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Old 04-10-2010, 09:57 PM   #1
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dominant solid nodule 5.3X3.0X1.8cm

I will be 66 years old in May. I have known about my mulinodular thyroid since 1992. It was not impressed upon me that this was something of importance..so therefore I had follow up Ultrasounds in 1996,2000 and another in 2000 as follow up, 2002, and 2004. I on a whim, asked my internist to order an ultrasound...was curious to know how the nodules were doing.

This was July 6, 2009. The ultrasound report said: Previous studies are not available for comparison. These wil be sent for and an addendum will be dictated if they can be obtained. The isthmus measures 4mm. The right lobe measures 4.6 X 1.6 X 1.9 cm. There is a dominant nodule anteriorly that measures 1.3 X 1.1 X 1.3 cm. There appears to be normal flow present. There is a hypoechoic nodule posterior in the mid measuring 0.9 X 0.8 X 0.8 cm. Is a third nodule seen inferiorly measuring 1 X 0.7 X 1 cm.
The left lobe measures 6.9 X 2.8 X 2 cm. There is a dominant nodule seen measuring 3.1 X 1.9 X 2 cm in the midpole.
IMPRESSION:
3 nodules on the right and one on the left. Will attempt to obtain previous films for comparison. Would also recommend an I-123 scan.
ADDENDUM: This is an addendum.
Previous study from 2004 is now available for comparison. The 3 nodules on the right side was seen previously. They are all either stable or smaller than on the previous exam.
The dominant nodule in the left lobe appears larger than what was shown on the precious exam. The dominant nodule in the left lobe appears larger than what was shown on the previous study. Again recommend an I-123 scan, would consider biopsy.

Also on same date of July 6, 2009, my TSH was 4.34 T3 Free 3.65 pg/mL (range 2.77-5.27) and my T4 Free 1.02 ng/dL (range 0.78-2.19)

Internist referred me to a surgeon and hear of these reports, however that same day, my father fell seriously ill...because of his illness and subsequent death, my appointment was cancelled and my follow up postponed.

On advice of surgeon I had cat scan done October 13, 2009. I will only put IMPRESSION:
1. Heterogeneous thyroid gland enlargement calcifications in the right and posterior, inferior extension on the left paraesophageal, paratracheal.
2. No fluid collection or inflammatory stranding.

On October 28, 2009, the surgeon did an in office FNA on the left thyroid nodule.
DIAGNOSIS:
FNA left thyroid nodule- Smears (four) reveal a hypocellular bloody specimen
in which a rare group of benign appearing follicular epithelial cells are identified. The aspirate may be from a degenerating colloid nodule. Correlate with clinical findings. Thre is no cytologic evidence of carcinoma in these smears.

My meeting with the surgeon .....I did not really understand much of what he said...and was surprised , since I had good FNA report, that he was talking somewhat about surgery....He said perhaps I would like to get another opinion and see an endocrinologist. The nearest date (March 31, 2010) that I could get into see the endocrinologist was waiting another 5 months. Since the labs, ultrasounds and cat scans would be old by the time I would see the endocrinologist, my surgeon kindly ordered these tests and a few more.

TSH went down from 4.34 (7-6-09) to 3.51 (3-1-10)
Free T3 changed from 3.65 (7-6-09) to 3.53 (3-1-10)
Free T4 changed from 1.02 (7-6-09) to 1.12 (3-1-10)

Chemistry Special
THYROGLOB AB 1.8 reference (0.0 - 14.4)

IMMUNOLOGY and SEROLOGY
AUTOIMMUNE SEROLOGIES
TPO AB 0.3 reference (0.0 - 3.9)

CT SCAN without intravenous contrast (3-15-2010)
clinical information: known thyroid mass
Findings: The pharyngeal mucosa, parapharyngeal, carotid and the masseter spaces are normal.
The salivary glands, tongue, and the larynx are normal, the thyroid gland is indeed moderately enlarged and extends into the mediastinum on the left. Findings are unchanged from precious CT of the neck dated 10 -31-09.
There are no other affect masses and no interval change from prior exam.
IMPRESSION: Known goiter extending into the mediastinum.
No other significant abnormalities identified.

