What Does My Ultrasound Scan Report Indicate?

Posted on Mon, 11 Jan 2016

Question: ultrasound thyroid. slightly lobulated contour and diffuse heterogenous exhotexture without discrete solid or cystic nodule. Increased thyroid antibodies. currently on 75 mcg of synthroid. hoarseness, body aches, weight gain. right lobe 3.5 x 1.2 x 1.1 left lobe 3.6 x 1.1x 0.9 isthmus .3 cm..
Thyroid perox ab 782.7
thyroglobulin ab 315
tsh 3 =1.9 previously 3.6
t4 free =.96 previously 1.01
ana tit 1:640
ana pattern speckled
tsh screen 6.168

Answered by Dr. Shehzad Topiwala (31 minutes later)

Brief Answer:
Thyroid

Detailed Answer:
Sorry to note your symptoms. You have clear evidence of Hashimoto's thyroiditis. This refers to an auto immune condition which makes your thyroid permanently and irreversibly under active. That is why you need Synthroid for life. Now the important thing to note is whether your TSH and Free T4 are in the target range or not. I see you have listed several values but can you tell me your most recent readings. In my patients I aim for a TSH of 0.5-2 with free T4 closer to the upper limit of normal. When I see a patient like you in my practice I order the following tests in addition o a physical examination : CBC, CMP, HbA1c and 25 hydroxy Vitamin D

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

Follow up: Dr. Shehzad Topiwala (10 minutes later)

t4 .96
t3 1.9

recent other blood work ran october 2015, only other abnormals other then listed in my first response were

mono was 11.1
lymphs 20.7

what would th hba1c or hydroxy vitamin d do to add to this diagnosis or treatment options. what about the new onset hoarseness and muscle aches?

should i INCREASE MY thyroid medications.

Answered by Dr. Shehzad Topiwala (2 days later)

Brief Answer:
Follow up

Detailed Answer:
So is your TSH about 6 or 3 now because you have mentioned three different readings above in the first note.

Free T4 range also varies from lab to lab. I would like to know your laboratory's reference range.

Furthermore your ANA is positive. This must be evaluated by a Rheumatologist.

HbA!c screens for diabetes. Uncontrolled diabetes and low vitamin D can cause muscle aches too. Likewise if the thyroid is not adequately treated ie with an appropriate dose , then this can also result in hoarseness and muscle soreness.

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

Follow up: Dr. Shehzad Topiwala (9 hours later)

T4 .96
Tsh screen 6.1

Tsh 3rd generation in October was 1 01

Previously the tsh 3rd generation was 3.6

Should i increase my medications i Cannot get into an endo until January February. ..i have been evaluated for the ana by a rheumatologist all test on her end are fine. ...so strictly a thyroid issue. ...if you weren't so far I'd come see you. ...i live in XXXXXXX ..

Answered by Dr. Shehzad Topiwala (4 hours later)

Brief Answer:
Second follow up

Detailed Answer:
When I see a patient in my practice with TSH and T4 in the ranges you are reporting, I typically increase their synthroid dose and recheck labs in 6 weeks.
So for example I would increase the dose to either 88 or 100 depending on findings on physical examination

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

Follow up: Dr. Shehzad Topiwala (1 hour later)

So would an endocrinologist agree to take the thyroid out to eliminate the back and forth hypo to hyper swings?

Answered by Dr. Shehzad Topiwala (10 hours later)

Brief Answer:
Second follow up

Detailed Answer:
Surgery would not be the right thing to do. Regulating the thyroid is not very challenging for the expert. Simply follow up regularly in person with your thyroid specialist ie a qualified endocrinologist and your thyroid condition will likely be controlled in a stable manner

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