Thyroid Enlargement Concerns: Seeking Insight on Testing Refusals
I am a 28-year-old female, standing at 160 cm and weighing 65 kg. I have been dealing with a thyroid goiter, diagnosed back in 2019, and have no habits of smoking or drinking. Currently, I am taking Gynefam, a prenatal vitamin that includes iodine, on a daily basis for the past three months as my partner and I are trying to conceive (TTC). I am not currently pregnant. Recently, I've noticed that my thyroid goiter has nearly doubled in size, yet my TSH and T4 levels remain normal. New ultrasound findings report: - Purpose: Monitoring a nodular goiter. - Findings: Compared to the previous evaluation conducted in 2021, there is a notable increase in thyroid size: - The right thyroid lobe measures approximately 29.6 ml with a linear probe and 34.5 ml with a convex probe, up from 17 ml. - The left lobe is assessed at 21.2 ml with a linear probe and 24.8 ml with a convex probe, increased from 13 ml. - The isthmus thickness is recorded at 8 mm. - The condition of the glandular musculoparenchymal structure is largely intact, though it shows some heterogeneous characteristics without any significant low-echo areas or abnormal blood flow on color Doppler imaging. - The previously identified solitary nodule in the lower third of the left lobe, categorized as Eu-TIRADS III, retains its size at 8.5 x 9 x 7.7 mm or 0.3 ml in volume. - No enlargement of nearby lymph nodes or abnormalities in the jugulocarotid regions were observed. In summary, there has been a marked increase in thyroid volume, but the known single nodule remains stable. An endocrinologist's consultation is advised. From my blood tests, the doctor only ordered TSH and T4 levels. The results are as follows: - TSH: 0.702 mU/L (with the normal range being 0.270 - 4.200) - T4: 12.9 ng/L (normal range 9.2 - 16.8) Both levels fall within the normal parameters. I inquired about conducting a urine test for iodine deficiency, but the doctor declined, stating it was unnecessary since my TSH is normal. Furthermore, I requested testing for antibodies and T3; however, these tests were also deemed unnecessary according to the doctor, as my TSH and T4 levels are normal. The physician has recommended a biopsy, yet my nodule has remained stable in size, measuring 0.8 mm for six years since its initial identification in 2019. Is this situation common?
Answers (1)
3/22/2025, 9:40:46 AM
OpenHealth AI
Your concerns about the noticeable increase in your thyroid goiter and the implications for your health are completely understandable. While your TSH and T4 levels are normal, the increase in thyroid size requires careful consideration. Let's break down the situation and provide you with actionable steps.
Summary of Concerns
- You have a significantly enlarged goiter, which has doubled in size since your last evaluation, though the nodule remains stable.
- Your TSH and T4 levels are within normal ranges, but the increase in size can still be concerning.
- You feel that additional tests (iodine levels, antibodies, T3) would provide more clarity, but your healthcare provider has declined them, suggesting they are unnecessary based on current results.
Explanation
The thyroid can enlarge due to various reasons, such as iodine deficiency, inflammatory conditions, or other thyroid disorders. An enlarged goiter does not automatically mean there is cancer or other serious issues, especially since your nodule has remained stable. However, monitoring changes is crucial. Normal TSH and T4 levels indicate that your thyroid is functioning well, but the increase in size suggests that ongoing observation is necessary.
Next Steps
-
Consult the Endocrinologist:
- Since the recommendation for an endocrinologist consultation is in place, prioritize scheduling this appointment. They can offer expert advice and recommend specific tests based on your ultrasound findings.
-
Document Your Observations:
- Keep a log of any symptoms you may experience, such as difficulty swallowing, changes in voice, or other unusual symptoms related to your thyroid. This information will be valuable for your endocrinologist.
-
Seek Clarity on Testing:
- During your visit to the endocrinologist, don’t hesitate to ask about the tests you are interested in (iodine levels, thyroid antibodies, T3), and explain your concerns for clarification. It’s okay to express that you seek a comprehensive understanding of your thyroid health.
-
Regular Monitoring:
- Plan to monitor the size of the goiter regularly with ultrasounds as directed by your healthcare provider. Keeping track of any changes will help in timely intervention if necessary.
-
Nutritional Considerations:
- Continue taking your prenatal vitamin that includes iodine, especially since you are trying to conceive. Adequate iodine intake is important for thyroid health.
-
Stay Informed and Communicate:
- Stay updated about thyroid health and potential symptoms indicating a change. Maintain open communication with your healthcare provider about any new concerns or changes you notice.