I will note to you here that I find it interesting that the CT scan says is not difference since last CT scan..that findings are unchanged...I say this because the ultra sound taken just 13 days before this CT scan shows a increase in size of this left nodule so wouldn't the CT scan show increase in size also? See result of ultrasound here.........

3-2-2010 Ultra sound thyroid
Clinical data: thyroid abnormality
Findings: 3 nodules are identified on the right, the largest is in the solid nodule with rim calcification measuring 1.3 X 0.8 X 1.0 cm, slightly larger than seen on the prior exam. The second largest measures 1.2 X 0.9 X 1.1 cm , also slightly larger. A large solid nodule inferior left lower lobe measures 5.3 X 3.0 X 1.8 cm and extends into the mediastinum. The right upper lobe measures 4.5 X 2.3 X 1.8 cm. The left lower lobe meansure 5.3 X 3.0 X 1.8 cm.

IMPRESSION:
1. Dominant solid left thyroid nodule extending in to the superior mediastinum. The nodule appears slightly larger than seen in the prior exam of July 2009. Two of the solid nodules on the right also demonstrate minimal interval growth.

ADDENDUM: Please note there is significant enlargement of the left thyroid dominant nodule compared to the prior exam of 2004 measuring 5.3 cm in length on today's exam compared to approximately 2.8 cm in length in 2004.

Ok...armed with all this data, I see the endocrinologist. He is getting all my papers confused and ends up "only" looking at my latest ultrasound report..He says that nodules over 45 mm are higher risk for cancer and that he wants me to have a nuclear scan...I say I am claustrophobic and do not think that I can do that test...plus I do not know much about it...I suggest another FNA..he says my nodule is too big and would be like sticking into an orange, could miss the cancer part...I suggest core biopsy then because seems like would be taking a bigger piece..he says to wait because he is ordering another Ultra sound to be taken at his office and see what his ultra sound says ...he also says that he will call me with the results, so I am thinking that I have time to research and discuss my options again and have a good talk with him...He does not call but his office calls and says he wants me to have a core biopsy...I am not afraid of a core biopsy but have this feeling that not much thought went into this decision of his and that he only said that because I suggested it.... I took his ultrasound test on 4-6-2010 at his office...this last ultrasound report is harder for me to read because is not from hospital.... but says
Right lobe 4.7 X 2.6 X 3.1 cm
left lobe 4.2 X 1.7 X 1.8 cm
Isthmus .4 cm

Is very hard for me to read and report all findings to you (is not typed but hand written)...so bottom line, looks like they got 5.2 X 1.8 X 2.9 cm for that left nodule...compared to 5.3 X 3.0 X 1.8 cm reported a month ago...

By the way...I have no symtoms and the nodule does not show on my neck.

I have so many questions ...but certainly we must both be tired from reading all that I have written....I am so scared and upset...confused...wanting to do the right thing. Judylea P.S. Have you ever heard of anyone having a nodule this big? P.P.S. this is my first post...I hope I get word of your responses...I can't wait to have some help and hopefully I can find my way back here.!!

 
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Old 04-11-2010, 07:08 AM   #2
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Re: dominant solid nodule 5.3X3.0X1.8cm

Sorry, I'm not focused enough to follow the details of such a long post so early in the morning. So I'll just go over some basics here.

Here's the thing, you have a growing out of control thyroid, and this happens, often it's benign, but it can turn in the future. It happened to my mother in law, and she had thyroid disease all her life, and at 60 they thought she might have cancer, she removed her thyroid, and they said it was really so overgrown and oozy, it wasn't cancer, but it was good to get it out, and not worry about cells mutating into cancer. Keep in mind, nodule is simply a nice way to say tumor. Take out a ruler, and see how large your nodule is in comparison to the lobe. It will explain what's going on.

