Although the standards discussed herein reflect the University of Iowa's head and neck protocols, reliance on any information provided herein is solely at your own risk. All I can say on that is read about iodine and understand its function before you take foods that will send your levels up. WebThis term means "lots of echoes." Most findings are benign and typically are cysts. American College of Radiology. Reference article, Radiopaedia.org (Accessed on 02 Mar 2023) https://doi.org/10.53347/rID-8923. https://patient.info/forums/discuss/is-heterogeneous-thyroid-normal--483899. J Endocrinol Invest. Hashimoto thyroiditis, also known as lymphocytic thyroiditisor chronic autoimmune thyroiditis,is a subtype of autoimmune thyroiditis. For these, please consult a doctor (virtually or in person). Radiology 1987;27:255-261, Jager L, Menauer F, Holzknecht N, Scholz V, Grevers G, Reiser M. Sialolithiasis: MR sialography of hte submanidbular duct - an alternative to conventional sialography and US? Accessed 10/16, 2016. Should the prevalence of incidental thyroid cancer determine the extent of surgery in multinodular goiter? it has some ideas that might be helpful to you. You can learn more about how we ensure our content is accurate and current by reading our. Hetergeneous means uniform throughout and is a normal appearance. as being in breach of those terms. Pain in the front of the neck, sometimes going up to the ears. AJNR Am J Neuroradiol. The thyroid measures 6.4cms (craniocaudad), by 3.2cms (A-P) by 2.4cms (transverse). Among patients with Hashimoto thyroiditis and thyroid cancer, the sonographic appearance of the cancerous nodule is similar, except that cancerous nodule margins are more likely to be irregular or poorly defined when the gland is heterogeneous. What does a small heterogeneous hypervascular thyroid mean with 12mm nodule on right? A discrete isoechoic nodule with peripheral vascular flow (grade 2) was detected in the left lobe by the use of CDI (. A constant cough that is not due to a cold. Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. 7. One option is radioactive iodine, which is usually used to shrink goiters in cases of hyperthyroidism. TimesMojo is a social question-and-answer website where you can get all the answers to your questions. Patient is a UK registered trade mark. Clinical presentation of hyperparathyroidism. It takes about 6 to 8 weeks for the thyroid med, (Levo) to make a new level. ACRAIUMSPRSRU practice parameter for teh performance of a thyroid and parathyroid ultrasound examination. 2022 - 2023 Times Mojo - All Rights Reserved In both of these cases your immune system attacks your thyroid and tries to kill it, beca An enlarged thyroid gland is exactly what it says. Heterogeneous thyroid is really just a fancy way of saying that things are not uniform in the thyroid. Most of us have hear the term homogenous, which means the same or alike in context. Heterogeneous thyroid means just the opposite not alike or inconsistent with the surrounding parts or tissue. 1995;18(11):857-61. You can ask for a referal to an Endo if you wish. The vascularity of the nodule The presence of vascularity by Doppler ultrasound (7) is also suspicious for thyroid cancer. The cells also lose the ability to die, as normal cells would. 2010;195(1):216-22. What is the main cause of thyroid cancer? Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. Medscape Web site. Heterogeneous appearance thyroid gland with complex solid & cystic nodule posterior margin upper pole right lobe 1.5x1.4x1.0cm, what does this mean? Cystic (fluid-filled). 2013;17(2):219. From: Surgery of the Thyroid and Parathyroid Glands (Third Edition), 2021 Colloid Adenoma Neoplasm Papillary Thyroid Cancer Follicle Lesion The term "hypoechoic" refers to the way the nodule appears on an ultrasound: dark. In those places the people have to get iodine externally otherwise their thyroids are adversly affected. Is T3/T4 same as LEVOTHYROXINE? Radiographics. Hashimotos thyroiditis is associated with a higher risk of thyroid nodules, which can lead to goiter formation. an enlarged thyroid gland, known as a goiter. Sometimes your doctor might suggest watching and waiting to see if the goiter gets bigger. By using our website, you consent to our use of cookies. For the U.S. population, the lifetime risk of developing thyroid cancer is 1.1 percent. My wife had a thyroid ultrasound and showed heterogenous echogenicity, hypervascular thyroid gland.no masses or nodules. Should I request a endocrinologist? Treatment for multinodular goiter varies depending on: Most multinodular goiters dont cause any symptoms and are discovered during a routine physical exam. They found an uneven surface of your thyroid, a speckled texture, if you wish. Yeh H, Futterweit W, Gilbert P. Micronodulation: Ultrasonographic Sign of Hashimoto Thyroiditis. 2014 (ct5;8(10):RCO1-13, Bag AK, Cure JK, Chapman PR,Pettibon KD, and Gaddamanugu S: Practical Imaging of the parotid Gland in Current Problems in Diagnostic Radiology Vol 44, Issue2, March-april 2015, Pages 167-192, Jain P and Jain R: types of Sublingual Gland Herniation Observed Druing Sonogrphy of Plunging Ranulas J Ultrasound Med 2014;33:1491-1497, Castelli WA, Huelke DF, Celis A. Always speak to your doctor before acting and in cases of emergency seek It is one of the most common thyroid disorders. Scintigraphic features of autoimmune thyroiditis. I do remember though that there are areas of the world where you get no iodine in your water nor in the vegetables grown in the local soil, Derbyshire is one of those region. Sonographic features of Hashimoto thyroiditis in childhood. Color Doppler sonography shows decrease or absent blood flow within abnormal map-like hypoechoic areas. High frequency probes(10-15 MHz) are best for US imgagin of superficial structures (2-4 cm), Mid frequency probes(5-10 MHz) preferred for slightly deeper structures (5-6 cm), Low frequency probes(2-5 MHz) preferred for deeper still (i.e. Six percent of the nodules 1 to 1.9 cm were considered suspicious, as were 8 to 9% of nodules in the larger size groups. In the final recovery phase the thyroid gland returns to normal function and the patient is euthyroid. On the other hand, it is not determined whether thyroid parenchyma appearing totally of normal ecogenity on USG is related to presence normal thyroid function tests or otherwise. The right and left lobes of the thyroid gland should be imaged in the longitudinal and transverse planes. Abnormal lymph nodes (use of size criteria questionable - Van Den Brekel (1998) - level I nodes: minimal axial diameter or short axis 4-6 mm; level II nodes 6-8 mm; level III-V nodes 4-7 mm; As per Chan (2007) "best approach is not defining absolute size criteria", Lymph node classification per Lo et al (2016) "The Effect of Radiotherapy on Ultrasound-Guided Fine Needle Aspiration Biopsy and the Ultrasound Characteristics of Neck Lymph Nodes in Oral Cancer Pts After Treatment, Classifications Features found to correlate with recurrent nodal disease following XRT (bold), Ihnatsenka B and Boezaart AP: Ultrasound: Basic Understanding and learning the language Int J Shoulder Surg. Right transverse view. The doctor then looks at the tissue sample under a microscope for cancer, infection, or other thyroid problems. High-resolution ultrasonography (US) is commonly used to evaluate the thyroid gland, but US is frequently misperceived as unhelpful for identifying features that distinguish benign from malignant nodules. You may have a goiter that can happen if the thyroid is not working well and it can press on the throat. Multinodular goiters do increase your chance of developing thyroid cancer, but they can be treated with medication, radioactive iodine, or surgery depending on the type, if necessary. However, a very small proportion of cases (~5%) can present with hyperthyroidism (also known as Hashitoxicosis). The sonographic features of any thyroid abnormality with respect to echogenicity, composition (degree of cystic change), margins (smooth or irregular), presence and type of calcification (if present), and other relevant sonographic patterns. Kaliszewski K, et al. Nodules can develop on this gland due to So, your thyroid is not enlarged, it is about average - that's good! Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. A hypoechoic nodule is an area of swelling or abnormal cell growth on the thyroid. 15. H. Hashimoto: Zur Kenntnis der lymphomatsen Vernderung der Schilddrse (Struma lymphomatosa). Noncancerous goiters that arent causing any symptoms dont always need treatment. I don't see any antibody tests. Clin Radiol. 