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  • Another nodule question.

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    Old 04-18-2005, 05:38 PM   #1
    mbmb1212
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    Another nodule question.

    I was scheduled today for a FNA biopsy on a 2cm solid nodule. The doctor that reviewed the original ultrasound recommended biopsy as well the gen. surgeon my GP refered me to while I wait on my first Endo appt.
    The hospital surgeon said he feels 2cm is too small to biopsy- would probably come back inconclusive. He declined to do the test unless thyroid scan comes back cold - I have the scan next week (of course he waited to tell me all this until after I had already been admitted for over an 1hr and missed work but that's typical of the care I've been getting.)
    Should I just accept this or should I be pressing for the biopsy?

     
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    Old 04-19-2005, 05:14 AM   #2
    Lorid
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    Re: Another nodule question.

    In my case, the nodule was 3cm and my doc wanted to do the biopsy, if I were you, I would push for the biopsy...just to be safe. Good luck. Lori

     
    Old 04-19-2005, 06:37 AM   #3
    Benzi
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    Re: Another nodule question.

    Two CM is not too small to biopsy but I would be leary of a surgeon that thought it was. A good surgeon could biopsy a nodule that was half that size. I wonder if he was feeding you a line. It may be however that the location of the nodule is in a hard place to reach by FNA. That would explain why the scan. Some surgeons are just more cautious then others about making sure all your tests are in order before doing certain procedures. If the ultrasound read cystic nodule he really might not have to do a FNA or if it looked to be really calcified it might make it pretty hard to do a FNA so unless you have a copy of the report, I could not second guess him.

     
    Old 04-19-2005, 06:37 AM   #4
    KCThy
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    Re: Another nodule question.

    I think the standard is over 1 cm, they should biopsy it. I've read that on several reliable websites (ie, John Hopkins, Mayo, St. Luke's - not sure if I can say that). I had one 1.9cm and they didn't hesitate to biopsy it. In my opinion, this absolutely should be biopsied and if it comes back benign, it should still be monitored closely, i.e. sono again 3-4 months to see if it's growing, shrinking or what. How was your blood work?

     
    Old 04-19-2005, 10:37 AM   #5
    mbmb1212
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    Re: Another nodule question.

    Thanks for the replies.
    He said right now the "benefits would outweigh the risk" of the biopsy. I don't have any other risk factors other than the nodule being single and solid and the size but I still was shocked when he declined to do the biopsy
    .
    I have been diagnosed hyperT; last blood work was normal for antibodies;
    TSH - .04 (.4-5.5); Total T3- 238 (60-181); T4- normal (I can't remember the #.)
    So... I am assuming maybe it is a hot nodule and causing my problems?
    I finally get into the endo on Monday- after months of waiting and doctors passing me off each other- Hopefully he will take ownership of everything.
    If it is a hot nodule- do you think they would recommend RAI or surgery?
    Anyone have a preference between the 2?

     
    Old 04-20-2005, 07:51 AM   #6
    Benzi
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    Re: Another nodule question.

    MB I would recommend a biopsy no matter what. The reason is because it is a single nodule and they are considered more apt to be cancer, than multiple nodules. Mine was a warm nodule and they tried without success to talk me out of biopsy and removal. I refused to listen and it was cancer. (papillary, well encapsulated, no spread to lymph nodes, 1.5 cm) I had symptoms of hyper but all of my blood tests came back "normal" so I was probably borderline hyper T. Back then (1991) there was no such thing as borderline hypo or hyper, it's only been in the last few years that you hear that term. Lab values have also changed since then. My nodule showed a normal uptake on an uptake scan. No more, no less! Since I had cancer I am going to be always on the side of caution though, so maybe my opinion might be very prejudiced.

     
    Old 04-20-2005, 08:11 AM   #7
    mbmb1212
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    Re: Another nodule question.

    Thanks Benzi,

    I finally see the endo on Monday and will press for the biopsy. Hopefully he will be more proactive than everyone else I've seen. Thanks again.

    MB

     
    Old 04-20-2005, 08:21 AM   #8
    Red Maple
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    Re: Another nodule question.