It’s perfectly reasonable to seek further evaluation and remain proactive about your thyroid health. Trust that you are taking the right steps, and don’t hesitate to seek a second opinion if you feel your concerns are not being adequately addressed.
Related Questions
Assessing My Health Concerns: How Anxious Should I Be?
I’m a 32-year-old woman, weighing 124 pounds and standing at 5 feet 6 inches tall. For over a year, I have been experiencing bright red rectal bleeding. Initially, I attributed this issue to hemorrhoids that developed during my pregnancy two years ago. The bleeding occurs with most of my bowel movements, sometimes happens without one, and on a few occasions, has been enough to stain the toilet bowl significantly. The color of the blood is typically darker than what I observe during a hemorrhoid flare-up. There is a notable family history of bowel cancer on both sides; one family member was diagnosed at age 45, and another at 60. In the past six months, I have encountered several episodes of severe abdominal pain—3 to 4 instances—intense enough to consider a trip to the emergency room. However, the pain usually subsides within about an hour. It’s unusual for me to experience such acute pain, given my high tolerance for discomfort; for example, I once played rugby shortly after dislocating and fracturing my finger. Recently, I mustered the courage to consult with my doctor, who recommended a FIT test, which returned a positive result (30.1). Additionally, I underwent a complete blood test, and aside from having low ferritin levels (7 µg/L), all other results were normal. I have since been referred for a colonoscopy on a two-week waiting list to rule out any possible bowel cancer. Given these circumstances, how concerned should I be? Thank you for your input.
Understanding Possible Seizure Triggers and Recurrence Risks
Health Background: I am a 21-year-old female, standing at 169 cm and weighing 65 kg. Over the past three years, I have been using oral contraceptives. As of this morning, I started taking 25 mcg of levothyroxine along with a weekly vitamin D supplement of 0.266 mg. Recently, I was diagnosed with hypothyroidism and found to have a vitamin D deficiency that I suspect has existed for the last three years. I do not consume alcohol or smoke, and I can confirm I am not pregnant. Two years ago, I experienced a mild concussion. I currently reside in Spain. A couple of months back, in mid-December, I blacked out twice. The second occurrence took place while I was at the doctor’s office after seeking urgent medical care for the initial incident. Following the second episode, I underwent a CT scan and an EKG, both of which returned normal results. Further tests, as directed by my physician, revealed a critical vitamin D deficiency and hypothyroidism; however, he expressed doubt that either of these conditions led to my loss of consciousness. I was then referred to a neurologist, and I am presently awaiting an appointment. Although the waiting period is lengthy, my doctor indicated that I should receive priority for scheduling, although the exact timeframe remains uncertain. The referral document summarized my events, labeling the second episode (which the physician witnessed) as a potential seizure devoid of tonic-clonic movements—a revelation that took me by surprise. After regaining consciousness, I felt extremely disoriented and terrified, struggling to process what was happening. I have no prior history of seizures, epilepsy, or any related conditions, and there is no known family history of these issues. If this indeed was a seizure, what might have triggered it? Additionally, what is the likelihood of experiencing another one? Since that time, I have not had any further incidents, but I have experienced moments where I felt a sense of impending doom, which I managed to overcome. I intend to wait for the neurologist's evaluation, but the uncertainty surrounding a possible neurological condition is quite distressing. Thank you for any insight you can provide!
Persistent Pain in Right Shoulder and Arm After Lifting
Hello, everyone! I’m a 23-year-old male and have been engaged in weightlifting for several years now. Recently, I’ve been struggling with ongoing discomfort in my right shoulder and arm, which I haven’t been able to accurately identify. The pain manifests during particular movements, especially with lateral raises or when my arm is raised to shoulder level while rotating my wrist. Certain pressing and pulling activities can also provoke this discomfort. Rather than feeling sharp, it’s a deep, nagging sensation that sometimes seems localized in the front area of the shoulder or at the biceps tendon, and at other times it feels more like it’s situated between the shoulder and upper arm. Fortunately, there’s no numbness or tingling involved. This issue began while I was working out. I decided to take a break for around two months, but when I returned, the pain persisted. After consulting a physician, I was diagnosed with bicipital tendinitis. Since then, I’ve reduced my upper-body workouts, completely steering clear of shoulder exercises and heavy lifting, and have begun a gentle rehabilitation regimen focusing on external rotations, pendulum movements, and scapular exercises. Despite adhering to this routine for about a week, I haven’t experienced any noticeable improvement. Is it typical for this type of tendon injury to require an extended period for recovery? At what point should I consider diagnostic imaging, such as an ultrasound or MRI? Additionally, are there frequent rehabilitation errors that might impede the healing process? I appreciate your insights in advance!
