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Old 10-04-2012, 04:10 PM   #1
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Large mass on thyroid/Need advice please

Well I am new to these msg boards and have never posted before. I am a 57 yr old female. I have been reading a lot of posts related to thyroid nodules. The past month has been an nerve wracking and emotional roller coaster for me. Last month, went to ER for swelling on right side of my face and swollen glands. For 3 weeks prior going to ER-I was sick with what I first thought was allergies, then worsened to cold symptoms, then flu like symptoms and pain in jaw area. So went I went to ER they did a Cat Scan to check lymph nodes and then incidentally found a 2.9cm mass on my thyroid and advised me to see an ENT dr. right away. Went to ENT dr. --had ultrasound --this is ultrasound results--
RT. thyroid lobe measures 5.7x2.0x1.5cm
It has a heterogeonous echotexture
Tiny round hypoechocic are seen in the right lobe measuring 0.3cm

Left thyroid lobe measures 5.7x2.1x1.7cm
It has a heterogeonous echotexture
In the mid lobe there is a 1.2x1.1x0.7cm isoechoic nodule.
In the lower pole there is a Dominant mass measuring up to 2.9x2.2x2.2cm

Isthmus --the thyroid isthmus measures .3cm

IMPRESSION: Multinodular node as described with dominant mass in left lower lobe measuring up to 2.9cm. There is also a 1.2 cm nodule in the left mid lobe. These are amendable to FNA

Ok so then I went and had the FNA--that was done on the 2.9 dominant mass--here are the results:

FNA left thyroid nodule
satisfactory for fna
Sheets and small clusters of benign appearing follicular cells with minimal colloid material, Favor benign nodule

Sparse lymphocytes also noted, suggestive of mild lymphocytic thyroiditis.
Recommend clinical and radiologic correlation and follow-up.

ok so the ENT dr's office called and said it was benign and to have another ultrasound in 6 months. I am new to all of this and was surprised when they did not even give me a follow up appt. for dr. to explain all the results and next steps to be taken. So I called back and said I had questions for the dr. and went in the other day. He said it can be left alone or I can have partial removal of thyroid--my choice--or check in 6 months if it got any larger. Well I am so confused right now--I am glad results came back as benign--but that was only done on the mass, my concern is the size of mass and other things listed on ultrasound. I do have problems breathing when lying down, and some times feel lump in throat or have to clear throat. How much bigger does this have to get? Should the whole thyroid be taken out or just partial? Read so many posts and so many differing opinions. I would also like to get a 2nd opinion and see another dr---ENT or ENDO.....any thoughts? I am already a very anxious person on meds for anxiety and depression which has worsened over the summer. My lab results for bloodwork also came back normal. Need some advice here please. Thank you

 
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Old 10-05-2012, 05:43 AM   #2
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Re: Large mass on thyroid / Need advice please

You have a multinodular goiter---a lumpy bumpy enlarged thyroid. You probably have hashimotos---hypothyroid. The worrisome thing is that this is constrictive, and if it keeps growing with further impede your breathing which it has already done.

You should first see an endo (you would need one if you have your thyroid removed anyway) and if you want you can see if medication shrinks this up after 3-6 months (in six months if you are not on thyroid meds, this will not shrink doing nothing).

If it's still there, and as large (or has grown), see an ENT that does many thyroid surgeries a week---this is not a "healthy" thyroid, as it's very enlarged---it can keep growing out of control, and you would want to likely take out the whole thing, because both sides are enlarged.

 
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Old 10-05-2012, 10:13 AM   #3
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Re: Large mass on thyroid / Need advice please

Thank you Reece!! I have been an Endo and I do have an appt with my primary dr. in a couple weeks. I am also going to ask her opinion on what I should do. I also did not mention that I have been suffering from depression and severe anxiety for several years--been on and off meds for depression. This past year the depression and anxiety has been the worse even while taking the meds. I have also gained about 20 lbs in past 2 yrs and that past yr feeling very tired, sluggish and no energy. My Mom also has Graves disease. Perhaps there is a connection to all of this. I thank you for your reply! However, my thyroid blood work came back normal, which is puzzling?

