Brief Answer:
TSH RECEPTOR ANTIBODY

Detailed Answer:
Good day,
Noted your thyroid nuclear scan reports. There is some uptake in the left lobe. However, it is not intense uptake. The scan shows that the reason for your hyperthyroidism could be due to early Grave's disease ( auto immune thyroid disease).

Usually, hyperthyroidism is due to few reasons.
1) Thyroiditis ,
2) Auto immune,
3) Toxic goiter.

In thyroiditis, there will not be uptake in gland during scan. In Grave's disease, there will be intense uptake in scan. In Toxic goiter, there will be intense uptake with in a nodule. In your case, the scan hasn't really helped to come to a conclusion. I would suggest to do a TSH receptor antibody done ( TRAB). That would give extra clues.

Sometimes, in early grave's disease the uptake may not be very intense ( like in your case). There could be few reasons for that.
1) Treatment with Carbimazole or Propyl thiouracil for hyperthyroidism. Ideally, these drugs should be stopped 7 to 10 days before scan.
2) High intake of dietary iodine or using iodine containing creams/anti septics ( like povidone iodine) . You are supposed to have low iodine diet and to avoid iodine containing products for 10 days prior to this scan.

How high are your thyroid function tests? Do you have a report to attach? What symptoms do you have now. Based on your thyroid function tests and symptoms, in your case, ( since nuclear scan hasn't really helped) we could either wait and watch or if symptoms are severe, treatment may be warranted.

I WOULD STRONGLY RECOMMEND A TSH RECEPTOR ANTIBIDY TEST ( TRAB).

Regards
Binu

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Brief Answer:
Toxic nodule

Detailed Answer:
Hello,
Thank you for the reply. Toxic nodule means there is a nodule ( lump) with in the thyroid which is excessiely and autonomously producing thyroid horones. Toxic nodules are usually benign lumps ( very unlikely to be cancerous) and they are treated with either radio iodine treatment or surgery.

However, the description in the report doesnt strongly favour a toxic nodule. It says there is possibiity of an "emerging toxic nodule". A toxic nodule ideally will show an increased intene concentration of the injected radio isotope with in the nodule. At times, an early grave's and an emerging toxic nodule are difficult to differente. Hence a TRAB antibody may help. Other option is to wait and watch while being treated with anti thyroid drugs like carbimazole.

If your thyroid hormones are controlled by these medicines, your symptoms of hyperthyroidism should subside. I suspect, some of the symptoms you mentioned could be from underlying anxiety itself. Your specialist should optimise the dose of anti thyroid drugs to control the hyper symptoms. You may also benefit with a small dose of Propranolol ( Inderal) to control some of your symptoms.

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Brief Answer:
Please do not get worried by the the term " TOXIC"

Detailed Answer:
Sorry for the typos. I was typing in from my XXXXXXX
Yes, there is a possibility that a nodule can develop. An ultrasound scan is cheap and helpful to find out if there is an existing nodule already.
Okay, if you have already done the TRAB test, what did it show?

Please do not get worried by the word " TOXIC". It simply means presence of a nodule which produce hormones excessively. Toxic in this context doesn't mean poisonous, cancerous or anything of that sort. Please relax. This is not difficult to treat, but a bit tricky to diagnose in your case. Once we arrive at a diagnosis, a curative treatment is easy

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Brief Answer:
TRAB results and ultrasound findings are important

Detailed Answer:
Hmm, we shall await the TRAB results. Nuclear scan only says about the functional status of the thyroid and can not detail the anatomical details. Where as ultrasound can tell us the anatomical details and if there is a nodule existing in the left lobe ( where an isotope concentration was seen in nuclear scan). The term "emerging thyroid nodule" is a bit of imaginary term based on the finding of isotope concentration in a specific area in the gland. I wouldn't give it too much of importance and shall rely on ultrasound for further clues.

Please stay relaxed. This is not life threatening situation. Our mind often create big problems out of small situations. However, the ear and throat problems can occur when the thyroid is inflamed. At times, I have seen patients complaining about upper back and shoulder pain as well when thyroid is inflamed. This will usually disappear in the due course.
You might need to consider about taking a short course of anxiety pills till the results are available. PLEASE remember that anxiety can trigger auto immune process with in the thyroid.
Your doc seems experienced enough to handle this issue. I hope he is an endocrinologist. Please trust his words.

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Brief Answer:
USG reports important.

Detailed Answer:
We have to wait for the ultrasound report. A large nodule can cause pressure symptoms in neck and discomfort while swallowing. However, such large nodules are generally very obvious on clinical examination and your doc would have picked it up while examining you. Another thing is that, as I mentioned earlier, an inflamed thyroid can produce such symptoms even with out having any nodules at all.

Nodules can only cause ear problem if they are large or malignant by pressing on nerves. I wouldn't fully agree with your doc on this matter.

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Brief Answer:
Small nodule in right lobe, no nodule in left lobe.

Detailed Answer:
Good day,

Saw the reports. Ultrasound shows an insignificant small right thyroid nodule. Where as the suggestion was in left thyroid in nuclear scan. So there is no nodule in left lobe at all. The right lobe nodule is small and non significant and is an incidental finding. Not to worry. Need another follow up scan after 6 months. Please stay relaxed.

The Thyroid blood profile shows a slightly low TSH with normal Free T4 and Ft3. How recently did you take anti thyroid medicines ( either Carbimazole or Propyl thio uracil) ? The tests should be interpreted on that basis.

You wrote Ab < 0.9. I presume it is antibody. Which one? TRAB or Anti TPO antibody ? . Anyway < 0.9 is a negative test for both these antibodies.

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Brief Answer:
Middle ear problems need to be ruled out.

Detailed Answer:
Yes, I would agree that ear and throat diseases particularly the Eustachian tube problems can cause ringing in the ear. Middle ear problems can also cause the ringing ( tinnitus).

Thyroid nodules are very common in the population over 30-35 years and vast majority are benign. Under less than 1 cm, they are usually benign. I can assure you that this particular right thyroid nodule is not the cause of ringing in ears or the abnormal thyroid profile. This is just an incidental finding in the ultrasound.

If the PTU was stopped 3 months back, I would say no immediate action should be taken for the low TSH in view of nuclear scan report( and if the TRAB is negative). We should wait for 3 months and repeat a thyroid blood profile and decide further.
regards
Binu

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