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What does this thyroid test regarding thyroid gland enlargement indicate?

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Posted on Mon, 30 Jun 2014
Question: First of all, Thank you for viewing and answering my question. I am in desperate to find out what's going on with my thyroid. The doctor i was visiting keep sending me to do more tests and leaving me with inconclusive diagnosis.
My tsh level is 7.3 (normal is less than 4) FT3 and FT4 is in the normal range. Further antibody results shows that my
TPab 193 U/ml (<41)
TPOab >1300 U/ml (<61)
TRab <0.3 IU/L (<1.8)

My ultrasound results

The thyroid gland is enlarged, particularly the right lobe which measures 7.2x2.3x2cm. The left lobe measures 5.5x1.8x1.9cm. No restrosternal extension is present on either side.
The echotexture is moderately heterogeneous throughout and the overall thyroid vascularity is increased. The appearances are consistent with thyroiditis.
There is no suspicious lymphadenopathy in the neck.


doctor
Answered by Dr. Binu Parameswaran Pillai (40 minutes later)
Brief Answer:
Hello

Detailed Answer:
Hi XXXXXXX

Good day.
Your diagnosis is simple. You have Hashimoto's Thyroiditis. The blood report shows that your antibody levels are high ( Anti TPO) and TSH is mildly elevated with normal Free T4 and Ft3. This is called as SUB CLINICAL HYPOTHYROIDIM.

The positive antobody shows that you have an auto immune thyroid disease ( Hashimoto's Thyroiditis) which is causing the TSH to go up. As the antibody levels are so high, it is likely that the TSH will further go up after a while.

At this stage, you may also have a slightly enlarged thyroid gland.

Regarding treatment, i would like to know if you are married/ planning for pregnancy etc? The treatment varies based on these information

Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai (1 hour later)
Dr. XXXXXXX

Thank you so much for your quick response. You are being very helpful.

In regards to your question, I have not married yet, but I am in a relationship. My partner and I were not planning to have baby any time soon before my condition is treated.

The doctor i was visiting had me gone through biopsy today. He was very hesitate to give me any concrete diagnosis. He also mentioned that I might have cancer.I wonder if this is absolutely necessary? or is this just routine check for every Hashimoto's patient? Unfortunately, I have to wait for the biopsy results.

This had me very worried at the moment.






doctor
Answered by Dr. Binu Parameswaran Pillai (7 minutes later)
Brief Answer:
Hi

Detailed Answer:
Hi Dear,
The ultrasoud findings which you described did not mention that there was a nodule. Could you please attach the report ? If there was no nodule in thyroid, there is no need of a biopsy or FNAC ( fine needle aspiration cytology). We do these tests only if there are nodules in thyroid which is more than 1 cm and if thera appear suspicious. In your description of ultrasoud there was no mention of any nodules . Could you clarify?
Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai (15 minutes later)

Hi Dr XXXXXXX

The report I mentioned is the report from the radiologist not a word missing (as below quoted). I have enlarged thyroid gland and the right lobe is larger than the left one. I can feel it myself. Its smooth and movable. This is why I don't understand the intention of my doctor asking me to do biopsy. Maybe he is just being cautious?

Could you please tell me What kind of diet should I be on ? low Iodine?
How often should I do blood test to check my tsh and anti bodies?
Is this Hashimoto's related with genetic?
Should I have my parents tested for this?


"
The thyroid gland is enlarged, particularly the right lobe which measures 7.2x2.3x2cm. The left lobe measures 5.5x1.8x1.9cm. No restrosternal extension is present on either side.

The echotexture is moderately heterogeneous throughout and the overall thyroid vascularity is increased. The appearances are consistent with thyroiditis.

There is no suspicious lymphadenopathy in the neck."





doctor
Answered by Dr. Binu Parameswaran Pillai (25 minutes later)
Brief Answer:
Hi

Detailed Answer:
Hi,
If that was the complete ultrasound report and if no nodules, there was no need of a biospy. There is no such recommendation. Your biospy report will come back as " lymphocytic infiltration suggestive of thyroiditis". There is nothing to suspect cancer n your ultrasound. Absence of suspcious lymphadenopathy is even more reassuring.

Yes, it can be genetic. This is a simple disease and easy to treat. No need to worry. First of all, you should repeat a thyroid fuction in a month time.
What you have is subclinical hypothyroidism which means that TSH is elevated and Ft4 and Ft3 is normal. There is a chance of this progressing to overt Hypothyroidism ( as the tpo antibody is strogly positive).

Now, regarding the treatment of subclinical hypothyridism, there are no concerete guidlines, however, generally we treat if any of the following is there,
1) TSH is > 10
2) Presence of goitre( enlarged gland)
3) Anti TPO positive
4) Pregnancy or infetility
5) abnormal cholesterol profile

In this you have 2 and 3 and hence you may require treatment with a small dose of levothyroxine. Let say, staring with 25 to 50 mcg levothyroxine early in the morning before food. Repeat TSH after 6 weeks and we need to adjust the dose based on this.

AS I MENTIONED EARLIER, THERE IS A CHANCE OF PROGRESSION TO OVERT HYPOTHYROIDISM AND HENCE TSH GOING UP. IN THAT CASE< WE MAY NEED TO INCREASE THE DOSE OF LEVOTHYROXINE TO FULL REPLACEMENT DOSE.

REgarding diet, you need a diet good in iodine. You may reduce the intake of cabage, lettuce, broccoli, cauliflower and raddish. Increase seafood.

Your parents ( especially mother) and sisters may need a TSH test if they have an enlarged thyroid.

AGAIN, LET ME REPEAT THAT THIS IS A SIMPLE DISEASE AND NOTHING TO WORRY. VERY EASY TO TREAT> LEVOTHYROXINE HAS NO SIDE EFFECTS ( with used in normal dose to keep TSH in normal limits)

Regards
Binu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Binu Parameswaran Pillai

Endocrinologist

Practicing since :2003

Answered : 1435 Questions

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What does this thyroid test regarding thyroid gland enlargement indicate?

Brief Answer: Hello Detailed Answer: Hi XXXXXXX Good day. Your diagnosis is simple. You have Hashimoto's Thyroiditis. The blood report shows that your antibody levels are high ( Anti TPO) and TSH is mildly elevated with normal Free T4 and Ft3. This is called as SUB CLINICAL HYPOTHYROIDIM. The positive antobody shows that you have an auto immune thyroid disease ( Hashimoto's Thyroiditis) which is causing the TSH to go up. As the antibody levels are so high, it is likely that the TSH will further go up after a while. At this stage, you may also have a slightly enlarged thyroid gland. Regarding treatment, i would like to know if you are married/ planning for pregnancy etc? The treatment varies based on these information Regards Binu