Suggest Treatment For Fatigue And Tingling Of Arms

Brief Answer:
Your thyroid function is ok, Nodule in thyroid needs FNAC

Detailed Answer:
Hi XXXXXXX

Welcome to HCM, Thanks for posting question.

I will explain in details

1. Thyroid function test

Thyroid hormones (T3 and T4) are normal. TSH (Thyroid stimulating hormones) is on lower side. No treatment is needed for this situation as thyroid hormones are normal. TSH can some times be low in patients with goiter or in mild inflamation of thyroid called thyroiditis. You can repeat a thyroid function after 2 months. Most of the cases it will return to normal.

2. Ultrasound neck

There is a nodule in thyroid that has to be evaluated further. The next test we do is a needle biopsy (FNAC). This will tell you if the nodule has to be removed or not. If the reports is abnormal we have to remove the thyroid. If not we can follow up after 6-12 months.

The indications of surgery in a nodule are

1. Nodule larger than 4 cm
2. Cancer in FNAC report (seen in only 5% of these nodules - so no need to worry)
3. Nodule extending into chest cage
4. You have problems with swallowing or breathing due to this swelling.

Hope I have answered your query. If you have any further questions I will be happy to help

With warm regards,
Dr Ajish TP (MD,DM)
Consultant Endocrinologist.

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Brief Answer:
Present symptoms are unrelated

Detailed Answer:
Hi XXXXXXX

Welcome back.

Weight loss is a feature of hyperthyroidism (increased function of thyroid), fatigue and tingling are seen in decreased function of thyroid. These symptoms are not specific for a thyroid disease. Since the thyroid hormones (T3 and T4 ) are normal, the symptoms are unrelated to thyroid.

The only function of TSH is to stimulate thyroid gland to produce thyroid hormone. It is not related to increased blood sugars.

The possible explanation to your symptoms, blood tests and ultrasound features are:

Probably you had thyroiditis - which has now recovered to normal now.

In thyroiditis there is an injury or destruction of thyroid gland. This may be due to a virus (Viral thyroiditis) or due to an auto immune disease in body (Hashimoto's thyroiditis). When thyroid is destroyed, thyroid hormones stored in thyroid will be released to blood. This will cause neck pain, neck swelling, fast heart rate, sweating, shivering and weight loss. T3 and T4 will be high and TSH will be low.

On recovery - The pain and swelling decrease, weight loss improve, palpitation, sweating etc will be gone. T3 and T4 will return to normal , TSH is the last thing to normalise - so may be still on lower side as in your case.

After thyroiditis the thyroid can function normally or go for under active thyroid.

Suggested follow up for you:
1. Do a FNAC (Needle test) will show you the type of thyroid nodule
2. Do a thyroid function and anti thyroid antibodies after 2 months

Hope I have answered your question. If you have any further questions I will be happy to help.


Regards
Dr Ajish TP
Consultant Endocrinologist

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