confuse the diagnosis of a thyroid nodule or lump on ultrasound, particularly to providers who are untrained and not experts in thyroid disease. There is no question that patients with Hashimoto's can develop real thyroid nodules/growths and real cancer. Hashimoto’s thyroiditis, however, may also be associated with thyroid pseudo-nodule formation. These pseudo-nodules are not true, discrete thyroid nodules, but they can be hard to distinguish from thyroid nodules/cancer, especially if a thyroid expert is not interpreting the ultrasound images. Pseudo-nodules found on ultrasound in Hashimoto’s patients will come and go or change based upon unknown clinical and pathophysiologic factors.
Wow.. thank you for finding this SlowDragon. To be fair, my appointment was with an ENT Consultant who was only giving an evaluation from a CT scan from a month ago. Until the ultrasound is done I won’t know what it is and if it’s what’s causing the hyper results and symptoms despite the Hashimotos antibodies.
L154C0,
I’ve just been reading your previous posts. You poor thing being just left but this is what conventional medicine does although GP did kindly prescribe some prednisone presumably to control/quell the immune response and give you some relief.
Your symptoms sound more Hashi to me now you have also the dry cough and a nodule, and you can have a mix of Hashi & Graves antibodies with the highest amount being dominant. You can also have any mix of labs as hormone levels wax and wane in response to antibodies and not everyone fits the classic mould. This link shows a patient with elevated FT3 which it states it is rare. It isn’t. pubmed.ncbi.nlm.nih.gov/309...
You can learn how to manage your autoimmunity yourself and quell the immune response with better strategies than taking prednisone by removing common triggers such as gluten. There are also known OTC supplements to help reduce thyroid antibodies such as selenium and NAC evidenced by much research.
thyroidpharmacist.com/artic...
thyroidpharmacist.com/artic...
I have provided these links purely for simple reading but if you want more sciencey stuff there is loads on pubmed.
I would also highly recommend you read ‘The Root Cause’ by Isabella Wentz who is a pharmacist with Hashi herself. I suffered attacks for years and sadly didn’t know any better but my son has managed to reduce thyroid antibody levels and recover health without meds through some simple strategies.
An ultrasound won’t show for certain if a nodule is non functioning or hyper functioning. It requires an uptake scan to see the areas of funtion throughout thyroid. It’s is simpler for drs to got by blood test results.
Doctors go by thyroid function results to decide what need treatment - in a way medics look at nodules & thyroid function as separate issues. Often Ear nose & throat doctors assesses any psyical issues caused by nodules. Often from a does this require surgery viewpoint. Endocrinologist will be looking at correcting thyroid hormone levels.
Transient raised levels are almost certainly due to Hashimoto’s, which you know you have. Toxic nodules would cause continuous elevated levels. Nodules are common with autoimmune but can occur without.
I did the worst thing and googled nodule on isthmus. According to one site, they’re more likely to be malignant than elsewhere, although the overall chances of malignancy are low.
Plus this is all being hypothesised from a full-abdo CT scan which I’m assuming isn’t as accurate as an US.
To be fair, ENT guy was cross a) nodule was missed on CT and that b) endocrinology haven’t picked up on my case yet. A strongly worded email is being sent inter-departmentally as we speak. He said he doesn’t like to do anything until thyroid levels are calmer.
My nodule being 5cm is very close to isthmus. I had a FNA & nodule classed as benign. The function levels were actually missed off though. Hyper levels weren’t picked up until later.
Nodules can reduce in size once levels are optimal. The entire thyroid & nodules can swell when levels are abnormal, which is why they drs say they like to wait until level are right.
Thank you ever so much for all your info. You’ve all been incredibly reassuring.
Hashimotos 
toxic nodule hyperthyroidism & RAI treatment 
Hyperthyroid with Hashimotos/thyroiditis? 
Hot nodule removal????
Hashimotos & Graves 
