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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Is A 2cm Wide Nodule On The Thyroid Large?

Hello, about 1 year ago (while I was pregnant)I was diagnosed with subclinical hypothyroidism. I am on a low dose synthroid and just had my bloodwork redone a few weeks ago. The results were as follows; T4 14, T3 4.8, and TSH 9.7. What does this mean, are my T4 and t3 levels normal? I know the TSH is high (normal range being 0-3). As well, I just had an ultrasound done of my thyroid and they found a nodule that was about 2cm in width. Is this large?
Thank you very much
Wed, 3 May 2017
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Internal Medicine Specialist 's  Response
Hello and welcome to HCM.

Yes, a thyroid nodule of 2 cm is a significant size. It needs to be evaluated by your doctors to find out if it is solid = dense tissue or cystic , hormone producing or not, benign or malignant. The sonogram report should have stated if the nodule was solid or cystic. Cystic means like a bubble filled with liquid.

Most solid nodules in the thyroid will need to be biopsied which means that a tissue sample is taken for pathology reading.

As to your Bloodwork = TFTs = thyroid function tests - it is very difficult to explain the particular set of numbers you provided and it looks like some of the results may be reported incorrectly, given your history of subclinical hypothyroidism and your being on a low dose synthroid.

Based on the numbers you gave and the normal values given below, your T4 of 14 is high , your T3 of 4.8 is extremely low and TSH of 9.7 is high.

The 9.7 TSH indicates that your brain is still receiving signals from your body that you are hypothyroid and is producing more TSH to stimulate your thyroid to produce more thyroid hormones (T3 and T4).
But the high level of T4 of 14 should be registering in your brain as enough of thyroid hormones in the body and stopping the production of TSH, so if T4 is high , TSH should be normal or even low.

Your taking a "small dose" of synthroid should not result in a high T4, only in norml T4.
It is not clear why your T4 is high - perhaps you are accidentally taking a larger than prescribed dose of synthroid?

Also unclear is why your T3 is so low.
Usually T3 and T4 are similarly increased or decreased as one is a precursor of the other.
When interpreting TFTs is important to know the clinical presentation - if you have symptoms of hypothyroidism, hyperthyroidism or if you are euthyroid which means neither hypo nor hyperthyriod.
Unfortunatley I did not have this information.


I hope I was able to give you at least the basic understanding of how the thyroid hormonal relationship works.

You may want to discuss this further with your doctor.
Also, when in doubt it is best to repeat the blood tests.

Regards and best of health.
..........................
Normal ranges for adults generally fall between these values (4).
Total T4 5.0-12 μg/dL
Total T3 80-190 ng/dL
Free T4 1.0-3.0 ng/dL
Free T3 0.25-0.65 ng/dL
TSH 0.4 ‑ 4.0 mIU/L
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Is A 2cm Wide Nodule On The Thyroid Large?

Hello and welcome to HCM. Yes, a thyroid nodule of 2 cm is a significant size. It needs to be evaluated by your doctors to find out if it is solid = dense tissue or cystic , hormone producing or not, benign or malignant. The sonogram report should have stated if the nodule was solid or cystic. Cystic means like a bubble filled with liquid. Most solid nodules in the thyroid will need to be biopsied which means that a tissue sample is taken for pathology reading. As to your Bloodwork = TFTs = thyroid function tests - it is very difficult to explain the particular set of numbers you provided and it looks like some of the results may be reported incorrectly, given your history of subclinical hypothyroidism and your being on a low dose synthroid. Based on the numbers you gave and the normal values given below, your T4 of 14 is high , your T3 of 4.8 is extremely low and TSH of 9.7 is high. The 9.7 TSH indicates that your brain is still receiving signals from your body that you are hypothyroid and is producing more TSH to stimulate your thyroid to produce more thyroid hormones (T3 and T4). But the high level of T4 of 14 should be registering in your brain as enough of thyroid hormones in the body and stopping the production of TSH, so if T4 is high , TSH should be normal or even low. Your taking a small dose of synthroid should not result in a high T4, only in norml T4. It is not clear why your T4 is high - perhaps you are accidentally taking a larger than prescribed dose of synthroid? Also unclear is why your T3 is so low. Usually T3 and T4 are similarly increased or decreased as one is a precursor of the other. When interpreting TFTs is important to know the clinical presentation - if you have symptoms of hypothyroidism, hyperthyroidism or if you are euthyroid which means neither hypo nor hyperthyriod. Unfortunatley I did not have this information. I hope I was able to give you at least the basic understanding of how the thyroid hormonal relationship works. You may want to discuss this further with your doctor. Also, when in doubt it is best to repeat the blood tests. Regards and best of health. .......................... Normal ranges for adults generally fall between these values (4). Total T4 5.0-12 μg/dL Total T3 80-190 ng/dL Free T4 1.0-3.0 ng/dL Free T3 0.25-0.65 ng/dL TSH 0.4 ‑ 4.0 mIU/L