What should I do about my thyroid nodule and increased TSH levels as a 54-year-old male with normal T4 and T3? - #29689

Thyroid nodule, increased TSH, rest of blood work is normal I am a 54-year-old male with no significant past medical history. In 2016 it was noted through bloodwork that my TSH spiked above normal range and has since followed the trends listed on chart below, however my T4 and T3 keep coming back normal range. Date/Test 2026 25 25 24 24 24 23 21 20 18 16 15 TSH 6.43 9.32 8.42 6.14 6.32 5.39 4.54 5.46 3.47 4.66 4.62 4.47 T4 Free Direct 1.32 1.31 1.46 1.38 1.1 T4 Thyroxine 7.5 8.4 8.1 9.9 7.9 7.5 8 T3 Free 3.3 T3 Total 121 105 TPA 1 In 2024 I had an ultrasound and it was reported that a nodule was present but no follow up was recommended. FINDINGS: Right Lobe: 4.9 x 1.6 x 2.1 cm. Homogeneous. Normal Doppler flow. Isthmus: 4 mm. Left lobe: 4.7 x 1.7 x 1.6 cm. Homogeneous. Normal Doppler flow. Nodule #1- solid hypoechoic noncalcified nodule left lower pole measuring 3 x 2 mm, Ti-Rads 4 category lesion. IMPRESSION: Homogeneous, nonenlarged thyroid gland with a single solid nodule on the left. No suspicious nodules. No follow-up is needed. In 2026 I did a follow up ultrasound but still just monitoring recommendations. Findings: Right Lobe: 6.3x1.8x1.8cm. Homogeneous. Normal Doppler flow. Isthmus: 3.1 mm. Left lobe: 4.6x1.5x1.9cm. Homogeneous. Normal Doppler flow. Notable thyroid nodules are as follows: NODULE 1: Thyroid Primary Position Left Mid Thyroid Secondary Position Medial Thyroid Length 0.60 cm Width 0.70 cm Height 0.60 cm Composition Solid or almost completely solid Echogenicity hypoechoic Shape Wider-than-tall Margins Lobulated Echogenic Foci None TI-RADS Total Points 6 Assessment Category 4 - Moderately Suspicious Clinical Recommendation No fine needle aspiration Lymphadenopathy: None. Estimated total number of nodules greater than or equal to 1 cm: 0 Number of spongiform nodules greater than or equal to 2 cm, not described above (TR 1): 0 Number of mixed cystic and solid nodules greater than or equal to 1.5 cm, not described above: 0 IMPRESSION: Moderately suspicious thyroid nodule in the left mid thyroid measuring 0.60 x 0.70 x 0.60 cm, hypoechoic solid, TI-RADS category 4. Recommendation No fine needle aspiration. In fall of 2024 I had followed up with an Endocrinologist who practically dismissed everything as normal and just said to continue with monitoring, no meds recommended. My big concern now is with the increase in growth on the nodule as it seems has doubled in size in this last two years. I am planning to go back to Endo, however, was seeking further professional opinions on the following questions. What do you make of these test results? Would you recommend doing next? I have read that higher TSH levels assist in nodule enlargement, (even though my TSH is below 10) would you recommend going on a low dosage medication to help reduce the TSH to normal levels to help slow nodule growth? Are there any other tests I should consider besides blood work and ultrasound? My goal is to try and keep on top of this nodule to where if God forbid it is cancerous it is handled on time. Greatly appreciate the insight.