 
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Old 10-05-2012, 10:18 AM   #4
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Re: Large mass on thyroid / Need advice please

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Originally Posted by lizbitts View Post
However, my thyroid blood work came back normal, which is puzzling?
It may not be as "normal" as you're being led to think. If you want to post your results along with the lab's reference range for each one, we can perhaps help you identify what your MD may be missing.
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Old 10-05-2012, 03:56 PM   #5
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Re: Large mass on thyroid / Need advice please

Ok here are the lab results

Thyroid Antibodies
Thyroid Peroxidase (TPO) Ab Result.....9 Reference Inerval....0 -34

Antithyroglobulin Ab Result <20 Reference Interval 0 -40
Siemens (DPC) ICMA Methodology

TSH Result 1.000 Reference Interval 0.450 - 4.500

Thyroxine (T4) 9.5 Reference Interval 4.5 - 12.0

So here is what was on my lab report that ENT dr sent me for.
I have no idea what these mean. Maybe someone can help. thank you

 
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Old 10-05-2012, 03:57 PM   #6
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Smile Re: Large mass on thyroid / Need advice please

Ok here are the lab results

Thyroid Antibodies
Thyroid Peroxidase (TPO) Ab Result.....9 Reference Inerval....0 -34

Antithyroglobulin Ab Result <20 Reference Interval 0 -40
Siemens (DPC) ICMA Methodology

TSH Result 1.000 Reference Interval 0.450 - 4.500

Thyroxine (T4) 9.5 Reference Interval 4.5 - 12.0

So here is what was on my lab report that ENT dr sent me for.
I have no idea what these mean. Maybe someone can help. thank you

 
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Old 10-06-2012, 11:04 AM   #7
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Re: Large mass on thyroid / Need advice please

Okay... Your thyroglobulin antibody test is negative. Your TPO Ab is also, technically; but the titer is high enough at 9 that it's suggestive of Hashimoto's thyroiditis. A totally healthy person might have a very small titer of TPOs; but since you have thyroid symptoms, it can't be assumed your thyroid is healthy just because the TPO titer falls within normal range.

The other tests, unfortunately, are simply inadequate to diagnose thyroid disease. It can't be concluded that you have no thyroid disease based on them. The thyroxine test is inaccurate, especially in women, because the test is influenced by estrogen flux and some medications. The free portion of thyroxine is one of the two levels that matters most, so you must get an MD to order the free T4 test for you to assess your thyroid status. I suspect it's below lab median, which is too low for almost everyone. A low FT4 level could allow the gland to grow or nodules to form.

My advice is the same as Reece's. Get an MD to prescribe some replacement hormone for you to try and shrink those growths and to see if it helps your symptoms.
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Last edited by midwest1; 10-06-2012 at 11:06 AM.

 
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Old 10-06-2012, 12:20 PM   #8
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Re: Large mass on thyroid / Need advice please

Quote:
Originally Posted by midwest1 View Post
Okay... Your thyroglobulin antibody test is negative. Your TPO Ab is also, technically; but the titer is high enough at 9 that it's suggestive of Hashimoto's thyroiditis. A totally healthy person might have a very small titer of TPOs; but since you have thyroid symptoms, it can't be assumed your thyroid is healthy just because the TPO titer falls within normal range.

The other tests, unfortunately, are simply inadequate to diagnose thyroid disease. It can't be concluded that you have no thyroid disease based on them. The thyroxine test is inaccurate, especially in women, because the test is influenced by estrogen flux and some medications. The free portion of thyroxine is one of the two levels that matters most, so you must get an MD to order the free T4 test for you to assess your thyroid status. I suspect it's below lab median, which is too low for almost everyone. A low FT4 level could allow the gland to grow or nodules to form.

My advice is the same as Reece's. Get an MD to prescribe some replacement hormone for you to try and shrink those growths and to see if it helps your symptoms.

 
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