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What Does My Ultrasound Scan Report Indicate?
Question: I am 56 and have IGA nephropathy for the past 7 years which is being treated with Cardace 10 mg, Minipress XL 5 mg, Lipitor 10 mg, and fish oil capsules. I had an ultrasound in XXXXXXX 2017 which showed a solitary small nodule in my right lobe of the thyroid at 9 x 6 mm. Left lobe was normal.
Accordingly I had a thyroid test in August 2017 : TSH (CLIA) 0.442 uIU/ml (Ref 0.45-4.5) , Free T3 (CLIA) 2.65 pg/ml (Ref 1.4-4.4), Free T4 (CLIA) 1.09 ng/dl (Ref 0.8-1.8) I do not display any thyroid symptoms
In addition I have a benign prostrate (Grade 1) - no medication. My platelet count has been historically low varying from 128,000 - 150,000, the latest test in August 2017 shows a platelet count of 122,000.
My questions are as follows:
1. Do the thyroid tests indicate that I have potential sub clinical hyperthyroidism or are my test reading ok ?
2. From my readings it appears that the reference level for TSH varies 0.45-4.5 and for some laboratories the refernce range is 0.3- 3.1 . This makes a big difference as to whether my TSH level is within the reference range or below the reference level and hence indicative of possible thyroid illness. Please advise
3. What can I do to increase the TSH levels through diet etc without resorting to medication.
4. If my TSH level at 0.442 is "normal" as it falls within the reference range although on the lower side , at what TSH levels should I be concerned that I could be diagnosed with sub clinical hyperthyroidism?
5. Would hyper-thyroid medication conflict with my IGA nephropathy medication?
Thanks and regards
Accordingly I had a thyroid test in August 2017 : TSH (CLIA) 0.442 uIU/ml (Ref 0.45-4.5) , Free T3 (CLIA) 2.65 pg/ml (Ref 1.4-4.4), Free T4 (CLIA) 1.09 ng/dl (Ref 0.8-1.8) I do not display any thyroid symptoms
In addition I have a benign prostrate (Grade 1) - no medication. My platelet count has been historically low varying from 128,000 - 150,000, the latest test in August 2017 shows a platelet count of 122,000.
My questions are as follows:
1. Do the thyroid tests indicate that I have potential sub clinical hyperthyroidism or are my test reading ok ?
2. From my readings it appears that the reference level for TSH varies 0.45-4.5 and for some laboratories the refernce range is 0.3- 3.1 . This makes a big difference as to whether my TSH level is within the reference range or below the reference level and hence indicative of possible thyroid illness. Please advise
3. What can I do to increase the TSH levels through diet etc without resorting to medication.
4. If my TSH level at 0.442 is "normal" as it falls within the reference range although on the lower side , at what TSH levels should I be concerned that I could be diagnosed with sub clinical hyperthyroidism?
5. Would hyper-thyroid medication conflict with my IGA nephropathy medication?
Thanks and regards
Brief Answer:
Thyroid
Detailed Answer:
1 Technically, your TSH is slightly below lower limit of normal for the laboratory. So it qualifies for the diagnostic possibility of Subclinical Hyperthyroidism, because the Free T4 is normal.
Free T3 is not a very reliable test owing to the lab method commonly used.
2 Regarding normal range of TSH, one has to respect the normal range given for each lab as each lab uses a different 'test kit' and the manufacturer provides the normal range.
That is why thyroid specialists are required to interpret the values in conjunction with findings on physical examination. It is not only about a number on a report that Endocrinologists treat.
3 Right now, the priority is to confidently ascertain whether or not you truly have a thyroid problem in the first place. It is quite likely that if you repeat the TSH test in a different lab, your TSH may fall in the normal range, and consequently no further action may be necessary.
Dietary changes are not relevant at this point
4 You already meet the criteria for Subclinical hyperthyroidism. However repeating the test would be worthwhile considering your TSH is only mildly below the lower limit of normal
5 No. Anti thyroid medication would have no direct impact on your medication for IgA Nephropathy
Thyroid
Detailed Answer:
1 Technically, your TSH is slightly below lower limit of normal for the laboratory. So it qualifies for the diagnostic possibility of Subclinical Hyperthyroidism, because the Free T4 is normal.
