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Old 12-31-2012, 11:17 AM   #1
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I have multiple nodules on thyroid,I am wondering do I need a biopsy

Hi I have been having overall bone pain and always tired and abnormal bloodwork..Rheumatologist says bloodwork points to malignancy..Doctor said during a recent cat scan of lungs they noticed my thyroid is enlarged..They sent me for an ultrasound of thyroid and here are the findings,I am worried because i think they should biopsy them.

results:The thyroid is normal size. The right lobe measures 4.6x1.8x1.7 cm.The left lobe measures 4.9 x 1.6 x1.6 cm

There are multiple nodules within the thyroid.On the right there are colloid cysts measuring 5mm,9mm,9mm and 10mm. Ovoid,well defined hypoechic nodules measure 9mm,11mm. A solid and cystic nodule measures 12mm. A mixed echogenicity nodule measures 8mm. Within the left lobe ,there are colloid cysts measuring 9mm,5,, and 6mm. A mixed echogenicity nodule measures 8mm. A hyoechoic nodule measures 7mm.

There is a small colloid cyct within the isthmus measuring 3 mm

Impression;There are multiple,bilateral,interminate thyroid nodules withou suspicious features.Consider periodic physical exam or ultrasound to demonstrate long term stability...Bilateral colloidcysts. those are the exact words in report and noone has done any bloodwork to see how my thyroid is functioning...So teh question is do I push for more tests or sit back and wait until they decide to check it again...They did order a bone scan for all the bone pain ,but dont have results yet..

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Old 01-01-2013, 10:37 AM   #2
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Re: I have multiple nodules on thyroid,I am wondering do I need a biopsy

The thyroid issues you have may or may not have anything to do with your other issues.

You should have thyroid blood work done---tsh, free t3, free t4, tg antibodies, tsi antibodies. You have a "multinodular goiter" ---a lumpy bumpy thyroid usually the result of thyroid disease.

The thyroid disease could cause your symptoms, but even thyroid cancer doesn't cause "bloodwork points to malignancy"---thyroid cancer doesn't show in blood work. That's also just a strange thing to say without further explanation and alternatives. I wouldn't feel comfortable with a doctor who told me that alone.

I would see an endocrinologist to see if you can control the thyroid bumps with thyroid meds, and then get another ultrasound of that in 3 months (after on meds), and if anything has grown consider needle biopsies of the larger nodules, and see a surgeon at that point. It may shrink up if its from thyroid disease such as hashimotos.

In terms of the other stuff, I would consider seeing a hemotologist/oncologist to continue to rule out any cancers of other kinds. I have a feeling that a rheumotologist is not the right team for you for this.

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Old 01-03-2013, 11:59 AM   #3
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Re: I have multiple nodules on thyroid,I am wondering do I need a biopsy

I can say that my ENT recommends ultrasound guided FNA biopsy of all thyroid nodules that are 1 cm in diameter or larger. Mine are not quite there yet. 9 mm in diameter. Little annoying floating encapsulated spheres.... So we watch them. At first every 6 months.. Now once a year... They have been growing slowly despite thyroid supplementationTSH suppression. From 6 mm to 9 mm in the last 7 years. So I guess in another year they should be the right size for a poke.

I truly hope that you find the answers you seek soon!
If we learn by our mistakes, I am working on one hell of an education.

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Old 01-03-2013, 02:00 PM   #4
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Re: I have multiple nodules on thyroid,I am wondering do I need a biopsy

I would absolutely push for the FNA on your nodules. Guidelines all recommend nodules above 1.0-1.5cm should be investigated further and I am very surprised this has not already been suggested.

However, please bare in mind my endo explained that once they start carrying out biopsies they may decide to continue with scheduled FNA's on an ongoing basis to keep an eye on it and it increases your chances of surgery in the future. I'm not sure why but I think once they start reaching certain sizes they advise surgery anyway. Perhaps to stop intrusion on vocal chords etc??

My largest is 3cm and I'm scheduled for FNA in 3 months - but like you I have been pushing for investigation into mine for 6 months now.

I wish you all the very best with your results, please keep us posted on how you get on!

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