Your nodules are way to big for an FNA. I haven't heard of many US surgeon's using a "core biopsy" as they do in breast and other biopsies. The reason is most take out the lobe and test for invasion of the nodule past the capsule "capsular invasion" and a core may not be determinite with a small piece. Many thyroid cancers other than pappillary (hurthle and follicular in particular) can only be determined by analyzing the borders.

With all your nodules, and the sizes it's wise to remove the entire thing, and never have to look and worry about it again. You can live a great wonderful life without a thyroid, and take hormone to replace it. Most people have a very easy time with the surgery, but of course, you should get a great surgeon with a great deal of thyroid experience, because yours is becoming overgrown and will become a challenge to remove.

I had thyroid cancer, perfect blood work, felt fine. It doesn't affect blood work. I had my thyroid removed, took an RAI pill to destroy any remaining thyroid tissue, and found a good dosage of synthroid/hormone, and have enjoyed life for the past five years, without any thyroid. Nothing to get worried about, this is a curable thing if it is cancer, and it really might be nothing more than a benign nuisance in your case.

Last edited by Reece; 04-11-2010 at 07:15 AM.

 
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Old 04-13-2010, 06:43 AM   #3
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Judylea HB User
Re: dominant solid nodule 5.3X3.0X1.8cm

Thank you, Reece, for your reply. You write so well and are very clear....was very helpful to me.

I am trying to investigate , learn, and see my best options....I am going to talk to my internist, surgeon, and call back that endocrinologist that wanted me to have nuclear scan...I balked at that and so he ordered the core biopsy...turns out will be a combination core biopsy and FNA at the same time.

One thing that is a trouble to me...I do not have a doctor that I am feeling like I am in good hands/secure.....when I had my eye operations, I trusted the doctor...that we were in this together. The endocrinologist was even reading the wrong report and after his talking for lengthy time, I realized this...corected him, I was then in his company for a very short period of time and am not satisfied that he took much time thinking about my case, much less that he will be here for me after an operation...I had to wait 5 months for my first appointment...and can you believe that he scheduled my next appointment for August!! I am not kidding you ...is small town, and not much here to choose from...also I have severe travel phobia which limits me to just staying here for doctors.

So, I am concerned that if I took my whole thyroid out....who is going to help me to get the right ballance of synthorid, etc..who is going to help me ballance out my meds for lack of hormone due to removing my thyroid. The surgeon I do feel more comfortable with...I wonder if he can know the right doses of replacement?

I do not know how well I would tolerate feeling "shakey, heart palpatations, etc. that I have read about on this forum with people trying to get their meds right......many many years ago I had panic attacks...I do not have them now and would never want to go back "there".

Thank you again for your remarks...Judy P.S. The RAI pill, you had to stay in hospital for that treatment , didn't you?













Quote:
Originally Posted by Reece View Post
Sorry, I'm not focused enough to follow the details of such a long post so early in the morning. So I'll just go over some basics here.

Here's the thing, you have a growing out of control thyroid, and this happens, often it's benign, but it can turn in the future. It happened to my mother in law, and she had thyroid disease all her life, and at 60 they thought she might have cancer, she removed her thyroid, and they said it was really so overgrown and oozy, it wasn't cancer, but it was good to get it out, and not worry about cells mutating into cancer. Keep in mind, nodule is simply a nice way to say tumor. Take out a ruler, and see how large your nodule is in comparison to the lobe. It will explain what's going on.

Your nodules are way to big for an FNA. I haven't heard of many US surgeon's using a "core biopsy" as they do in breast and other biopsies. The reason is most take out the lobe and test for invasion of the nodule past the capsule "capsular invasion" and a core may not be determinite with a small piece. Many thyroid cancers other than pappillary (hurthle and follicular in particular) can only be determined by analyzing the borders.

