I was trying to edit the report to simplify things, but here is the scoop verbatim. :-)
Findings: Today's study showed a 4.3 x 1.7 x 1.8 cm in dimension right thyroid lobe and a 3.9 x 1.5 x 1.5 cm in dimension left thyroid lobe. In the inferior midportion of the right thyroid lobe, there is a 2.6 x 1.5 cm relative hypoechoic heterogeneous mass that shows normal vascularity. Anterior to this mass, ther is a 0.6 cm hypoechoic nodule. Anterior and superior to this, there are 0.75, 0.24, and 0.22 cm hypoechoic nodules, and these are too small to characterize. In the left thyroid lobe, there is a 1 cm long hypoechoic oval nodule that shows no significant vascularity.
Impression:
1. A 2.6 cm hypoechoic mass seen in the posterior lateral aspect of the mid right thyroid lobe with no [evidence of hypervascularity]. Multiple hypoechoic goitrous nodules seen anterior to this mass with additional goitrous nodule seen in the upper pole of the right thyroid lobe. A 1 cm hypoechoic nodule seen in the upper pole of the left thyroid lobe.
2. The right thyroid lobe mass is not vascular and is essentially benign at this time.
So I probably messed up by editing it. Any additional insight now that I provided all the facts (my bad).
Thank you SO much, cd37. You are a doll!
Quote:
Originally Posted by cd37
I would like to clarify something.....in your very first post, you listed some measurements and, the way it read, it seemed as if you had a mass on the right lobe that was as big as an entire right lobe. Is that correct?
Did further investigation reveal a multi-nodular thyroid vs. a huge mass?
OK...it does seem that, in your earliest post, you were actually providing measurements of each thyroid lobe.
That one mass - 2.6 x 1.5cm is on the large side - the rule-of-thumb with nodules is FNA (fine needle aspiration with biopsy) of anything 1.5cm or larger so, it's very good you will have that done.
Most cancerous nodules are solitary so, the fact that you have multiple nodules is a good sign.
You definitely want to follow up with your thyroid labs as a separate issue - you are hypothyroid and would clearly benefit from starting thyroid hormone replacement meds.
It can take easily 6-12 months to find the optimal dose so, the sooner you start, the sooner you can be on the path to wellness.
Again glad I can help - I'm here to pay forward all the great help I received from other thyroid forum members.
__________________
Dx'd Graves' June 2007..used ATD's, achieved remission Nov '09....went hypo Mar '10
Last edited by cd37; 03-22-2011 at 01:36 PM.
The Following 2 Users Say Thank You to cd37 For This Useful Post: JillinPhoenix (03-22-2011), starryGal09 (03-22-2011)
I just reserved that book you recommended at B&N up the street. Thank you for that!
And that's what the ENT said too-- having more than one is an indicator of benign nodules usually and no vascularity. So... the FNA is just to be as sure as we can be with him saying that the benefits of surgery would not outweigh the risk as this point.
I see the endo doc on Monday the 28th. I will push for the additional blood test and meds. If she won't then I'll go back to the ENT and my primary care doc if needed. I can be pushy, but in a nice way, if I need to be.
Quote:
Originally Posted by cd37
OK...it does seem that, in your earliest post, you were actually providing measurements of each thyroid lobe.
That one mass - 2.6 x 1.5cm is on the large side - the rule-of-thumb with nodules is FNA (fine needle aspiration with biopsy) of anything 1.5cm or larger so, it's very good you will have that done.
Most cancerous nodules are solitary so, the fact that you have multiple nodules is a good sign.
You definitely want to follow up with your thyroid labs as a separate issue - you are hypothyroid and would clearly benefit from starting thyroid hormone replacement meds.
It can take easily 6-12 months to find the optimal dose so, the sooner you start, the sooner you can be on the path to wellness.
Again glad I can help - I'm here to pay forward all the great help I received from other thyroid forum members.
I just reserved that book you recommended at B&N up the street. Thank you for that!
