Hi Elaine,

So glad to have found you and this forum. Hope you can help me with my questions. I am a 60 year old female, have never been on any thyroid meds. On a routine lab panel, I noticed my TSH was low and asked the nurse practitioner if it was ok and she said yes, I suppose because my other values were within range. I wasn't satisfied with her answer, so I went to my GP and I retook the test and it was even lower so she referred me to an Endo. He examined me and said I didn't have any overt signs over being Hypertthyroid, asked if I had taken any steroids to which I said yes, I had a Kenalog shot for psoriasis a month prior. He said that could suppress the TSH. He then felt my neck and said one side was bigger so he ordered an ultrasound and another blood test. Labs came back with higher TSH but still suppressed. Also had antibody test to which I hope you can tell me what they mean as I won't see him for a month.

My ultrasound came back with diagnosis of multi modular goiter- one on each side. He now wants me to do the 123 uptake test. From my labs, do you think this is necessary? I have no symptoms. I don't mind doing the test if it is warranted, but I don't want to if it's not necessary.

Here are my labs.

5-2-2017
TSH .175 (.350-5.500)
T4 Free 1.15 (.89-.1.76)
T3 Total .91 (.60-1.81)

5-17-2017
TSH .0.053
T4 Free 1.20
T3 Total 105

6-9-2017
TSH 0.083
T4 Free 1.20
T3 Total .88
Thyroid Peroxidase AB 1 (<9 IU/ML)
TSI .10 (.60-1.81 ng/ML

What can you tell me in regards to the information I have given? I appreciate your time and expertise.
Thank you so much,
Sally

Hi Sally,
Your thyroid peroxidase and TSI antibody levels are negative, which means you don't have Graves' disease or an autoimmune thyroid disorder. You wouldn't need an uptake.
You have multiple nodules but you don't have toxic multinodular goiter (TMG), which is the second most common cause of hyperthyroidism. You have subclinical hyperthyroidism, a condition that's watched but not treated as treatment can cause your thyroid hormone levels to fall too low and they're already on the low side.
With nodules, multiple nodules are nearly always benign. But your doctor will order another ultrasound down the road to check nodule size to see if any one nodule is growing fast or is unusually large. in this case he'd order a fine needle aspiration biopsy. Nodules can shrink on their own and are more common in people who are initially hypothyroid. Best, elaine