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What Do Elevated TSH Levels And Following Ultrasound Reports Indicate?
Posted on
Thu, 30 Mar 2017
Thu, 30 Mar 2017
Answered on
Thu, 20 Apr 2017
Last reviewed on
Question : HI
I recently had an elevated TSH at 11.6. My thyroid ultrasound reports states " mid thyroid lobe measuring 1.5x1.6x1.1cm, which is echogenic with a hypochoic halo and internal cystic area. there is a lobulated collection of diminished echogenicity in the anterior aspect of the right mid thyroid lobe measuring 1.4x2.0x0.7cm. There is a hypochoic mass in the right side of the isthmus measuring 1.2x0.3x0.8 cm.
I recently had an elevated TSH at 11.6. My thyroid ultrasound reports states " mid thyroid lobe measuring 1.5x1.6x1.1cm, which is echogenic with a hypochoic halo and internal cystic area. there is a lobulated collection of diminished echogenicity in the anterior aspect of the right mid thyroid lobe measuring 1.4x2.0x0.7cm. There is a hypochoic mass in the right side of the isthmus measuring 1.2x0.3x0.8 cm.
Brief Answer:
Thyroid
Detailed Answer:
Considering you are on levo thyroxine, it is likely you have chronic Hashimoto's thyroiditis. This is the name for a medical condition that typically leads to a permanently under-active thyroid state called Hypothyroidism. So if your diagnosis is correct, then you are on the right treatment for this condition.
Notably, in this type of hypothyroidism, often the thyroid gland appears to have nodules when in reality there are none. This has been well described in medical literature as 'Pseudo-nodules' implying that these mislead the ultrasound technician or radiologist to believe there are lumps in the thyroid gland. So one has to be careful while interpreting the thyroid ultrasound in this situation.
If indeed nodules are actually present then they need to be further characterized in terms of borders, calcifications, vascularity etc in addition to the description you have been provided. It is helpful to decide whether or nor to proceed with biopsy. The latter is also known as FNA (Fine Needle Aspiration).
Moreover the decision for FNA will also depend on a thorough assessment by an endocrinologist in-person because a detailed neck check is necessary.
When I see someone like you in my practice, I tend to increase the levo thyroxine dose by 25 mcg , and then 6 weeks later I typically order the following blood tests in addition to a detailed physical examination:
CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH (checks your thyroid)
Free T4 (this too checks your thyroid) Thyroid autoantibodies : Anti Thyroid Peroxidase (TPO) antibodies and Anti Thyroglobulin antibodies
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)
None of these tests require any fasting and can be done at any time of the day Correct diagnosis and treatment requires the opportunity to examine the patient so you must see an endocrinologist in-person.
Thyroid
Detailed Answer:
Considering you are on levo thyroxine, it is likely you have chronic Hashimoto's thyroiditis. This is the name for a medical condition that typically leads to a permanently under-active thyroid state called Hypothyroidism. So if your diagnosis is correct, then you are on the right treatment for this condition.
Notably, in this type of hypothyroidism, often the thyroid gland appears to have nodules when in reality there are none. This has been well described in medical literature as 'Pseudo-nodules' implying that these mislead the ultrasound technician or radiologist to believe there are lumps in the thyroid gland. So one has to be careful while interpreting the thyroid ultrasound in this situation.
If indeed nodules are actually present then they need to be further characterized in terms of borders, calcifications, vascularity etc in addition to the description you have been provided. It is helpful to decide whether or nor to proceed with biopsy. The latter is also known as FNA (Fine Needle Aspiration).
Moreover the decision for FNA will also depend on a thorough assessment by an endocrinologist in-person because a detailed neck check is necessary.
When I see someone like you in my practice, I tend to increase the levo thyroxine dose by 25 mcg , and then 6 weeks later I typically order the following blood tests in addition to a detailed physical examination:
CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH (checks your thyroid)
Free T4 (this too checks your thyroid) Thyroid autoantibodies : Anti Thyroid Peroxidase (TPO) antibodies and Anti Thyroglobulin antibodies
25 hydroxy Vitamin D levels (ideal range 40 to 60 ng/ml = 100 to 150 nmol/liter)
None of these tests require any fasting and can be done at any time of the day Correct diagnosis and treatment requires the opportunity to examine the patient so you must see an endocrinologist in-person.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I am scheduled to see an endocrine surgeon in 2 weeks for a biopsy and consultation.
Brief Answer:
Follow up
Detailed Answer:
Noted.
Follow up
Detailed Answer:
Noted.
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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