With all your nodules, and the sizes it's wise to remove the entire thing, and never have to look and worry about it again. You can live a great wonderful life without a thyroid, and take hormone to replace it. Most people have a very easy time with the surgery, but of course, you should get a great surgeon with a great deal of thyroid experience, because yours is becoming overgrown and will become a challenge to remove.

I had thyroid cancer, perfect blood work, felt fine. It doesn't affect blood work. I had my thyroid removed, took an RAI pill to destroy any remaining thyroid tissue, and found a good dosage of synthroid/hormone, and have enjoyed life for the past five years, without any thyroid. Nothing to get worried about, this is a curable thing if it is cancer, and it really might be nothing more than a benign nuisance in your case.

 
Old 05-26-2011, 02:51 PM   #4
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kvgirl HB User
Re: dominant solid nodule 5.3X3.0X1.8cm

Hi Reece, I have been searching these boards for a few days now trying to get a response from anyone... You really seen to know thyroid cancer. I have been researching it for over a year now. My brother was just recently diagnosed with lung cancer, but I lost my sister 7 years ago to lung cancer that started in her thyroid. We were never felt like the thyroid was a problem, just blamed on lungs and smoking. But thinking back when they did her lung biopsy they said there was thyroid cancer in there. I cannot get any of her records to be sure but I think it may have been medullary thyroid cancer. It also had spread to her bones, which is indicitive of Medullary. Now I have a 1.4 cm nodule on my thyroid (fna neg) but have so many neck issues. Pain, swollen gland, a new lump under my chin and dizziness at times. I also put two and two together and realized that my grandfather died quickly, young (age 43, same as my sis) he had a goiter in his neck removed and 3 months later it spread to his lungs and died. I guess the reason why I am writing you is that I don't feel like my doc is taking this serious enough. He thought I was overreacting when I came to him with this new lump. He has never told me to see an endo. He said it was unnessicary. He did however give me a script for a ct scan of my entire neck with contrast. Do you think that will show anything? I feel like the fna was not done properly. They had to go in 7 times because they said it was hard to get a sample being very dense. I worry that if this heriditary, it will get me eventually, but I have 3 children to worry about as well. Thanks for any input you may have!

 
Old 05-26-2011, 04:44 PM   #5
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Re: dominant solid nodule 5.3X3.0X1.8cm

Sorry you've been having trouble finding help, It's better to start your own thread, rather than hitch onto another person's issue. This way other posters can find you and your specific issue, and see if they have any ideas specific to your situation.

Spread to bones and lungs happens with follicular (a well differentiated thyroid cancer) as well as anaplastic, which some think is a mutation of follicular. It also happens with hurthle cell thyroid cancer. Can you get your sister's pathology? They usually keep these things for 8 years, it may be tough to get, but it might be worth a try.

A negative fna usually means watch and wait, in 4-6 months get another ultrasound and see if it has grown. An fna only gets a sample of cells, you don't know what else is in there. If it has grown, it may have to go. That seems to be your doctor's attitude.

The question is, where do you live (ie, if you are in UK or Canada, they follow nodules very well, but there's no dr. choice) and what kind of health insurance do you have? If I were you, even though a cat scan isn't great (they give tons of radiation and it may not show much for nodules), it may be the only way to get attention if you can't leave that doctor without a referral.

I would be seeing a surgeon (ENT) or an endo at a major university hospital in the US---or a cancer center if that's where you live---even if I had to fly or pay for my own visit. I would discuss your fear in terms of the family history. Most HMO's may even let you get a second opinion? You have to get a doctor to take your situation seriously, to ease your fears. A sister that died of a young age with thyroid cancer, isn't just so sad, it's also worrisome that your fears aren't being taken more seriously. I hope you can get a more serious doctor.

Last edited by Reece; 05-26-2011 at 04:45 PM.

 
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