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Dr. Andrew Rynne

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Thyroid test shows nodule posterior at the mid thyroid Ievel. What does this mean?

Answered by
Dr. Shehzad Topiwala


Practicing since :2001

Answered : 1663 Questions

Posted on Wed, 27 Nov 2013 in Thyroid Problem and Hormonal Problems
Question: hiThe overaLl slze of the t,hyroid gland is within normal Limits. Parenchymal echogenicity is diffusely heterogeneous with multiple areas of decreased echogenicity. ?hls makes posit.ive recognj.tlon of nodules difficult. On the left there appears to be I x Smm hlpoechoic noduLe posteriorly at the mid thyroid Ievel. On the right a slightJ.y larger 12 x 5mm nodule is noted posteriorly as weII. Vascularlty of the thyroid was satisfactory and there was no retrosternal extensi.on.
Answered by Dr. Shehzad Topiwala 12 hours later
Brief Answer: Thyroxin dose Detailed Answer: You seem to have clear evidence of 'Hashimoto's thyroiditis' ie autoimmune damage to your thyroid gland which has likely resulted in permanent hypothyroidism (an underactive thyroid). This typically entails taking thyroxin for life. I see your TSH is about 5. Most endocrinologist aim for a TSH in the range of 0.4 to 2 by giving a higher dose of thyroxin such as 75 or 88 mcg. There are a few exceptions to this approach such as if you have an irregular heart beat, or angina type chest pains in the setting of coronary heart disease, or if you have severe osteoporosis. In these circumstances, lower doses of thyroxin are justified and the TSH targets are lenient (for instance, your 5 ish value would be acceptable). Otherwise, higher doses generally allow patients to feel best, but it is important to monitor levels periodically to prevent over-dosing. The nodules do not appear worrisome. Sometimes there is a 'pseudo-nodular' appearance in the setting of Hashimoto's thyroiditis, meaning there are no true nodules really. If you do not have major risk factors for thyroid cancer, such a family history or radiation exposure to the neck, then these can be left alone.
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