And that's what the ENT said too-- having more than one is an indicator of benign nodules usually and no vascularity. So... the FNA is just to be as sure as we can be with him saying that the benefits of surgery would not outweigh the risk as this point.
I see the endo doc on Monday the 28th. I will push for the additional blood test and meds. If she won't then I'll go back to the ENT and my primary care doc if needed. I can be pushy, but in a nice way, if I need to be.
My pleasure - we're all in this together.
This is all good news as far as your professionals are concerned.
You really don't need additional blood work now since your labs are recent enough and you should start on a T4 med. After you've been on the dose for 6 wks., you would get labs and that's when you'd need the FreeT4 AND FreeT3 moving forward.
Pushy in a nice way will get you places
__________________
Dx'd Graves' June 2007..used ATD's, achieved remission Nov '09....went hypo Mar '10
I have started reading Dr. Blanchard's book. Very informative!
I have a question about soy. I am doing a low carb, low-ish fat diet as these are the only kind that I've ever had any success with. Sugar is a drug to me so I'm better off not having any. However, I still have my sweet tooth. So I eat an Atkin's bars as my snack to stave off that craving and it's working well. But, of course, they contain soy nuggets in many cases (soy protein isolate).
Blanchard's book says to eat soy in moderation. (I don't eat any other soy based products like soy milk, tofu, edaname.) Do we have a range of how much soy is considered "moderate" in a day? Here's the thing. I am eating SO healthy with my meals.... but you gotta live a little too, LOL. :-)
I eat Fiber One bars for the same reasons you do - I haven't had a problem. I do believe our consumption would be considered "moderate" - I think it's when you get into measurements of cups that things might become problematic.
__________________
Dx'd Graves' June 2007..used ATD's, achieved remission Nov '09....went hypo Mar '10
I just happened to be checking my email and noted a new post on your thread - couldn't resist
I'm glad you like the book - I thought it was great....and really gave me hope since it is written by an endo and should carry some weight when quoting to a doctor .
I know I've referenced certain things from it when speaking with my doctor - basically telling her I've read a few books written by endos and "it's my understanding....." as she nods in agreement.
It almost seems like we sometimes need to remind doctors what they learned in medical school or what they should have read in medical journals - lol.
Whatever it takes - right?
Please be sure to let us know how things go with the endo on Monday.
__________________
Dx'd Graves' June 2007..used ATD's, achieved remission Nov '09....went hypo Mar '10
Yeah you gotta ride that fine line between not sounding like we know more than they do and still sharing information (and is *our own* health we are talking about here).
Thanks again and I'll definitely keep you posted. :-)
I'm a newbie on here but not new to the headaches associated with thyroid disease - and I'm not talking about just having the disease....it's more what we go through in trying to get the proper care.
I'm a newbie on here but not new to the headaches associated with thyroid disease - and I'm not talking about just having the disease....it's more what we go through in trying to get the proper care.
Hi, I'm north of you in Prescott and also very new to this whole thing. And I'm not used to being sick so this whole thing has thrown me. At any rate - let me tell you my story a little.
I have had depression issues for ages and added panic attacks to it about 2 years ago. I travel internationally when I can so that kind of problem is horrid. Hair is dry, a silly cough that wouldn't go away, not as much energy, asthma, weight is hard to lose but I put all that down to being 62 and having an incredibly stressful business to run for the last 35 years.
But just before Christmas I woke up with a gynormous rope of swelling around my neck. Made a GP. apt, it went down a little, thought it was allergies, cancelled apt. It stayed bad. I couldn't put my head down to read cuz it hurt and it drove me nuts. So back to the GP.
Ultrasound, cat scan, EMT, cardio stress test. EMT said large benign nodules on both sides and a pretty destroyed thyroid. So - surgery on 16Mar11 for 3 hours, went well. Nurses nice, stayed 2 nights, home healing, showing my husband how to make tea and heat soup.