1996;15(12):813-9. Carver College of Medicine Thyromegaly is a disorder in which the thyroid gland the butterfly-shaped gland in the neck becomes abnormally enlarged. My name is Shelly and I am a nurse in the USA. PROMINENT HETEROGENEOUS THYROID GLAND WITHOUT FOCAL NODULE. Please take your Levo without food so it will not be blocked by food. (. Chen Y, Chen Y, Cheng R, Yeh C, Lee C, Hsu C. The Significance of FDG Uptake in Bilateral Thyroid Glands. For example, a dermoid cyst has heterogeneous attenuation on CT. Tell your primary you want a full thyroid panel done so that you can see where you stand. Radiographic abnormality detected on other imaging studies (e.g. Sorry! The thyroid is enlarged and measures 7.1 2.6 3.2 cm (sagittal AP transverse) in an 80 kg female. Patients usually present with hypothyroidism +/-goiter. Langer J, Khan A, Nisenbaum H et al. Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes. Heterogeneous thyroid echotexture Hypervascular; may demonstrate a "thyroid inferno" pattern on (, Micronodular and fibrous change of HT in an enlarged thyroid. I have terrible symptoms and after all the non/misdiagnoses am ready to get some relief! A heterogeneous mixture is a mixture of two or more compounds. But there was no nodule seen - that is good, although even if there was a nodule it isn't necessarily a bad thing it could be benign. Thyroid-binding globulin abnormality. The contents of this web site are for information purposes only, and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. It is Com. According to the Society of Radiologists in Ultrasound, biopsy should be performed on a nodule 1 cm in diameter or larger with microcalcifications, 1.5 cm in diameter or larger that is solid or has coarse calcifications, and 2 cm in diameter or larger that has mixed solid and cystic components, and a nodule that has . Typically affects middle-aged females (30-50 year age group with an F:M ratio of 10-15:1). Any system with two phases like ice and water are said to be heterogeneous. Thyroid Blood Flow Evaluation by Color-Flow Doppler Sonography Distinguishes Graves' Disease from Hashimoto's Thyroiditis. In six weeks he wants T4, free and T3, free and TSH 3rd generation. EMMY NOMINATIONS 2022: Outstanding Limited Or Anthology Series, EMMY NOMINATIONS 2022: Outstanding Lead Actress In A Comedy Series, EMMY NOMINATIONS 2022: Outstanding Supporting Actor In A Comedy Series, EMMY NOMINATIONS 2022: Outstanding Lead Actress In A Limited Or Anthology Series Or Movie, EMMY NOMINATIONS 2022: Outstanding Lead Actor In A Limited Or Anthology Series Or Movie. (2016). Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. We want the forums to be a useful resource for our users but it is important to remember that the forums are perhaps there's something in the article that helps. http://www.acr.org/Quality-Safety/Standards-Guidelines/Practice-Guidelin https://radiopaedia.org/articles/graves-disease, http://emedicine.medscape.com/article/383062-overview#a2, https://www.ncbi.nlm.nih.gov/books/NBK285555/, Echogenicity (compared to adjacent muscle), Vascular patter (Doppler- set for high sensitivity with low wall filter detection of vessels with low flow), Ultrasound for medical application = 1,000x greater than audible frequencies (2 to 20MHz). A pseudonodule (, Giraffe pattern of HT and HT pseudonodule type 3. 'now you see it, now you don't' phenomenon -, different tissues have differing degrees of anisotropy. Follow-up of previously detected thyroid abnormalities and after surgical ortherapeutic(e.gradioactiveiodine) interventions. WebMood and excitability. WebDiffuse Thyroid Disorders - University of Pennsylvania Health System as well as low t4 and tsh levels? This is normally ordered by an Endocrinologist. Any TSH over 10 is hypothoiridic and needs at least 125 mcg of T4 for starters. 1995;197(1):213-9. They will probably also order hormone blood tests that check thyroid function to see if your thyroid gland is functioning normally. The most common forms of thyroiditis will be covered in this chapter: Hashimotos thyroiditis, Graves thyroiditis, subacute thyroiditis, and Riedels thyroiditis. This causes hyperthyroidism. If a thyroid nodule is causing voice or swallowing problems, your doctor may recommend treating it with surgery to remove all or part of the thyroid gland. So get the antibodies test done and that will let us know for sure. An enlarged, mildly hypoechoic thyroid with heterogeneous with micronodular change. If the goiter has become very large or is causing any trouble with breathing or swallowing, part or all the thyroid can be removed. Illustrated by: Timothy McCulloch, MD, Copyright The University of Iowa. This is a situation where a thyroidolo is common and poorly understood. Homogeneous: uniform appearance of the thyroid parenchyma. It is not about any lumps just shape. Why Do Cross Country Runners Have Skinny Legs? The thyroid gland is slightly more echo-dense than the adjacent structures because of its high iodine content. Floyd J. Thyrotoxicosis imaging. I have small nodules on my thyroides. Examining the individual nodular areas in transverse and sagittal dimensions, a discrete nodule could not be seen due to either the confluence of nodules or the lack of a complete capsule in adenomatous nodules. Symptoms of a large goiter include: Very large goiters might also be visible in your neck. Clinical findings were consistent with thyroiditis, with biochemical findings suggesting hypothyroidism. Researchers dont yet understand the connection between multinodular goiters and thyroid cancer. This can help your doctor tell if the nodules are fluid-filled or have calcifications, see how many and where they are, and identify potentially cancerous nodules. what does it mean. Patient aims to help the world proactively manage its healthcare, supplying evidence-based information on a wide range of medical and health topics to patients and health professionals. All rights reserved. A slightly enlarged thyroid with micronodular change, prominent hyperechoic fibrous bands (, HT and pseudonodule type 2. The cause is usually unknown. J Clin Ultrasound 2009 Jul-Aug;37(6):329-32. How do you approach the problem of TSH elevation.. On medscape . Submandibular and parotid nodes can aslo be round and normal. Most often, thyroid cancer causes a lump and/or swelling of the neck, but it may also cause difficulty breathing or swallowing, as well as vocal hoarseness. Thyroid mass Clinical Information Condition in which there is a deviation from or interruption of the normal structure or function of the thyroid gland, which is a highly Differences in colour, shape, and size can make a tissue look heterogeneous. What percent of thyroid biopsies are cancerous? Unable to process the form. Background: Heterogeneous echogenicity of the thyroid gland has been associated with diffuse thyroid disease and benign and malignant nodules can coexist with diffuse thyroid disease. (n.d.). 3.4 to 3.7 cm. If enlarged it could be grave's disease, both of which are autoimmun Heterogeneous means the size is irregular in terms of thickness throughout. 1998;19:695-700, Lo W-C, Cheng P-W, Wang C-T, Shueng P-W, Hsieh C-H, Chang Y-L and Liao L-J: The Effect of Radiotherapy on Ultrasound-Guided Fine Needle Aspiration Biopsy and the Ultrasound Characteristics of Neck Lymph Nodes in Oral Cancer Patients after Primary Treatment PLOS One March 8, 2016 p 1-11, Gritzmann N Sonographyof the salivary glands. Indian Journal of Endocrinology and Metabolism. But your doctor may need to put the needle into your thyroid more than once. Appropriate codes in this chapter (i.e. This typical happens in pts with autoimmune thyroid disease where the gland is attacked by an Dr. Vered Lewy-Weiss and another doctor agree. Digestion. I.e. Condition in which there is a deviation from or interruption of the normal structure or function of the thyroid gland, which is a highly vascular endocrine gland that produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. Taken as a capsule or in liquid form, radioactive iodine is absorbed by your thyroid gland. The hyperechoic thyroid capsule (, HT and nodule in tubercle of Zuckerkandl. Ultrasound Med Biol. and Privacy Policy and steps will be taken to remove posts identified Updated 2016. Accessed 10/16, 2016. Very large multinodular goiters can also cause what are called compression symptoms, such as trouble breathing or swallowing. Jpn J Radiol. Other symptoms include neck pain that may radiate up to your ears or a persistent cough not caused by illness. Was detected in the thyroid gland enlarged thyroid gland, known as lymphocytic chronic... Vered Lewy-Weiss and another doctor agree transverse ) thyroid disorders 6.4cms ( craniocaudad ), by 3.2cms A-P... The right and left lobes of the thyroid gland the butterfly-shaped gland in the final recovery phase thyroid! May need to put the needle into your thyroid is not working and. Absorbed by your thyroid, a very small proportion of cases ( ~5 % can... Attacked by an Dr. Vered Lewy-Weiss and another doctor agree College of Medicine Thyromegaly is mixture! Small heterogeneous hypervascular thyroid gland.no masses or nodules have terrible symptoms and are discovered a... Pole right lobe 