    I don't know what you mean by a "hot" nodule. Two years ago I had a solid nodule (only about 1.5 cm) that came back "suspicious" with an FNA. It had type "A", or what they call pre-cancerous cells. That means that it does not show all the characteristics of cancer cells by does show some signs of cancer. I was scheduled for surgery about 3 months later. To my understanding from my doc, thyroid cancer is usually one of the slowest growing cancers and therefore in my case not an immediate risk thus it was safe to wait until a convient time for my doc to do the surgery. They needed to remove the right half of the thyroid gland to remove the nodule. A biopsy was done on the nodule and the results came back as no definate malignancy. The doc said there were a lot of the "type A" cells, but at this time it was not yet cancerous, and may never have become cancerous but it was what they call suspicious. I am very glad to have had the surgery and be rid of a problem. I am now hypothyroid and need to take synthroid the rest of my life, but I don't care. My advice to you is that if there is any suspicion that your nodule could be malignant-- HAVE IT REMOVED!!! I am so very glad mine was caught before it became a malignancy and a serious and perhaps life threatening problem.

     
    Old 04-20-2005, 08:44 AM   #9
    Benzi
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    Re: Another nodule question.

    There are aggressive forms of thyroid cancer, the worst is medullary or MEN"S, followed by anaplastic, hurthle cell and follicular the least agressive is papillary. This said there is a form of very agressive papillary thyroid cancer, that should be taken care of ASAP. There are also thyroid cancers that are iodine resistant and therefore hard to treat (must be treated with external beam radiation). Sometimes 2 or even 3 of these cancers can be mixed up in one nodule. That is why I recommend biopsy as soon as it is posssible. Yes the Dr's will tell you that thyroid cancer is very curable, non agressive ect.... This is true 90% of the time, what I have a problem is what happens to the other 10% of the people. Hi lisman, a hot nodule is a nodule that takes up more than it's share of iodine, sometimes but not always making a person feel a little hyper. I am glad your nodule was removed, best of luck to you.

     
    Old 04-20-2005, 02:20 PM   #10
    Red Maple
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    Re: Another nodule question.

    Hi Benzi. I am also glad my nodule was removed. Thanks for the great info on the different types of thyroid cancers. I am with you that 90% are not aggressive but was very glad I had a doc who takes all signs of a malignancy seriously. I am happy that I don't have to worry about being in that last 10%. I see my doc regularly and have sonograms etc. to make sure nothing pops up again. If it does at least it can be caught as early as possible so treatment will have the best opportunity of success.

     
    Old 04-21-2005, 07:06 AM   #11
    Benzi
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    Re: Another nodule question.

    You have a good Dr.then because he realizes that one year they can do a FNA and find no cancer cells and the next year the same nodule can change and become cancerous. That's one the reason's for sonograms, the other is to check for new nodules and change in size of old ones. So I assume yours is gone? Did they take it out along with your thyroid? If we all had a Dr. like yours it would be wonderful!

     
    Old 04-21-2005, 11:24 AM   #12
    Red Maple
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    Re: Another nodule question.

    Yes, Benzi, my nodule is gone. It was removed when I had surgery. To remove the nodule my doc had to take out half the thyroid. While I was "out" on the operating table, a "quick" biopsy done on the nodule/thyroid to see if there were any signs of a malignancy. If the biopsy had come back conclusive that cancer existed, the doc would have removed the entire thyroid gland to be sure there were no cells left in the other half of the gland to spread later. (of course I had to sign releases before surgery for that treatment if it was necessary). I got some flack from friends who said that my doc was too aggressive in treatment by removing half the gland when no definate cancer cells were present. Some people said he should have just treated it with radiation rather than surgery, but I don't care what anybody says--I am very glad to be rid of a "suspicious" nodule. I rest much easier knowing it is GONE with no chance of that nodule becoming malignant in the future. I am also pleased that my doc monitors me so closely with follow-up visits and ultrasounds regularly, so far there have been no other problems. I do have a terrific doc, the only problem is that he is so good, and thus so very busy, it's sometimes difficult to get a convienent appointment.

     
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