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Small multi-nodular goiters,elevated T3 in thyroid profile,TSH and T4 normal,anxiety,ADD medicine

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Healthy 34 year old woman, exercise regulary. Height 5'6, weight 144 lbs. Always get my annual physicals and this time I was told I have multinodular goiters (very small) and slightly elevated free T3 but normal TSH and T4. Wanting to have another baby but not sure after this news that I should even try. Anxiety has been an issue all my life but has seriously been controlled lately with ADD medicine (Vyvanse). ADD medicine works wonders compared to the Lexapro and Paxil that I've taken in the past. No other health issues. All other bloodwork came back good.

TSH 0.825 uIU/mL (lab range 0.360-1.46)
Free T4 1.28 ng/dL (lab range 0.76-1.46)
Free T3 4.66 pg/mL (lab range 2.18-3.98)
Also, what can women take, that's safe and effective, to increase libido?
Answered by Dr. Naveen Kumar 1 hour later

Welcome to XXXXXXX Forum

You seem to be very anxious when you were posting this query.
Relax! I have gone through the results of your thyroid profile. All the hormones are within the normal limits except for T3, which is marginally raised. According to the physiology of the thyroid hormones, T3 (Tri-iodothyronine) and T4 (Thyroxine) present in the blood are in the free form which is regulated by the TSH (Thyroid Stimulating Hormone).

In the blood T4 forms the major component, approximately around 80% while T3 is around 20%. Even though T3 is present in less quantity, it is more active than T4 and is the final form of the hormone. Whenever the levels of T3 and T4 are depleted in the blood the TSH automatically stimulates the release of T3 and T4 through various biochemical processes and thus maintain the hormonal balance. Accordingly, the most reliable indicator of the derangement of the thyroid hormones is TSH.

In your blood report, even though T3 levels are marginally raised the TSH levels are still within the normal limits. And hence, there is no need for you to worry about this report as the increased T3 levels are not very significant.

Secondly, the multinodular goiter can be of two types one is toxic and another the non-toxic. As the TSH levels are normal, and you do not have any symptoms of hyperthyroidism, this finding can be of non-toxic in nature. These findings are absolutely not contraindications for you to plan for your pregnancy. Before you plan for your pregnancy discuss with your gynecologist regarding the past medications.

Finally, as you have almost recovered from your anxiety related issues, you can definitely expect for your libido to be back gradually. I would suggest you not to go for over the counter medicines to increase the libido as most of them do not work and will leave you much more depressed. Eat plenty of fresh fruits and vegetables; keep your mind relaxed. Always remember! Relaxed mind is the secret of the healthy life and a great libido.

Hope I have answered your queries; I will be available to answer your follow up queries.

Wish you Good Health.

Dr. Naveen Kumar
Above answer was peer-reviewed by
Follow-up: Small multi-nodular goiters,elevated T3 in thyroid profile,TSH and T4 normal,anxiety,ADD medicine 17 hours later
So, I just got back from my Endo who luckily had a cancellation and could get me in. He is not putting me on any medicine now but wants to re-run my blood work, which he did, and he is sending me for an uptake scan???? Whatever that is. Here's why he's sending me to do the uptake:

Per ultrasound:

Right side - right lobe measures 5.0x1.5x1.9 cm
Left side - left lobe measures 4.1x1.3x2 cm.
Isthmus - 0.2 cm
There are multiple bilateral heterogenous nodules and cysts, some containing coarse calcifications. (WHAT IN THE HECK DOES THIS MEAN?)
The largest right lobe nodule measures approx. 0.7 cm in greatest dimension and the largest nodule of the left lobe measures approx 0.6 cm.
No microcalcifications are visualized

Ok, so now I'm really freaked out! What is my ultrasound results actually saying in language I can understand?

Do this new information indicate a reason to not get pregnant?


And THANK YOU SO MUCH for your response to my first question. I totally understood what you were saying...the doctor I saw today, not so much. He just seemed like he was in a big hurry and really didn't break things down for me.

So, what are your thoughts now on all of this?

Answered by Dr. Naveen Kumar 4 hours later

Thanks for follow upi,

Calcifications in the thyroid gland mean deposition of the mineral calcium in the soft tissues of the thyroid gland. The microscopic structure of the thyroid gland can be compared to that of a honeycomb. It contains number of follicles with a semisolid substance called colloid. When there is accumulation of the mineral calcium in the soft tissue of the thyroid gland the colloid material is replaced by the dense deposits of this mineral.

Your ultrasound report mentioned that there are few fluid filled sacs in your thyroid gland along with some sacs containing the calcium deposits. While the dimensions of the thyroid gland mentioned is almost normal.

Thyroid uptake scan (Radioactive Iodine Uptake Scan) is an investigative procedure where in a radioactive iodine is administered orally and the uptake of this iodine by the thyroid is recorded after a gap of 6 hours and 24 hours. This test is done to find out whether it is an overactive thyroid gland (hyperthyroidism) or not and to plan for the treatment of the same.

After learning about the new proceedings, I feel we should keep our fingers crossed. The calcifications and the thyroid nodules are not a good sign. You need to wait for rest of the investigations to be completed. Only when all the investigations are completed we can come to a conclusion.

Regarding pregnancy, I am of the opinion that, it is better to wait till all the investigations are over and then decide over it.

Dr. Naveen Kumar
Above answer was peer-reviewed by
Follow-up: Small multi-nodular goiters,elevated T3 in thyroid profile,TSH and T4 normal,anxiety,ADD medicine 1 hour later
My Endo said that all of my nodules are small and therefore cannot be biopsied. Is this true?

Why are the calcifications and the thyroid nodules not a "good sign?" What could this indicate? The last part of the ultrasound says:

-No microcalcifications are visualized.
-The appearance of the thyroid is consistent with multinodular goiter. No definite suspicous sonographic features are visualized.

Does this mean that I should never have any more children and just be thankful for the beautiful, healthy ones that I have been blessed with?
Answered by Dr. Naveen Kumar 10 hours later

Welcome back,

There is a small confusion over here, the doctor has mentioned in his report that:
1.     There are multiple bilateral heterogenous nodules and cysts, some containing coarse calcifications.
2.     No micro calcifications are visualized
Here in the first part he mentions that there are coarse calcifications and later on he says there are no micro calcifications visualized. I do not know what he means by this; hence I did not want to comment about this part of the report.

Generally thyroid gland with calcifications and multinodular goiter are prone for cancer. But in your case, the report was contradicting one another. Therefore I did not make any comments pertaining to this and mentioned that, we need to wait and watch till all the investigations are over.

Regarding biopsy, I do not know whether your Endo was referring to Fine Needle Aspiration Biopsy (FNAB) or Open Biopsy. FNAB can be done under ultrasound guidance also. In this procedure, a small needle is inserted through the skin into the thyroid and whatever they aspirate from that tissue will be sent for pathological examination. FNAB might be difficult if nodules that need to be studied are small

I can understand you are very anxious to have another child. Wait till all the investigations are over rather than being apprehensive. I feel, your Endo was not commenting much about this, as the present reports are inconclusive. And that must have been the reason why he opted for further investigations.

Wish you good luck and health

Dr. Naveen Kumar
Above answer was peer-reviewed by
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