Thyroid Enlargement: Symptoms, Diagnosis, and Treatment Options

Goiter

Hello Dr.
Lin, I recently visited an endocrinologist after my physical therapist mentioned that my thyroid might be enlarged.
The doctor performed a physical examination and noted a thyroid enlargement of grade I-II.
My blood test results were Free T4 (1.32), TSH (1.31), and Anti-TPO (5.37), all of which were within the normal range.
The doctor diagnosed me with "simple goiter" and prescribed Eltroxin for one month.
I would like to ask: 1.
Since I tend to be anxious, sweat a lot, have a fast heartbeat, and experience diarrhea, could these symptoms be more indicative of hyperthyroidism? If I take Eltroxin, will it exacerbate these symptoms? 2.
My mother also sought medical attention for thyroid enlargement, and her blood tests were normal, but her doctor did not prescribe any medication for her.
3.
If my thyroid function is normal, why is medication necessary? The doctor did not provide a clear answer during my visit, and I am still feeling anxious.
I would appreciate your clarification.
Thank you.

P, 20~29 year old female. Ask Date: 2019/09/08

Dr. Lin Jianliang reply Internal Medicine

1.
The symptoms mentioned above are similar to those of hyperthyroidism.
The dosage of Eltroxin can also affect the severity of symptoms; some doses may exacerbate symptoms while others may not.

2.
There are several different types of thyroid enlargement, so it is advisable to consult your attending physician for further information.

3.
Similarly, thyroid enlargement comes in various types, so it is recommended to ask your attending physician for clarification.

Reply Date: 2019/09/08

More Info

Thyroid enlargement, or goiter, can be a source of concern for many patients, especially when accompanied by symptoms such as anxiety, sweating, rapid heartbeat, and diarrhea. Understanding the underlying causes, diagnosis, and treatment options is crucial for managing this condition effectively.

1. Symptoms and Diagnosis: The symptoms you describe—anxiety, sweating, rapid heartbeat, and diarrhea—can indeed be associated with hyperthyroidism (overactive thyroid). However, your blood tests indicate that your Free T4 (1.32) and TSH (1.31) levels are within the normal range, which suggests that your thyroid function is currently normal. The presence of anti-TPO antibodies (5.37) can indicate autoimmune thyroid disease, but it is not definitive for hyperthyroidism. The physician's diagnosis of "simple goiter" means that while your thyroid is enlarged, it is not necessarily functioning abnormally.

2. Concerns About Eltroxin: Eltroxin (levothyroxine) is a synthetic form of the thyroid hormone thyroxine (T4). It is typically prescribed to patients with hypothyroidism (underactive thyroid) to normalize hormone levels. In your case, since your thyroid function tests are normal, the use of Eltroxin may not be necessary unless there is a specific indication for its use, such as a mild hypothyroid condition that has not yet been detected. If you are concerned about worsening symptoms like anxiety and rapid heartbeat, it is essential to discuss these concerns with your physician. In some cases, taking levothyroxine when not needed can lead to symptoms of hyperthyroidism, including increased heart rate and anxiety.

3. Why Medication Might Be Prescribed: The decision to prescribe medication can vary based on individual circumstances. In some cases, a physician may choose to monitor a patient with a goiter without immediate treatment if thyroid function is normal. In other cases, they may prescribe medication to prevent potential future complications or to manage symptoms associated with the goiter itself. The rationale for prescribing Eltroxin in your case may be to ensure that your thyroid hormone levels remain stable, especially if there is a concern about the goiter affecting thyroid function in the future.

4. Family History and Thyroid Health: Your mother's experience with thyroid enlargement and normal lab results is not uncommon. Family history can play a significant role in thyroid health, and it is essential to monitor thyroid function regularly, especially if there is a history of thyroid disease in the family. Each case is unique, and treatment decisions should be tailored to the individual based on their symptoms, lab results, and overall health.

5. Next Steps: It is crucial to maintain open communication with your healthcare provider. If you have concerns about the medication or your symptoms, do not hesitate to express these to your doctor. They may consider adjusting your treatment plan, conducting further tests, or referring you to an endocrinologist for specialized care. Regular follow-up appointments and monitoring of thyroid function tests will help ensure that any changes in your condition are addressed promptly.

In conclusion, while thyroid enlargement can be concerning, understanding the underlying causes and treatment options can help alleviate anxiety. It is essential to work closely with your healthcare provider to determine the best course of action for your specific situation. Regular monitoring and open communication will be key to managing your thyroid health effectively.

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