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What Do You Suggest For Growing Thyroid Nodules?

Posted on Thu, 6 Mar 2014

Question: I have thyroid nodules which are slowly growing; they've already ruled out cancer; but looking at an Ultrasound and blood work, the initial thought is I'm border line Hypothyrodism but then a thyroid uptake shows I'm Hyper... Can someoen be both? And what do you do for this since all medications seem to be one or the other.

Answered by Dr. Dr. Ivan Romich (2 hours later)

Brief Answer: Hi and welcome to HCM Detailed Answer: Thanks for the query. Basically you cant have both. You can have high or low thyroid hormones level(T3,T4) . These levels can be different and vary from too low to too high like it is seen in certain thyroid disorders such as autoimmune diseases or adenomas. High uptake suggests Graves' disease which is usually manifested with hyperthyroidism,BUT it can be associated with normothyroidism or occasionally also with hypothyroidism. So the same disorder can cause different T3 and T4 levels. Rarely increased uptake with hypo can be seen in thyroid hormone receptor insensitivity in which the T4 has no peripheral efects (hence the hypothyroidism) and no feedback effects (hence the elevated TSH and increased uptake). This is condition where thyroid hormonal replacement therapy wont be succesful but this disorder would be manifested already in childhood. So I think that you could have graves or thyroid adenooma in phase where there is autoimmune "attack" on healthy cells so T3,T4 levels are not produced enough. If you have symptoms of hypo,you should treat it with hormonal replacement,if not,then no treatment is necessary at this point.You just need frequent follow up. Wish you good health. Feel free to ask. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Ivan Romich (2 hours later)

My new primary is sending me to another endriconolgist (sp?)but I've been down this path before. They take tests but the only thing it shows outside of what already has been discussed is a high RA factor. I then get referred to a rheumatologist who finds nothing else wrong! Graves' disease was ruled out the last go round. Having had Guillan Barre, I have a history of auto-immune issues but I'm at a loss! I'm dealing with symptoms of both hyper and hypo but no one seems to know what to do... Fatigue, weight gain, dry skin,constipation(alternating with loose stool), joint pain,poor eye sight, memory issues (off and on) low body temp (97.5), headaches, and the list goes on...what type of testing should I demand?

Answered by Dr. Dr. Ivan Romich (2 days later)

Brief Answer: Hi Detailed Answer: These are sign of hypo and this is the first thing which should be considered and treated. If there are normal or elevated thyroid hormonal levels then it could be thyroid hormone receptor insensitivity. You need to repeat thyroid tests and determine the exact pathology. I think you need thyroid replacement therapy,considering symptoms that you have. Secondly,it may be systemic autoimmune disease,most common are rheumatoid disorders, SLE or fibromialgia,but there are various autoimmune diseases. You should check all autoimmune markers. Thirdly, it can be hormonal disorder caused by steroid hormones,not thyroid. so you need to check your estrogen, progesterone, testosterone,prolactine and cortisole levels. There may be also beginning of menopause. Guillan barre may cause some permanent consequances but i dont think it is related to your symptoms now. Also,I suggest to do brain MRI to rule out neurologic disorders such as MS.and it would also show if GB left any brain damage.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar