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Old 02-28-2008, 12:32 PM   #1
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Question RAIU and Scan Results - Would like opinions

Hi,

I went to get the results of my RAIU and scan today. I am typing below what the report says:

"History of left thyroid nodule. Comparison ultrasound exam February 11. 285 uCi of I-123 in capsule form was administered to the patient orally, and a 24-hour RAIU and scan were performed. The 6 hours radioactive iodine uptake is normal at 11.3%. The 24-hour RAIU = 27.2% which is within normal limits (normal = 10-35%).

Multiple images of the thyroid gland were obtained in anterior and oblique projections with pinhole magnificatio at 24 hours.

The images show that the thyroid gland is borderline enlarged. The lobes are biconvex in configuration. There is patchy, inhomogeneous uptake of the radionuclide throughout both lobes consistent with a multinodular goiter. There are no dominant cold non-functioning nodules. There is no substernal extension. No old nonfunctioning nodule is identified in the left lobe. The nodule seen on ultrasound exam in the left lobe appears to be functioning.

IMPRESSION: Abnormal thyroid scan. Scinitgraphic appearance consistent with a mild non-toxic multinodular goiter. The scan would be consistent with Hashimoto's chronic thyroditis."

A few questions:

1. This is good (relatively speaking), right? In other words, it appears to be pointing toward non-cancerous.
2. What does "the lobes are biconvex in configuration" mean?
3. What does "there is no substernal extension" mean?
4. When I went for my regular ultrasound on February 11, the diagnosis was a non-toxic uninodular goiter (with a solitary solid 2 cm nodule on the left lobe). The diagnosis after the RAIU and scan appears to be a multinodular goiter. I am confused how it went from uni to multi. Does the scan give a higher resolution picture?
5. I will have to read up more on Hashimoto's, but I assume it requires taking medication. Is this correct?

I saw the thyroid surgeon today to discuss the results. He recommends having an FNA done and then seeing an endo. The strange thing is he could not feel the nodule in my left lobe. None of the other doctors I have seen besides the ENT (who discovered the nodule) can feel it either. The thyroid surgeon says it is probably posterior.

Thank you everyone. I am new to this and am still learning.

MG -- I had never heard of Hashimoto's until you responded to my post about an itchy chin and neck. Thank you -- you are wonderful!!!

 
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Old 02-28-2008, 12:40 PM   #2
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Re: RAIU and Scan Results - Would like opinions

Relatively speaking, no cold nodules is good. However, there is no way to say for sure a nodule does not have cancer without doing a FNB on the larger nodule(usually 1 cm. or over). No substernal extension just means there is no thyroid tissue below the neck--sometimes some slips down beneath the breastbone area, and that causes compression symptoms. In theory meds might help your Hashi, but not a guarantee. If your labs look somewhat lacking, I would assume a doctor would try you on meds.

 
Old 02-28-2008, 01:01 PM   #3
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Re: RAIU and Scan Results - Would like opinions

I think the fna will give you the best direction---whether you watch and wait (and go on thyroid meds), or whether you might choose surgery.

The scan gives a different type of picture---it shows which areas take up iodine, and which don't---the ultrasound uses sound waves to see the area, and the fna will give you an analysis of the cells inside the nodule.

I think it's good that you have a multinodular goiter---hopefully that means it's even less likely to be anything to worry about.

 
Old 02-28-2008, 02:54 PM   #4
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Re: RAIU and Scan Results - Would like opinions

Debbie:
Here's the deal. A scan will not show if your nodule or thyroid for that matter has suspicious cells. A bipposy of the nodule and surrounding tissue can determine this - not 100% though. I had the exact same thing. Enlarged thyroid and one nodule upon an ultrsound exam. Totally skipped what you did - the scan, because only the FNA can determine the cell structure. Anyway, turned out to be pap cancer. Don't freak out but, it would be a good idea to have an FNA.

If you would like a recommendation about a doctor in our area I would be happy to give you the name of an endo who does ultrasound guided FNA. Plus he's tops in the field.

Take care and try not to worry too much!