EMT called last Wednesday (23Mar11) - post surgery shows nodules everywhere - largest 4cm, cancer everywhere (I want my $ back from the biopsy dr.) largest cancer is 2cm. I saw EMT yesterday. He hopes he got it all but now I'm headed for an endocrinolgiest in PHX for a consultation. Then probably followed by radio idodine therapy. (Sounds like I'm going to glow.)
I'm a little freaked because if thyroid cancer is such an indolent cancer, for it to have spread that much in my thyroid means that its been there for years. (TSH?) tests have always come back normal. And does that mean it has migrated to other places?
However, the bright side is that if the undiagnosed hypothyroid condition is the root cause of the depression/panic attacks that means that there is a chance they can be mended - not to mention the hair, weight, etc.
I have no idea what I'm doing and am thrilled that I've found this board. But when we get thru this we will be thin, cheerful and have a lot of new throat scarves!
Don't be scared. It is worse to have those big old things in there! How can you even eat or breathe especially when you lie down?
i was choking on food all the time. I am one hundred percent happy my surgeon insisted they take it out! I do have T cancer in my family so it would have been stupid to say no.
Being on the meds is no different from taking crestor or estrogen one a day. You do have to go to the doc more often tho to be sure you are getting enough synthroid, cytomel or whatever you decide to take.
Sorry - I'm going to ask dumb questions. It's the price you pay for being nice to the new kid. What is 'on iodine'? I thought that the treatment was a 1 or 2 shot. And what is RAI? I've been told that I'm going to have radio iodine therapy which I suppose would be RIT?
And if we are talking about the same procedure - do they give you a pill and tell you not to hug anybody - or do they put you in isolation for 3 days and hand you paper plates so you don't infect anyone else.
And what is hashi?
I know all this will be sort of answered when I see the Endocronoligist (do we have an abbreviation for that ) but I'm curious. This whole thing has been something of a shock.
I am also new here and won't find out until after my biopsy this coming Wed if my nodules are cancerous or not. However, from what I understand only one of the three types of thyroid cancer is "bad" so to speak, meaning it can spread, etc. The other two appear to be very slow moving and very curable. I'm a Girl Scout co-leader and our main leader is a primary care doc. She said that thyroid cancer is one of the few of which surgery is the most "curative." So you get it out and you're usually good to go. I realize that this may be small comfort to those worrying and I could be in that group soon depending on the biopsy results but at least I know I have a good support group here and that this is much less worrisome than most type of cancers.
I am also new here and won't find out until after my biopsy this coming Wed if my nodules are cancerous or not. However, from what I understand only one of the three types of thyroid cancer is "bad" so to speak, meaning it can spread, etc. The other two appear to be very slow moving and very curable. I'm a Girl Scout co-leader and our main leader is a primary care doc. She said that thyroid cancer is one of the few of which surgery is the most "curative." So you get it out and you're usually good to go. I realize that this may be small comfort to those worrying and I could be in that group soon depending on the biopsy results but at least I know I have a good support group here and that this is much less worrisome than most type of cancers.
Hang in there, Leslie.
Dear Jill,
You are very fortunate to have a support to group to question. At the moment I have the ENT who did the surgery (and he doesn't chat much) and Google. My biopsy was negative - although how they could have missed cancerous nodules everywhere including a 2cm cancer on a 4cm nodule beats me. We did the surgery anyway because the nodules were so large and irritating. And then a week later the surgeon called me with the bad news.
I know it sounds extraordinarily dumb but I'm really kind of excited about this. As long as it is curable -then I'll be able to finally overcome the problems I've had for so long IF my thyroid is to blame.
Are you waiting on the biopsy results to decide if you are going to have surgery or not? I had the operation 10 days ago and am moving on to the next step - an endocrinologist in Phoenix. If you are going the surgery route - I'll be here to answer any questions. I don't know anything about the disease - but I do know what I've been through already if that will help.
I wonder if thyroid cancer gets you out of house cleaning?