Understanding EEG Results for My 22-Month-Old Son: Insights Needed
Could someone help clarify this for me? My son, who is just 22 months old, hasn’t started walking yet, becomes tired easily, and has been experiencing behavioral outbursts. He had a febrile seizure in February 2025, followed by another unexplained seizure in April 2025, which led us to consult a neurologist. Since he was 3 months old, he has been receiving therapy from a physical therapist for torticollis. At birth, he spent five days in the NICU due to issues with meconium aspiration. A recent MRI showed normal results, and he also had a follow-up EEG after one conducted in July 2025. The results from this recent EEG were abnormal for a pediatric patient in awake, drowsy, and sleeping states. Notably, there were brief episodes of left frontotemporal delta slowing, which occurred mainly when he was awake and drowsy. There were no signs of epileptiform activity detected. In contrast, the EEG performed back on July 3, 2025, was deemed normal for both awake and drowsy states, again with no evidence of epileptiform irregularities, although it did not capture any sleep data. This examination was prompted by the child's existing history of febrile seizures. Importantly, he is not currently on any anti-seizure medications. The EEG procedure used standard electrode placements per the 10-20 system, conducted a single-lead EKG, and included continuous video monitoring. During the analysis, the background activity was symmetric, indicating some anterior-posterior (AP) organization, with a dominant rhythm of 50-80 microvolts at 7 Hz. His drowsy state was marked by a reduced amount of eye blink activity, less breathing motion interference, and a generalized slowing in theta/delta frequencies. Stage II sleep exhibited spindles and vertex waves patterns. Additionally, there were intermittent bursts of 250-300 microvolts in the left frontotemporal region with semi-rhythmic activity of 2-4 Hz, mostly observed during wakefulness and drowsiness. No definitive epileptiform discharge was noted. Photic stimulation during the test did not elicit a strong response, and hyperventilation was not conducted during this session.
Understanding Atrial Fibrillation and Thyroid Issues: Variability in Cardioversion Decisions
Hello everyone, I’m reaching out for guidance regarding my mother’s current health situation, and I’d greatly appreciate any shared experiences or thoughts. **My mother's background:** - **Age**: 55 years - **Weight**: Recently dropped to 116 kg from 118 kg in just two days, likely due to diuretics. - **Health history**: Previously an underactive thyroid, undiagnosed and untreated, now presenting as overactive. - **Medications**: Currently taking thyroid medication and a beta-blocker (Rapiblock). **Current health status:** My mother has been hospitalized since Tuesday, experiencing **atrial fibrillation with heart rates exceeding 200** beats per minute due to her thyroid's hyperactivity. - The plan for cardioversion was initially settled on Tuesday. However, the following day, the medical team advised postponing it until her thyroid levels could be stabilized, believing that her heart rate would return to normal once her thyroid condition was managed. - Her **obesity** precludes her from undergoing a transthoracic echocardiogram, and due to her thyroid concerns, she cannot handle contrast dye (this has been a consistent issue for over four years). Therefore, the only feasible option was a **transesophageal echocardiogram (TEE)**, which has yet to be performed. - She has been prescribed various medications including beta-blockers and thyroid treatments in the past. - On Friday, a doctor proposed proceeding with cardioversion; however, the attending senior physician objected. - Today (Saturday), another clinician has expressed a desire to move forward with cardioversion, having initiated a new medication, as the senior physician is unavailable. - **Communication has been unclear**, as we were notified of developments by a nurse rather than the physician in charge, causing confusion and anxiety. - Currently, only a **chest X-ray** is scheduled, and the TEE remains unaddressed. **My inquiries are as follows:** 1. Is it common for medical professionals to have varying opinions and frequently revise medication or treatment plans like cardioversion? 2. Is it safe to conduct cardioversion in the absence of a TEE? I presumed that this was a standard procedure to exclude the presence of blood clots. 3. Is it usual practice to have only a chest X-ray prior to moving ahead with cardioversion? 4. How typical is it for patients or their families to not be directly informed about treatment changes and learn about them through nursing staff instead? I recognize that this cannot substitute for professional medical advice. I’m simply trying to discern whether these circumstances are typical or if we should express our concerns more assertively with the healthcare facility. Thank you for your insights!