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THE Q & A

Welcome to The Q&A with Elaine Moore. Registered members are invited to ask any question of Elaine Moore on autoimmune diseases, Graves' disease, other thyroid diseases and subconditions, laboratory work, traditional and complementary medicine, triggers and environmental influences, thyroid and immune disorders in pets and animals, and other relevant areas of inquiry.

Each thread represents one question with one answer and will only appear at the time it is answered. Once answered, further replies cannot be made to the same thread since each thread represents only one question. A new thread will need to be started for additional questions.

Questions are answered solely by Elaine Moore, a medical writer and clinical laboratory scientist, MT, CLS, with more than 30 years of experience in immunology. Moore has also authored and edited over a dozen books in the area of health sciences and is an editor for McFarland Publisher's Health Topics Series.


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 2/29/2012 10:30 PM
 

Hello Elaine,

First off I would like to say I hope all is well. Ok, I have switched endocrinologists after my last complaint about my old one. The new one is great so far, she is not trying to push me into something I do not want to do like RAI or surgery. She listens, has run a complete workup of my blood, I have already had another ultrasound which they do in office, they also do a biopsy on site if needed and she has given me a referral for a surgeon just in case I decide to go ahead with it. Well, the reason I am writing you is the blood work shows that it is not in fact Grave's disease, I have toxic multinodular goiter. I have been on 5mg of MMI which I had lowered on my own after my last endo wanted to double my 10mg dose even though I was feeling poorly and my numbers were in range. My current endo wants to up it to 15mg because I am a bit high (I will include those numbers below) Well now this whole TMNG diagnosis leaves me with some new questions. Will I always be hyper because of it or could I possibly go into remission as with Grave's? Will my TSH always be low? I have been avoiding excess iodine in my diet for a couple of years and now I believe I should add more goitrogenous foods, good thing I like raw brocolli. LOL Also, the ultrasound technician mentioned that the nodules are all fluid filled and that they can be drained to help alleviate some of the discomfort but there is still a chance that they will refill. I have never heard of this option. Do you have any thoughts on this? I am told that the last biopsy was unpleasant mainly because of the doctor that performed it but I would consider having another if they could drain the larger nodule even if it was a small amount (the largest nodule is 46mm). I am a little unsure of the 15mg dosing but I am really trying to put trust in this doctor. Do you have any other advice for me? I feel like I have finally found a doctor that is right for me and I am trying to look at everything more positively. One last question. Have you heard of women not being able to have children after a thyroidectomy? We have a 6 month old daughter and would like to have one more child so I'm not sure if I should wait until after to consider the surgery. Thank you for everything. My labs are below, including some antibody results I have never seen on any of the other labs I've had done.

TSH <.004 (0.6-4.8)

T4 12.3 (4.6-12.0)

FT3 5.1 (1.5-4.1)

TU 29.1 (22.9-35.0%)

T7 3.6 (1.2-4.2)

ATA <10.0 (0-35)

ATG <20.0 (0-40)

I dont know what any of the last four lines meant but she also said my TSI was less than .05%

Thank you again Elaine!!

~Melissa

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 3/1/2012 6:05 PM
 
 Modified By Elaine  on 3/1/2012 7:08:26 PM

Hi Melissa,

TMG is the second most common cause of hyperthryoidism in young women. Multiple nodules are usually always benign. The College of American Pathologists recommends a low-iodine diet to reduce the size of nodules and any associated hyperthyroidism so your plan to add more goitrogens is sound.

Your thyroid levels are only slightly elevated although a FT4 level is much more accuate than the T7, which is a calculation based on the T4 and uptake (measures binding proteins). Most labs don't even run the T7 since it's considered obsolete.

With your labs only being slightly elevated, staying on your 5 mg dose sounds reasonable and if there was any increase, it doesn't seem that more than a 7.5 mg dose would be needed.

People who have thyroidectomies can have problems with infertility if their hypothyroidism isn't properly treated. As you might have noticed from comments on the board, hypothyroidism that requires full replacement hormone is not easy to treat.

The usual protocol with multiple nodules is to repeat the ultrasound in 6-12 months to see if the nodules have changed in size. A reduction in size is always good and suggests benign nodules. An increase in size would be an indication for a repeat FNA. In general, it's better to have labs and imaging tests at a dedicated facility than a doctor's office as the quality assurance guidelines for tests performed in doctor's offices are less stringent.

TU is the obsolete thryoid uptake test, sometimes called a T3 uptake. T7 is just a calculation that we used twenty years ago before tests for measure FT4 were available. The last two tests are thyroid antibody tests. These are always present in Hashimoto's thryoiditis and in 70% of patients with Graves' disease. I'd ask for the TSI result as well since many doctors have trouble interpreting the results.

Best, elaine

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TO USERS: Q&A posts are visible to all readers. Users can delete their own threads at any time. Users must provide information which is true and correct to the best of their knowledge as well as provide sources or references to any health / medical information if not taken from personal experience. All users including the moderator must behave at all times with respect and honesty. Advertising and self-promotion is not allowed. The moderator or site administrator has the right to ban users with or without warning for not following the basic rules of this site. All posts by default are not to be considered that of medical professionals unless otherwise indicated. As sole moderator, Moore has no conflicts of interest in the sponsorship of this forum.

 

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