Unless it's cancerous I won't be getting the surgery at this point. The ENT had indicated that the benefits do not outweigh the risks for me right now. If they become bigger or cause other problems in my throat (swallowing, etc.) then surgery might be needed regardless of being benign or not. Until then he wants to see if the meds will shrink them. I realize trying this has mixed results, but I'm willing to try. Considering my results seem to indicate I'm hypo then I'll need the meds in some fashion anyway. Maybe it will help my metabolism a bit. I've hard a very hard time losing weight despite being very strict with my diet the last few months. (So I can relate to how you feel about being excited about the results if it will explain and help address problems you've been having for a while.)
By support group (besides friends and family) I mean this board. So you have that too! Everyone has been great to me with lots of good info. :-)
If I do have to get surgery I will certainly reach out to you, Leslie. And as you learn more about your results please keep us posted.
Saw endocronologist today. What a cluster. First, she was running 1.5 hours behind and no one called. Don't you just love that? Then when I finally saw the woman she had obviously not read my list of meds or anything that was going on with me. She was going to put me on a new medication (not related to thyroid) because of my sex hormones. When I then asked (for a 2nd time) about adjusting the amount of testosterone in my prog/test cream (because my DHEA was high) she said "oh! you are already on sex hormones! Never mind!" Unreal. I felt like she was utterly clueless.
To make matters worse she wants to repeat my bloodwork even though it's only from 2 weeks ago because "things can change." Mind you, she did order a host of tests to potentially get the bigger picture (see list below) but I practically had to BEG for a thyroid med based on the .9 level noted previously and the nodules. She indicated there is no evidence that the meds shrink the nodules. Yeah, I'd read that too. But STILL- I'm borderline hypo; and she didn't really deny that-- that's when she brought up the new bloodwork and the subject got changed.
So she gave me and RX for synthroid (smallest dosage- .25 if memory serves) to take every other day. AND she marked that "substitution is permissible."
Anyway, I get the biopsy day after tomorrow and will at least rule out maligency then (hopefully).
After this cluster of a visit I am seriously thinking about taking my care of this back to my primary care doc who has a good head on her shoulders and is always willing to discuss options. She was on leave due to some family issues but is back in biz now.
So here is what the endo doc ordered:
*Acth, plasma
*CBC w/diff, w/plt
*Comprehensive metabolic panel
*Cortisol, am
*FHS, LH, Prolactin
*Insulin, fasting
*Lipid Panel
*Thyroid Cascade Panel
*Thyroid Panel
*TSH, high sensitivity
*Vitamin D, 25-hydroxy, Total
When I asked about T3-Free testing she said it's very expensive (hence why it is rarely ordered as part of normal thyroid testing) and it isn't all that helpful.
Oh, and when I asked-- if the nodules are benign and I don't go on any meds what stops them from growing, etc. "Nothing," she says. !!!
She also said I may just have metabolic disease and/or pre-diabetes (the latter runs in my family, for sure) and wanted to put me on Metaformin in case blood sugar is causing these issues (e.g. being pre-diabetic). Yet my BS has been normal, although the higher cholesterol is a marker for diabetes evidently. Talk about confusing! I feel like i need to see her again, though, to fully understand all of this. Although that's probably a BAD idea!
Last edited by JillinPhoenix; 03-28-2011 at 05:07 PM.
Jill -
What a day you've had! I'm so sorry. I think I will come armed with Nook and coffee just in case my dr is as late as yours was.
My path to this point has been G.P. with Xrays-then med lab for blood work and follow up for ultra sound. Then biopsy done (which came back benign-ha!) Follow up with ENT then heart stress test and finally a decision that even if the nodules were not cancerous that they were so bothersome that surgery was called for.
Post surgey was the cancer diagnosis and referral to Daniel Duick, the endrocrinologist. (Who doesn't sound and fuzzy - but I'll take smart.) Whom I haven't seen yet but who will start the RAI process.
If you're thinking about going back to your G.P because you're ., have you seen an ENT yet? That was my second step. And if nothing else, I'd see an alternative endocrinologist. (Who was she?)
I think stress is part of the thyroid problem - and this certainly isn't helping!
Any additional insight now that I provided all the facts (my bad).
