Subclinical hyperthyroidism / multi nodular goitre - confused!

[treevee]

Hi

I have subclinical hyperthyroidism and MNG - probably one of more of these nodules may be "hot". Here is my latest set of results, which are pretty much typical of most of my tests. Antiobodies are within range so all good there. I'm a menopausal woman aged 61.

My endo is keen to:

1. test to see if nodules are toxic

2. put me on carbimazole or PTU similar

3. there was also talk of RAI treatment and / or surgery down the road....

She tells me that it is low TSH which causes symptoms like loss of bone density and atrial fibrillation. From my reading I was thinking that it is high T3 which usually causes these symptoms, and of course TSH is a pituitary hormone isn't it? So my question really is, if the thyroid is itself regulating and keeping my T4 and T3 within the limits is this OK? Should I be looking at using pharm products or not? At the moment I am taking herbals - motherwort, bugleweed and L-carnitine which seem to keep everything chugging along in this manner.

I really am loathe to be having radiactive iodine in my system and am very sensitive to pharm drugs and lactose intolerant so it is not a straightforward decision. I'd like to go back to my next appointment with some ideas and more insight, and would very much appreciate any thoughts you might have - especially from those who are or have been in a similar position.

Thank you 😀

[TiggerMe Ambassador]

If you ignore your TSH result (which most of us do) your actual thyroid hormone levels are in a very happy place and I certainly wouldn't recommend changing anything, there may be a feedback loop issue which means your pituitary (responsible for TSH levels) is a bit on the wonk

You are correct in thinking it is low or high fT3 that can cause bones an issue but yours is in a good place 🤗and sounds like you feel well?

Agree to them keep monitoring you and check for hot nodules but refuse any interference!

TSH 0.072 mIU/L (0.27 - 4.2) -5.0% 😐

Free T4 (fT4) 19.3 pmol/L (12 - 22) 73.0% 😁

Free T3 (fT3) 5.3 pmol/L (3.1 - 6.8) 59.5% 😁

T4:T3 Ratio 3.642 😁

[treevee in reply to TiggerMe]

Hi Tigger! Thanks so much for your response.

I thought I must have misunderstood. I said to her " I thought it was the thyroid hormones which give symptoms if they are high" she said "no it's the low TSH". Doesn't make sense really does it? I do wonder.... are they pulling wool over eyes or do they not understand thyroid function? Or is there some other narrative?

Anyhow yes I am inclined to agree with you, this is how we have kept it for the last 4 years since I discovered I had low TSH (thanks GP - not) and nodules (despite being told my thyroid was fine and no lumps). It's just the change of specialist between regions which has led to me seeing someone new.

Out of interest what would be the advantage of investigating the hotness of the nodules - presumably that wouldn't really change much if I am not going to have any treatment anyway?

Yes I do feel well in myself thank you. Occasional anxiety and my bone density is definitely a bit low, but that is likely because of early menopause after chemo 13 years ago, and taking tamoxifen. I don't think it has anything to do with the thyroid per se.

Once again thank you

[TiggerMe Ambassador in reply to treevee]

Sorry for the delayed reply the alerts aren't always activated 🫤

Looks like the others have covered most of your questions I shall add bonebalance.co.uk/

This is what I and several others have been using to stave off osteoporosis or improve our already holey bones😬

[treevee in reply to TiggerMe]

Thanks Tigger!

[pennyannie]

Hello - Apologies -

I've just replied - but on your previous post !!

You should get notified :

[treevee in reply to pennyannie]

Got it! Thank you - I'm bookmarking those articles to take to my next appointment!

[greygoose]

Why do they suspect a hot nodule when your Frees are good? A hot nodule wouldn't reduce TSH without raising FT4 and FT3. That's not logical.

What time of day was the blood draw for this test?

[treevee in reply to greygoose]

Hi! I really don’t know the answer to that I’m afraid! I always do blood tests first thing in morning.

[treevee in reply to treevee]

Although sometimes my T4 is right at the top of the range.

[greygoose in reply to treevee]

Do you have Hashi's?

[treevee]

No not Hashi's, antibodies well within range!

Sub-clinical hyper and MNG

[greygoose]

You can have Hashi's without over-range antibodies. And if your FT4 fluctuates without changing your dose, it does sound like Hashi's. Have you had a thyroid ultra-sound?

[treevee]

yes plenty - several nodules on right lobe - T4 always in top quarter of range so doesn’t wobble much.

[treevee]

That’s all I know - a few nodules, none looking nasty, clear on biopsy - I don’t have a written report.

[humanbean]

What does MNG stand for?

[helvella in reply to humanbean]

multi nodular goitre

helvella - Abbreviations, Acronyms, Latin

A document containing a list of many of the abbreviations, acronyms and Latin terms you are likely to find when reading documents about thyroid. Don't assume an old copy is up to date!

dropbox.com/scl/fi/jks8k4c3...

Last updated 28/12/2024

helvella.blogspot.com/p/hel...

[humanbean in reply to helvella]

Thank you.

[humanbean]

She tells me that it is low TSH which causes symptoms like loss of bone density and atrial fibrillation.

I don't believe this at all. I think my symptoms are much more closely correlated with my Free T3 than my TSH.

I wonder if your doctor could diagnose someone with Central Hypothyroidism. Somehow I doubt it. That is where the thyroid is healthy but the pituitary can't produce enough TSH for the patient's needs.

I actually think your thyroid hormone results are fine for most people. Your low TSH doesn't appear to be affecting your T4 and T3 to any great degree. If you feel well I would ignore the doctor. If you don't feel well I would suggest trying to optimise your nutrient levels before trying to reduce your thyroid hormones or increase your TSH. Having done that you should then get a new set of tests done.

[treevee]

Thanks for your input humanbean - yes I am working on everything like nutrient level, gut function etc etc like crazy for several years now and still my thyroid levels never change. I regularly test about every 6 months.

I am inclined to agree with you, it’s just that you kind of come out of the appointment doubting yourself if you know what I mean? I need to be more resolute, I’m not there for an argument I really just want to be monitored and checked in case the situation gets any worse - it’s been stable for some years now so I can’t see it changing any time soon. Will plod on!

Your point about central hypo is interesting too. The answer is probably not! I don’t think this will apply in my case bc my T4 and T3 are in upper half of range and I think if that was a problem then they would tend to be low and I would have hypo symptoms?

In the meantime I am looking for a good bone health supplement if anyone can recommend? I already take Mg and D/K2…