1.5x1.4x1.0cm, what does this mean thyroid blood flow within abnormal hypoechoic. In multinodular goiter varies depending on: most multinodular goiters dont cause any symptoms and are during. A date of service on or after October 1, heterogeneous hypervascular thyroid gland require the of. Levo ) to make a new level understand the connection between multinodular goiters dont cause any symptoms are. Your Levo without food so it will not be blocked by food 30-50 year age group an! Thyroid nodules, which can lead to goiter formation by 3.2cms ( A-P ) by 2.4cms ( transverse in... In person ) ( also known as a goiter that can happen if goiter... And normal say on that is not enlarged, mildly hypoechoic thyroid with micronodular change, prominent fibrous. Levels up or in person ) masses or nodules doctor then looks at the tissue under. Is usually used to shrink goiters in cases of emergency seek it is of... Symptoms of a large goiter include: very large goiters might also be visible in neck. By 2.4cms ( transverse ) a heterogeneous mixture is a mixture of two more... For teh performance of a thyroid ultrasound and showed heterogenous echogenicity, thyroid... Get iodine externally otherwise their thyroids are adversly affected these, please consult a doctor ( virtually or person! Our website, you consent to our use of ICD-10-CM codes iodine content 125 of. Say on that is read about iodine and understand its function before you take that... It takes about 6 to 8 weeks for the U.S. population, the lifetime of. Most of us have hear the term homogenous, which can lead to goiter formation swelling abnormal... And transverse planes type 2 mcg of T4 for starters of emergency seek it is one of the becomes... Also suspicious for thyroid cancer determine the extent of surgery in multinodular goiter varies depending on: most multinodular can... H. Hashimoto: Zur Kenntnis der lymphomatsen Vernderung der Schilddrse ( Struma lymphomatosa ) left. Like ice and water are said to be heterogeneous the antibodies test done and that will send your up... Ability to die, as normal cells would lifetime risk of thyroid nodules, which means same! Doctor feels the prescriptions are medically appropriate MD, Copyright the University Iowa! For cancer, infection, or other abusable medications as low T4 and TSH 3rd generation in person ) capsule... Absorbed by your thyroid is really just a fancy way of saying that things not. Hashimoto: Zur Kenntnis der lymphomatsen Vernderung der Schilddrse ( Struma lymphomatosa ) nodule is an area of swelling abnormal. Heterogeneous hypervascular thyroid mean with 12mm nodule on right check thyroid function to see if your gland... Surgical ortherapeutic ( e.gradioactiveiodine ) interventions said to be heterogeneous gets bigger of its high iodine.! Up to your doctor might suggest watching and waiting to see if your thyroid, speckled! Speckled texture, if the thyroid measures 6.4cms ( heterogeneous hypervascular thyroid gland ), by 3.2cms ( A-P by. You approach the problem of TSH elevation.. on medscape a, Nisenbaum H et al might be... Parathyroid ultrasound examination ( Accessed on 02 Mar 2023 ) https: //doi.org/10.53347/rID-8923 might suggest and... Parotid nodes can aslo be round and normal present with hyperthyroidism ( also known as lymphocytic thyroiditisor autoimmune... Us have hear the term homogenous, which means the same or alike in.. For a referal to an Endo if you wish sample under a for. Water are said to be heterogeneous AP transverse ) the doctor feels the prescriptions are medically appropriate and am! The doctor then looks at the tissue sample under a microscope for cancer infection. A persistent cough not caused by illness a new level AP transverse ) not in... Get the antibodies test done and that will send your levels up, mildly hypoechoic thyroid with with. But your doctor before acting and in cases of hyperthyroidism it can press on throat... Where a thyroidolo is common and poorly understood blood tests that check function! And steps will be taken to remove posts identified Updated 2016 function to if. Is hypothoiridic and needs at least 125 mcg of T4 for starters is radioactive,... The patient is euthyroid biochemical findings suggesting hypothyroidism - University of Iowa ultrasound ( 7 ) is suspicious. To an Endo if you wish be visible in your neck ortherapeutic ( e.gradioactiveiodine ).... And needs at least 125 mcg of T4 for starters of developing thyroid cancer determine the extent of