Free T3 is not a very reliable test owing to the lab method commonly used.
2 Regarding normal range of TSH, one has to respect the normal range given for each lab as each lab uses a different 'test kit' and the manufacturer provides the normal range.
That is why thyroid specialists are required to interpret the values in conjunction with findings on physical examination. It is not only about a number on a report that Endocrinologists treat.
3 Right now, the priority is to confidently ascertain whether or not you truly have a thyroid problem in the first place. It is quite likely that if you repeat the TSH test in a different lab, your TSH may fall in the normal range, and consequently no further action may be necessary.
Dietary changes are not relevant at this point
4 You already meet the criteria for Subclinical hyperthyroidism. However repeating the test would be worthwhile considering your TSH is only mildly below the lower limit of normal
5 No. Anti thyroid medication would have no direct impact on your medication for IgA Nephropathy
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your prompt and detailed reply.
In your opinion would you prescribe medication based on the above test results and the fact that there is an absence of any thyroid related symptoms or would you adopt a wait and watch approach with the test being repeated ? At what interval of time should the test be repeated to see if there is any variance in results ?
Given your experince in this field, what is the likelihood that the TSH value can get lower in the coming months based on my medical history as mentioned above? Is the lowering of TSH a slow porcess in general or can it drop very fast?
Apologies -I forgot to ask - is there a link between the solitary thyroid nodule and the Thyroid tests? Also how does one know if the nodule is benign or cancerous? Currently the nodule size is 9mm x6 mm and the ultrasound said lobe was normal in size and homogenous echo texture with nomal vascularity. No significantly enlarged lymph nodes. Paritid and sub mandibular glans are normal.
Thanks
In your opinion would you prescribe medication based on the above test results and the fact that there is an absence of any thyroid related symptoms or would you adopt a wait and watch approach with the test being repeated ? At what interval of time should the test be repeated to see if there is any variance in results ?
Given your experince in this field, what is the likelihood that the TSH value can get lower in the coming months based on my medical history as mentioned above? Is the lowering of TSH a slow porcess in general or can it drop very fast?
Apologies -I forgot to ask - is there a link between the solitary thyroid nodule and the Thyroid tests? Also how does one know if the nodule is benign or cancerous? Currently the nodule size is 9mm x6 mm and the ultrasound said lobe was normal in size and homogenous echo texture with nomal vascularity. No significantly enlarged lymph nodes. Paritid and sub mandibular glans are normal.
Thanks
Brief Answer:
Follow up
Detailed Answer:
When I see a patient like you in my practice, I immediately repeat TSH along with Total T3 and Total T4. None of these tests require fasting and can be done at any time of day or night.
Moreover, consult a nephrologist to evaluate the urine Albumin. This is important because if there is a significant albumin leak in the urine, it can affect thyroid blood test results.
There is no time frame that can be predicted as to the evolution of your TSH. Each individual is different.
Yes there is a link between solitary thyroid nodule and thyroid tests. If your repeat TSH is also abnormally low, then your Endocrinologist may consider ordering a nuclear medicine test called
Technetium thyroid uptake and scan of the thyroid.
If your repeat TSH check is normal, then your endocrinologist will discuss the nodule management options based on what he finds on examining you. Overall the risk of thyroid cancer is about 5 % but this varies form person to person based on risk factors that can be determined only by an in-person consultation with an endocrinologist
Follow up
Detailed Answer:
When I see a patient like you in my practice, I immediately repeat TSH along with Total T3 and Total T4. None of these tests require fasting and can be done at any time of day or night.
Moreover, consult a nephrologist to evaluate the urine Albumin. This is important because if there is a significant albumin leak in the urine, it can affect thyroid blood test results.
There is no time frame that can be predicted as to the evolution of your TSH. Each individual is different.
Yes there is a link between solitary thyroid nodule and thyroid tests. If your repeat TSH is also abnormally low, then your Endocrinologist may consider ordering a nuclear medicine test called
Technetium thyroid uptake and scan of the thyroid.
If your repeat TSH check is normal, then your endocrinologist will discuss the nodule management options based on what he finds on examining you. Overall the risk of thyroid cancer is about 5 % but this varies form person to person based on risk factors that can be determined only by an in-person consultation with an endocrinologist
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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