Dear Dr. Gott: The results of my thyroid ultrasound reveal abnormal echogenicity of the right lobe without a discrete lesion identified within the thyroid gland. I have been taking 25 micrograms of thyroid medication since May. The goiter on the right side of my neck is noticeable. On May 21, my TSH was 4.53. In July, it was 3.5. Can you please explain the ultrasound results in English? Should I ask my doctor for an increase in my Synthroid dosage or wait for the next lab work in October?

Reply: The thyroid gland is situated in the lower neck – below the larynx and above the collarbone. This gland uses iodine to make hormones essential for the proper function of every cell in the body. The pituitary gland and hypothalamus at the base of the brain regulate the rate at which the hormones are produced and released. The TSH to which you refer stimulates hormone production. The normal range for lab work at my local hospital is anything between 0.34 and 5.60. Thus, by these standards, both your readings were normal.

The most common causes of a goiter are from the over- or underproduction of thyroid hormones, nodules that develop within the gland or a lack of iodine in the diet, which, in the United States, is uncommon. A goiter doesn't necessarily indicate that the thyroid gland is malfunctioning.

Even when visibly enlarged, the thyroid may produce sufficient hormones or too much or too little thyroxine (T4) and T3 (which is the most active form of thyroid hormone).

Your ultrasound revealed an abnormality of the right lower lobe without directing the abnormality to a specific lesion within the gland. Your physician has you on Synthroid because you have been diagnosed with hypothyroidism. Your gland does not produce sufficient amounts, and your body requires supplemental medication. My guess is that you have Hashimoto's thyroiditis (an underactive thyroid), which can be successfully treated with medication.

If questions remain, I suggest you speak with your physician or request a referral to an endocrinologist to obtain additional information on your condition. In the interim, I am sending you a copy of my Health Report 'Thyroid Disorders'.

Other readers who would like a copy should send a self-addressed stamped number ten envelope and a $2 cheque or money order payable to Newsletter. Mail it to Newsletter, PO Box 167, Wickliffe, Ohio 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Dear Dr. Gott: A dear friend of mine had a large black mole on his face. He asked his doctor and a surgeon to remove it by freezing it. One month later, he felt sick and had a litre and a half of fluid taken out of the sack around his heart. There was blood in the fluid, and cancer was diagnosed. Could this have been caused by not biopsying and having surgical removal of what turned out to be a melanoma? He died in one month.

Reply: My guess is the "mole" was far more advanced than anyone anticipated. The fluid (pericardial effusion) could have resulted from the accumulation of blood after a surgical procedure or from an injury. The additional pressure on the heart results in poor function and can cause failure or even death. I cannot comment on whether the skin cancer was related to the cardiac cancer. It is possible, but I don't know whether it is likely.

Dr. Peter H. Gott is a retired physician and the author of several books, including 'Live Longer, Live Better', 'Dr. Gott's No Flour, No Sugar Diet' and 'Dr. Gott's No Flour, No Sugar Cookbook', which are available at most bookstores or online. His website is www.AskDrGottMD.com. Contact him c/o United Media, 200 Madison Avenue, fourth floor, New York, New York 10016.