Brief Answer: Thyroid Detailed Answer: I reviewed the ultrasound images. However, I could not find a formal description of the details ie if there are any nodules present and if so what size, and if the gland appears heterogenous etc The radiologist always gives a printed report. Your wife's thyroid condition requires systematic management. In general, it is not advisable to double the dose of thyroid medication. Here, it is being more than doubled if the recommendation to take 200 mcg twice a week is followed. This is deemed unsafe by thyroid experts. When I see someone like this, I generally advise increasing the dose to 125 or 137 mcg daily for 6 weeks and retesting the TSH and free T4. This too, provided the person in question does not have osteoporosis or irregular heart beat/chest pain for heart blockages. In such instances, the target TSH is 0.4 to 2 with free T4 in the high normal range. It can take a few months before TSH is gradually normalized. This requires finesse and I strongly suggest you find an endocrinologist to do this

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Brief Answer: Ultrasound Detailed Answer: It is obviously challenging to interpret the ultrasound report. From what i could make of it, the thyroid texture is heterogenous which is compatible with Hashimoto's thyroiditis. The latter is the most common cause of hypothyroidism. There is nothing to worry here. It seems there are no nodules in the thyroid although this needs to be confirmed by a legitimate english translation. There are some enlarged lymph nodes that, according to the radiologist, meet the description of 'reactive' response. This typically refers to a benign cause. However, I would encourage you to show this report to an ENT doctor who will interpret the findings better to see if the lymph nodes need further evaluation.

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Brief Answer: Lithium Detailed Answer: I reviewed the TPO chart. It is notable how the increments have occurred. Lithium can induce hypothyroidism, so we have an answer there, but it is not known to cause lymph node changes.

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