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HomeAnswersEndocrinologythyroid glandMy thyroid has enlarged recently. Why could this be?

What could be the reason for an enlarged thyroid despite normal test results?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Shaikh Sadaf

Medically reviewed by

iCliniq medical review team

Published At May 27, 2024
Reviewed AtJune 5, 2024

Patient's Query

Hi doctor,

I am a 51-year-old post-menopausal female with various symptoms of hypothyroidism, which include fatigue, weight gain, constipation, dry skin, hoarse voice, puffy face or eyes, brittle hair and nails, hair loss, and more. I was also recently diagnosed with anemia and severe sleep apnea. I take medication for high blood pressure and high cholesterol, both diagnosed within the past year or so. I also have a history of bilateral breast cancer (14 years ago) with treatment that included surgery, chemotherapy, and radiation across my entire chest (both sides and center). Most recently, my thyroid enlarged, so my PCP (primary care physician) ordered the usual thyroid tests, and I received the results today.

TSH = 2.98 (between 2 and 3.8 over the last several years); FT4 - 0.59; FT3 - 3.70; TPOAb - 2; TgAb = < 1. My PCP tells me my results are in range, but I know differing opinions exist. I have a history of thyroid disease in my family; my mother had hyperthyroidism. Given my medical history and all the problems I am beginning to experience, I truly believe there is something wrong with my thyroid, but no one will take the time to take a second look at the test results. Please help.

Thank you.

Answered by Dr. Shaikh Sadaf

Hi,

Thank you for stopping by!

I am here to provide an expert opinion on your medical issues.

From what you have attached (attachments removed to protect patient identity) and the symptoms that you have described, I would recommend doing an ultrasound of your thyroid gland and neck to know what is causing the neck swelling. The thyroid test results are certainly within the normal range, but the symptoms that you have described suggest neck swelling, particularly the hoarseness of voice. It could be a thyroid nodule or a lymph node. We can not confirm without examination or a scan. However, the other symptoms are menopause-related, unfortunately. Hope you get a scan done soon to find out the cause of the neck swelling.

I hope this information helps provide some insight into your symptoms.

Please do not hesitate to reach out if you have any further questions or concerns.

Thank you.

Patient's Query

Hi doctor,

Thank you for the quick response.

I am scheduled to have an ultrasound performed this weekend. I have read that TSH above 2.5 is high, and FT4 below 0.8 is low. Do you agree? Also, what would cause my T3 to be on the high-end while my FT4 is on the lower end? My medical team was unable to determine the root cause of my iron deficiency anemia, and I have heard that it can also be associated with a slow thyroid, along with my sleep apnea.

Thank you.

Answered by Dr. Shaikh Sadaf

Hi,

Glad to have you back!

I am here to help you get the best medical advice.

So, the first thing in people who have never been treated with thyroxine is that the TSH (thyroid-stimulating hormone) has to be above 10 to be diagnosed as hypothyroidism.T4 (thyroxine) is variable throughout the day and is not a reliable marker to diagnose thyroid-related illness. T3 (triiodothyronine) means that you have good thyroid hormone production, and that is expected to be in this range. So, iron deficiency anemia is multifactorial. You can have a hematology doctor (blood doctor) look at your blood levels to be able to suggest a reason for it, although this age of pre and post-menopausal women is usually similar to what you have. Sleep apnea is another separate entity that is looked after by a sleep specialist, who does a sleep study to determine what has caused it. At the moment, we are not sure of the swelling in the neck.

I hope this information helps provide some insight into your symptoms.

Please do not hesitate to reach out if you have any further questions or concerns.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Shaikh Sadaf
Dr. Shaikh Sadaf

Endocrinology

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