Concerns Over Increasing Thyroid Size and Limited Testing
A 28-year-old woman, standing at 160 cm and weighing 65 kg, is a non-smoker and does not consume alcohol. She is currently expecting a child in 2023 and is on no medications with no known allergies. She was diagnosed with a thyroid goiter in 2019. Recent ultrasound examinations revealed significant changes: The objective of the ultrasound was to follow up on a nodular goiter. Upon review compared to a 2021 assessment, there has been a remarkable increase in the volume of the thyroid: - The right lobe's size has risen to 29.6 ml when measured with a linear probe and 34.5 ml via a convex probe, up from a previous measurement of 17 ml. - The left lobe now measures 21.2 ml and 24.8 ml respectively, increasing from 13 ml earlier. - The isthmus' thickness measures 8 mm. Overall, the gland appears to maintain its structural gradient despite a heterogeneous look without any hypoechoic areas or significant blood flow noted during color Doppler imaging. The single nodule in the lower third of the left lobe, classified as Eu-Tirads III, remains unchanged, measuring 8.5 x 9 x 7.7 mm or a volume of 0.3 ml. No enlargement of nearby lymph nodes is observed, and the jugulocarotid axes show no abnormalities. In conclusion, there is a substantial increase in thyroid volume, but the known nodule in the left lobe remains stable. A consultation with an endocrinologist is advised. In terms of her blood work, the physician ordered only tests for TSH and T4: - TSH: 0.702 mUi/L (normal range: 0.270 - 4.200) - T4: 12.9 ng/L (normal range: 9.2 - 16.8) Both results fall within the normal limits. When she inquired about testing for iodine deficiency through a urine test, she was told it was unnecessary as her TSH levels appeared normal. She also requested tests for antibody levels and T3, but was informed that these were not required given that her TSH and T4 levels were standard. Ultimately, a biopsy was recommended, though the nodule has not changed in size over the past six years, consistently measuring at 0.8 mm. Is this situation typical?
Answers (1)
3/22/2025, 9:30:41 AM
OpenHealth AI
Your concerns about the significant increase in thyroid size and the limited testing are valid, especially considering your history of a thyroid goiter and your current pregnancy. Let's break down what's happening and outline actionable steps.
Summary of Key Points
- Recent ultrasounds show a significant increase in thyroid volume, but the existing nodule is stable.
- Blood tests (TSH and T4) are normal, indicating thyroid function is currently adequate.
- There is a recommendation for a biopsy, but the nodule hasn't changed in size over several years.
- Limited additional testing has been offered.
Explanation
The thyroid gland's increase in size can occur for several reasons, including nodular growth, inflammation, or iodine deficiency. In your case, while the structural changes are marked, the stability of the nodule and normal TSH and T4 levels suggest that there isn't an immediate cause for alarm regarding thyroid dysfunction. The decision not to pursue additional tests like T3 or antibodies stems from those normal values, but it's crucial to feel comfortable and informed about ongoing monitoring.
Next Steps
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Follow Up with an Endocrinologist: Since a consultation has already been advised, make sure to see the endocrinologist. They will provide a thorough evaluation and tailor recommendations based on your unique situation, especially considering your pregnancy.
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Monitor Symptoms: Watch for symptoms such as changes in weight, mood, energy levels, or any new neck swelling. Record these for your consultation, as they can provide valuable context.
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Discuss Further Testing: During your appointment, express your concerns about iodine deficiency and the desire for comprehensive testing. Even if not typically indicated, advocating for your health is essential. Ask about the possibility and implications of checking for antibodies, especially if there are any unexplained symptoms.
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Healthy Diet: Maintain a well-balanced diet rich in iodine (found in seafood, dairy, and iodized salt), and ensure adequate nutrition during your pregnancy, focusing on both your health and the baby's development.
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Regular Monitoring: Continue with regular imaging and follow-ups as advised by your healthcare team, especially to keep an eye on any changes in the nodule or overall thyroid function.
Feel free to reach out if you have more questions or need clarification on any of these points. Your proactive approach to your health is important, and it's great that you're looking to understand your situation better!
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