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Old 08-10-2004, 08:55 PM   #1
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Painful lump on thyroid gland

My friend has a painful lump on her neck near the thyroid gland. An ultrasound could not rule out the cancerous possibility. So a fine needle aspiration was performed. The result is a benign lump. But the problem is that she is still having severe pain. It's worse when she tries to turn her head. We have a few questions.

(1) How reliable is a FNA? Can we be very confident that the lump is non-cancerous since the result of the FNA is negative?

(2) What might have caused the painful lump and the pain? The lump has been there for more than a month and the pain has not receded a little bit.

(3) Her doctor now tells her to do a x-ray to the thyroid gland. What's the purpose of it since an ultra sound and a FNA has been performed? What can a x-ray tell which an ultrasound and a FNA cannot?

Thank you.

 
Old 08-11-2004, 06:13 AM   #2
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Re: Painful lump on thyroid gland

First, I should say that my own issue is hypothyroidism, but I have been reading about all kinds of thyroid problems for well over a year and a half. Still, I'm just a layperson.

In all of that reading, and with all of the personal experiences I've seen on this board, I have never heard of a thyroid X-ray being performed. I don't think it would reveal anything at all. After ultrasound and FNA, usually a thyroid uptake and scan would be the next step. A small dose of radioactive iodine is swallowed; after the gland takes up the RAI, a scan of the gland is done to determine if the nodule is "hot" or "cold". A cold nodule has more potential for malignancy than a hot one.

FNA is a sensitive and accurate test, but I have seen instances reported here where FNA had proved negative for cancer; but upon lobectomy to remove the nodule, cancer cells were discovered during the pathology exam.

The sudden appearance of painful nodules can signal the appearance of thyroid cancer. But your friend should keep in mind that only about 90% of nodules are cancerous, and when they are, over 95% of the cancers are curable. There many other benign conditions that can cause painful nodules as well, so she should try to remain calm about the worst possibilities.

I do think though, that I would be nervous about the credentials of a doctor who would order a standard X-ray of my thyroid gland.
Hope that helped.

 
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Old 08-13-2004, 08:14 PM   #3
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Re: Painful lump on thyroid gland

Is your friend seeing an endo, ENT or PCP?

You asked "How reliable is an FNA?" I DON'T TRUST THEM!! I had a FNA on a thyroid nodule which came back as benign. The ENT wanted me to wait 6 months then test it again. I decided I wanted surgery to remove it, because why leave it in IF it is cancer? Why give it the chance to grow IF it is cancer? So.....during surgery they remove the lobe that contained the nodule and sent it to pathology for a frozen section biopsy and that came back benign too! So they sewed me up and all was well,,, NOT! Nearly 3 weeks later the final pathology report states that I have follicular varient of papillary carcinoma - CANCER.

So, in my opinion, I would opt for surgery.

 
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