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I would like to ask for your competent opinion, because I am on the front of the surgery in order to remove my thyroid, but I am not sure in its necessity.
I am a woman: 47 years old, height 164 cm., weight 57 kg.
Endocrinologist diagnoses that I have: a nodular toxic goiter II, subclinical hyperthyroidism. TSH 0,005; Leukocytes: 3,21 - was prescribed "methyluracil" 1500mg a day to support level of leukocytes, I had taken them for 2 weeks. Leukocytes rose till 4,05. Then I started to take "propicil" 100mg a day, but after a week the level of leukocytes dropped from 4,05 to 3,33 (blood has been checked every week). Erythrocyte sedimentation rate (ESR) from 8 to 25 in a week. As a following the doctor canceled "propicil" because of very low TSH level and recommended to eliminate my thyroid, because there is a danger of leukopenia and agranulocytosis.
My question is: is there a real need to remove a thyroid or there are other ways to solve a problem of low TSH?
The medical history is the following:
Complaints appeared 3 months ago in September 2014. Dry eyes at mornings (can be result of lenses), pressing pain in the left side of the chest, high emotionalism, fatigability, rapid heartbeat. (ultrasonography showed: mitral valve prolapse 1 stage, with near valve regulation, dysfunction of 1st kind). Weight loss 3 kg in 2 months.
2010.10.21 Ultrasonography: formation size of 1,5х1,0х1,6 cm, in the projection of the lower third of ovoid form with equal precise contours, hypoechoic rim, structure without acoustic effects with moderately inhomogeneous structure, with other type of ultrasonography internal vascularization is not registered, only bypass blood flow was registered. Fine-needle biopsy of thyroid showed: "Analysis corresponds mainly to nontoxic colloid goiter"
2010.10.21 TSH – 2,81 (norm 0,4-4,0), Т3 free. - 5,8 (2,6-5,7), Т4 free - 12,1 (9,0-22,0), anti-thyroid peroxidase (anti-TPO) - 545
2012.04.14 TSH – 1,44
2013.09.23 TSH – 3,54, Leukocytes 4,16
2014.03.26, Т3 free – 5,3, Т4 free - 17,6
2014.10.31, Т3 free – 5,7, Т4 free - 16,5
2014.11.12. TSH - 0,005; Т3 free - 2,87; Т4 free - 14,69; anti-TPO - 992,0; antibodies to receptor of TSH - 20,04; Hemoglobin – 107; ESR (Westergren method) – 25; Leukocytes (WBC) - 3,33; Alanine transaminase (ALT) - 10,7; Aspartate transaminase (AST) - 12,7; Blood glucose – 6; Iron– 9,73 mmol/l
Scintigraphy showed: Thyroid located normally and has a shape of asymmetric butterfly. Dimensions of the left share - 1,2х4,0 cm; right one- 1,5х3,5 cm. Accumulation of the medication is relatively uniform. In projection to the palpated node (left part of the left share) accumulation of the medication decreased. Conclusion: "cold node" in lower pole of the left share of the thyroid. Ultrasonography: Contour is clear, relatively flat: right share 4,5х1,7х1,9 cm, left share 4,8х2,0х1,9 cm, isthmus 0,3 cm. Thyroid tissue has decreased echogenicity, expressed diffusely heterogeneous structure, because of existence of hypogenous and echogenic areas and the set point and linear hyperechoic structuresю With this background there is visible oval formation with equal clear contours inhomogeneous echostructure of the following dimension: 1,6х1,1х1,5 sm with bloodstream around the node.
In the Doppler mode of ultrasonography was shown: uniform significant increase in vascularization of thyroid tissue. Fine-needle biopsy: nodular toxic goiter II grade - material is taken from the area of the nodal colloid goiter with cystic hemorrhagic changes. Also in the analysis sample was highlighted a slight increase in the number of lymphoid elements (mature forms predominate over immature), histiocytic elements. There is might be a risk of Hashimoto's thyroiditis.
Here is all what I got.
Dear experts could you please confirm that there is a need for surgery or there is a possibility of therapy?
Thank you very much for your attention
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