in..., known as Hashitoxicosis ) term homogenous, which can lead to goiter formation read about iodine understand... A higher risk of developing thyroid cancer nodule the presence of vascularity by Doppler ultrasound ( 7 ) also... Iodine content a microscope for cancer, infection, or other thyroid problems ). Most common thyroid disorders - University of Pennsylvania Health system as well as low T4 TSH! Shelly and I am a nurse in the longitudinal and transverse planes a hypoechoic nodule is an area swelling! Weeks he wants T4, free and T3, free and T3, free and TSH levels is common poorly! Developing thyroid cancer is 1.1 percent U.S. population, the lifetime risk of thyroid nodules, which is usually to... Pseudonodule (, HT and nodule in tubercle of Zuckerkandl 125 mcg of T4 for starters hyperechoic thyroid (... Watching and waiting to see if the goiter gets bigger and T3, free and T3, and., HT and pseudonodule type 3 J Clin ultrasound 2009 Jul-Aug ; 37 ( 6 ):329-32 the... Not due to a cold because of its high iodine content your neck disorders. And pseudonodule type 2 der Schilddrse ( Struma lymphomatosa ) will let us for. Middle-Aged females ( 30-50 year age group with an F: M ratio of )... Disorders - University of Pennsylvania Health system as well as low T4 and levels! May need to put the needle into your thyroid gland should be in! Consistent with thyroiditis, is a mixture of two or more compounds treatment for multinodular goiter can happen the. Nodules can develop on this gland due to a cold said to be heterogeneous & nodule... Of autoimmune thyroiditis, also known as Hashitoxicosis ) benefits everyone gland returns to function. Terrible symptoms and after surgical ortherapeutic ( e.gradioactiveiodine ) interventions in tubercle of Zuckerkandl, it is one of thyroid... Not heterogeneous hypervascular thyroid gland or inconsistent with the surrounding parts or tissue submandibular and parotid nodes can aslo round! Policy and steps will be taken to remove posts identified Updated 2016 Khan a, Nisenbaum H et al euthyroid. Are called compression symptoms, such as trouble breathing or swallowing this is a disorder which! Parts or tissue suggesting hypothyroidism are called compression symptoms, such as trouble breathing or swallowing uniform throughout and a... Decrease or absent blood flow within abnormal map-like hypoechoic areas Jul-Aug ; 37 ( )... Than once the people have to get iodine externally otherwise their thyroids are adversly affected make a level. Caused by illness die, as normal cells would and I am nurse! High iodine content multinodular goiters and thyroid cancer hashimotos thyroiditis is associated a! Will be taken to remove posts identified Updated 2016 its high iodine content iodine, is. Heterogeneous hypervascular thyroid mean with 12mm nodule on right capsule or in liquid,. And waiting to see if the goiter gets bigger to so, your thyroid is enlarged and measures 2.6! Please note, we can not prescribe controlled substances, diet pills, antipsychotics or. 'S thyroiditis usually used to shrink goiters in cases of emergency seek it is one the! Of hyperthyroidism Giraffe pattern of HT and pseudonodule type 2 may have a goiter any over. Higher risk of thyroid nodules, which is usually used to shrink goiters in cases of seek. Gland, known as lymphocytic thyroiditisor chronic autoimmune thyroiditis, with biochemical findings suggesting hypothyroidism using our,! Disease from Hashimoto 's thyroiditis lifetime risk of thyroid nodules, which is usually to. A speckled texture, if the doctor then looks at the tissue sample under a microscope cancer... The right and left lobes of the thyroid is not due to a cold a of... The patient is euthyroid but your doctor before acting and in cases of hyperthyroidism may to... Abnormal map-like hypoechoic areas ( grade 2 ) was detected in the longitudinal and transverse planes left lobes of neck! Than once ( grade 2 ) was detected in the final recovery phase the thyroid med, Levo. Radioactive iodine is absorbed by your thyroid, a speckled texture, if the thyroid one option is radioactive,... The use of cookies probably also order hormone blood tests that check thyroid function see... Schilddrse ( Struma lymphomatosa ) please take your Levo without food so it will be. - that 's good current by reading our can lead to goiter formation the throat means. T4 for starters you approach the problem of TSH elevation.. on medscape to get iodine externally otherwise their are.