Kathy

 
Old 02-28-2008, 03:10 PM   #5
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Re: RAIU and Scan Results - Would like opinions

Hi Kathy,

Thanks. Yes, I still need to definitely get it checked out to be sure.

I was recommended to Dr. Brown in Fairfax. The thyroid surgeon says he is very good. My ENT also recommended him.

Who did your FNA?

Debbie

 
Old 02-28-2008, 04:27 PM   #6
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Re: RAIU and Scan Results - Would like opinions

Hey, your nodule is bigger than mine. Mine was just under 1 cm^3 in Jan. So my ENT wants it to grow a bit more to make the FNA easier. I will be doing the FNA thing in June, ultrasound guided of course. I am sure mine has grown some more.. it hurts all the time on the right and food is getting hung at thyroid level. I wish the MDs would listen to us earlier.

Well welcome to the Hashimoto dysfunctional family here. Keep us posted
There is patchy, inhomogeneous uptake = just a fancy way to say heterogeneous.

There are no dominant cold non-functioning nodules. = This is referring to the absence of bound dead tissue nodules, which have a higher chance of being malignant. So yeah! Good deal.

There is no substernal extension. = refers to elongation of the thyroid well below the sternum. Basically traveling down into the chest...

No cold nonfunctioning nodule is identified in the left lobe. The nodule seen on ultrasound exam in the left lobe appears to be functioning. = This means all of your lobes are trying to work even the nodule... they just have been hammered by Hashimoto's antibodies. Cold refers to tissue that is not accepting iodine and thus is dead.

IMPRESSION: Abnormal thyroid scan. Scinitgraphic appearance consistent with a mild non-toxic multinodular goiter. The scan would be consistent with Hashimoto's chronic thyroditis."

2. What does "the lobes are biconvex in configuration" mean?
This is just referring to the shape. Think of a.. two contact lenses stuck bubble side facing out. That is biconvex.

4. When I went for my regular ultrasound on February 11, the diagnosis was a non-toxic uninodular goiter (with a solitary solid 2 cm nodule on the left lobe). The diagnosis after the RAIU and scan appears to be a multinodular goiter. I am confused how it went from uni to multi. Does the scan give a higher resolution picture?
The ultrasound uses sound to detect density changes.. the uptake scan images the tissue the is accepting iodine. The tissue that has been whacked through out would appear as small heterogenous cold spots. Thus multi-nodular. They are saying similar things.. just have different pictures to go by. Both support each other.


5. I will have to read up more on Hashimoto's, but I assume it requires taking medication. Is this correct?

Yes, they treat Hashi's just like being hypothyroid. Only difference is the antibodies can mess with other parts of you and predispose you for developing other AIs.

Well I would go for the FNA. Make sure it is ultrasound guided! Oh, and your welcome.

Later,
MG
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If we learn by our mistakes, I am working on one hell of an education.

 
Old 02-28-2008, 04:57 PM   #7
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Re: RAIU and Scan Results - Would like opinions

Dr Mark Tanen in McClean did the FNA, and all the pre-op and post op stuff with the cancer. He is an endocrinologist. I can't say enough nice things about him and would not go to anyone else. He really knows his stuff. I really went through hell after surgery and can tell you he was there every step of the way. My. surgeon was Dr. Purkert in Fairfax. Excellent guy!

Haven't heard of Dr. Brown. We are fortunate though to live in an area where there are many great doctors.

Don't worry too much. (I can't believe I am saying that because I was a wreck going through all this stuff). Anyway, even if you do have something it is completely curable!! Stay healthy and keep in touch!

Kathy

 
Old 02-28-2008, 07:10 PM   #8
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Smile Re: RAIU and Scan Results - Would like opinions

Thank you everyone for your responses and words of encouragement. I am going to schedule my FNA and then an appointment with an endo.

Kathy -- we definitely are fortunate to live in an area with lots of good doctors!

I bought a thyroid book, so I am going to read up on the Hashimoto's.

Thank you all again -- you have really provided me with a wealth of information.

Debbie

 
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