Hello,
Thanks for choosing health care magic for posting your query.
You have mentioned your health details quite elaborately and have given much of the needed information. From your description and the investigation reports its quite certain that there is an enlargement of thyroid gland. The best part is that you have come negative for the antibodies. It rules out many of the autoimmune causes of increase in the size of thyroid gland like hashimotos, graves disease etc.
Even a routine goiter occurring cause of iodine deficiency can result in such thyroid involvement which need not be essentially nodular. Infact certain viral infections may also lead to such transient increase in the size of thyroid. Some increase in sizes of goiter can be idiopathic as well wherein no specific cause is evident.
If the autoimmune causes have been ruled out and the USG has not mentioned it to be cancerous, then most of the causes of worry can be put to rest.
As your endocrinologist has suggested you should get a repeat ultrasound after 1 year. If still its not confirmatory then an FNAC investigation will be useful to look for the actual cause.
Hope I am able to answer your concerns.
If you have any further query, I would be glad to help you.
If not, you can close the discussion and rate the answer accordingly.
In future if you wish to contact me directly, you can use the below mentioned link:
bit.ly/dr-srikanth-reddy

Wish you good health,
Dr. Srikanth Reddy M.D.

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Hello,
Thanks for your follow-up query.
In medicine, everything is possible.Our statements are mostly meant on what generally occurs. Mostly its the antibodies which come first and start destroying the thyroid tissue followed by noticeable thyroid problems. The otherwise is possible but is very very rare. In-fact Iodine deficiency goiter is much much common. Goiter can cause enlargement of thyroid. The ruling out of autoimmune is not "pre-mature" but logical.
In goiter the difference in the sizes of either lobes is possible. Its not essential that both of them should increase together.
Asof now whats in our hands is to follow it up after 1 more year and any treatment initiated based on intuitions wont be a wise decisions. We do have an illness in hand but things need to wait. As of now, there is no evidence that what you are facing is serious.
Regards,
Dr. Srikanth Reddy MD

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Hello,
Thanks for the follow-up query.
For hypothyroidism to occur, there has to be a tissue damage and if the cause if hashimotos or graves, the cause is the autoimmune antibodies which attack the own thyroid tissue and thereby causing hypothyroidism. In short for developing these autoimmune diseases there has to be auto-antibodies.
You are right in stating that some women do have these diseases where in the tests have come negative initially, but then if the test had no value, who would somebody do it?
Its obvious that this test detects most of the cases and some may escape initially, but will be diagnosed as the days go by, by repeat testing.
At present with a negative test result, worrying about the slight possibility of the test failing to detect the illness, wont do much good to you. If it has to happen,it will happen,but we dont have any proof at this time that you are having an autoimmune illness. I am not saying that there is 100% surety but what is the proof that you are having one?
The slightly larger right lobe and slightly smaller left lobe is not the sign of an autoimmune cause.
Iodine deficiency is not common , but people do have them. There are iodine fortified salts available in the market and that will help you in recovering from the deficiency if any. It will do no harm.
While repeating the autoantibody test , do take plenty of sugars and gluten as this will increase the chances of detection of autoantibodies if at ll they are there.
Hope I am able to answer your queries,
Dr. Srikanth Reddy MD

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Hello,
What I meant to explain was, gluten and sugars tend to increase the inflammation if at all there is one. So, if you have undetectable antibody levels, then eating gluten and sugars will increase their number and will help in detection.
Gluten is present in all the preparation which are made of wheat or like-wheat products, bread, dough etc. Do eat plenty of bread for 3-4 days before testing.
Likewise increase your sugar content by taking more of sweets and juices 3-4 days before testing. It may increase the detection chances.
But then, this is not 100% proof, but it helps.
Hope everything turns out to be negative.
Wish you good health,
Thanks and regards,
Dr. Srikanth Reddy MD

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Hello,
Yes you are right. Antibody tests are pretty reliable.
Secondly you are right in suggesting that both the lobes of thyroid are not always equal in size. And they can never be a symptom of illness or malfunction.
Wish you good health.
Thanks

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Hello
Sorry for the delayed reply.
Radioactive thyroid uptake scan is a new investigation procedure present since last 5 years.
Most of the things can be diagnosed in blood work but then the radioactive uptake scan has an added advantage of looking for structure as well as function.
The advantages of this procedure over previosly done are
1. If there is one , it can differentiate between thyroiditis and graves diease.
2. Look for nodular hyperuptake suggesting malignancy.
3.overall functioning of throid
4. Any nodularity and its uptake which might miss out on ultrasound
I dont want to scare you but if you are so anxious about your illness why not confirm yourself againwith this new test. If it comes nevative you will stay calm for the whole one year until you get reevaluated.
Otherthan mild radiation exposure,which is ok, it doesnt have much sideeffect.
Hope i am able to solve your concerns.
Thanks and regards
Dr. Srikanth Reddy

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Hello,
I can understand your anxiousness,
I know that there were no nodules found on ultrasound and its likely that you will come clean on the newer test as well. However all said, Radio Uptake is much more sensitive than USG.
Your antibodies are negative and that does suggest that 95% you don't have graves disease. But as in the previous case this newer test is more sensitive. Why not just check yourself again, as such you were quite anxious even with a negative result.
You are right in suggesting that you should diagnosed first to start the treatment. You have a change in the size of the thyroid lobe and it can be a sign of athyroid disease, but then as i said, it could be as simple an illness as goiter. Unless you are diagnosed, treatment cannot be initiated. As of now, no test has shown you to be suffering from any serious illness. So that should reduce your anxiety. If in future if at all anything is diagnosed there are plenty of treatment options available.
No point in starting treatment based on the symptoms without any diagnosis.
One thing I just want to add. Don't be so much afraid of the thyroid symptoms. There are not very bad and can be controlled fast.
Just give it a thought. You are more worried by your thoughts of having a big thyroid illness, than the illness itself as of now.
Hope everything turns out to be negative.
Wish you good health,
Thanks and regards,
Dr. Srikanth Reddy MD

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Hello,
Thanks for the follow-up question.
If its for graves or hashimotos, yes your doctor is right in stating that , the treatment should ideally wait until the blood work shows up.
But if its a nodule and if there is any suspicion of malignancy,then no blood work will ever show the findings. Its only further investigations like FNAC which will be needed.
Take home message as far as the Radioactive uptake test is considered:
1) Nodule with malignancy suspicion will require radioactive uptake and FNAC rather than any blood work. Although there is no suspicion of malignancy at present but still it will be wise to get the radiouptake done.
2) If it comes negative, it will decrease your anxiety for whole 1 year until you redo your blood work. Otherwise this question and anxiety will cause more harm than the illness itself.
3) if you have time and can afford, do go for it.

Hope that's fine,
Thanks and regards,
Dr. Srikanth Reddy MD

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Hello,
What ever tests you have done until now, none of them show that you have any kind of serious illness.
Further there are no signs suggestive of any kind of malignancy or nodules.
Its perfectly fine, even if you wish to skip this test (or even otherwise).
But do get a 1 year re-test of blood investigations.
Thanks and regards,
Dr. Srikanth Reddy

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