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    Old 10-28-2005, 02:24 PM   #1
    missyb57
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    Question Question about Cold Nodule and Graves/Hyper

    I finally got the results of my RAIU scan and blood work but have a question.

    My dr said that I was definitely hyperthyroid and that the hospital FORGOT to do the TSI. So he couldn't say Graves for sure, but suspects it. So I went back and took another blood test for the TSI.

    But, the RAIU scan showed a single "cold" nodule on the right lower lobe. I was under the impression that nodules associated with hyperthyroid or Graves were "hot" nodules?? Everything I can find seems to indicate that.

    I am going to see an endocrinologist but not until Dec 14. Long time to worry about this!!

    My dr did tell me that the majority of nodules are benign, but since I also have swollen lymph glands in my throat and under my left arm and have hoarseness and a non stop sore throat, that he is a bit concerned.

     
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    Old 10-28-2005, 03:00 PM   #2
    K9Mom
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    Re: Question about Cold Nodule and Graves/Hyper

    If your doctor chooses to do so, they can call the Endocrinologist and lobby on your behalf to get you seen quicker. They can send the Endo your lab results and uptake and scan results for the Endo to evaluate to see if he thinks you should be seen sooner.

    I can only tell you what *I* would do if I had a cold nodule....I would definitely have it biopsied. It's always better to be safe and find out that it's nothing...than sorry if you don't have it done and find out it's malignant.

    People with Graves can have cold nodules, hot nodules or no nodules. Good luck!
    __________________
    Dx Graves 4/99, tx w/Tapazole & Atenolol - Remission 7/03; Relapse 1/06, back on Tapazole, remission & off meds again 11/06.

     
    Old 10-28-2005, 05:29 PM   #3
    merrillin
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    Re: Question about Cold Nodule and Graves/Hyper

    I would make them act quicker........................since my nodule was complex and I had swollen lymph nodes my surgeon acted right quick. Everything was fine but it is better to get it checked out right away. Do NOT let dr's put you off because in the end it is your life that is affected.

    Good luck,
    karen

     
    Old 10-29-2005, 05:44 AM   #4
    missyb57
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    Re: Question about Cold Nodule and Graves/Hyper

    Hello All,
    I just received an email from someone who has been helpful to me throughout my new thyroid event, but what they wrote is something that I am not sure about and I really need to know some other opinions about it.

    Here is what they said:
    A nodule or a goiter can result...and they can be hot or cold...cold is better of course since it can dissolve and go away on it's own.

    I was under the impression that a "cold" nodule was worse than a "hot" nodule and I want to know if it will dissolve and go away on its own.

    No sense worrying if it really isn't necessary!!
    Thanks

     
    Old 10-29-2005, 06:50 AM   #5
    K9Mom
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    Re: Question about Cold Nodule and Graves/Hyper

    It is my understanding that a cold nodule is more worrisome than a hot nodule. Your friends information sounds erroneous to me. There is a good section on thyroid nodules on endocrine web.

    NO nodules "dissolve" on their own....especially solid nodules. (Cystic nodules which are fluid filled can burst and be reabsorbed)
    __________________
    Dx Graves 4/99, tx w/Tapazole & Atenolol - Remission 7/03; Relapse 1/06, back on Tapazole, remission & off meds again 11/06.

     
    Old 10-29-2005, 08:09 AM   #6
    merrillin
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    Re: Question about Cold Nodule and Graves/Hyper

    right..................cold nodules are the ones for concern. Nodules can go away in a rare case, but most of the time they grow. You need to have them biopsied if they are cold to make sure you are not dealing with cancerous or pre-cancerous cells. I think you got some wrong info there from your friend.

    Karen

     
    Old 10-30-2005, 06:47 AM   #7
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    Re: Question about Cold Nodule and Graves/Hyper

    Statistically, cold is more likely to be cancerous than hot. However, a cold one won't be pouring extra hormones into your body---so in that way, perhaps it is perceived as "better."

    Don't worry, even a cold one is statistically not very likely to be malignant.

     
    Old 01-04-2006, 02:05 PM   #8
    missyb57
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    Unhappy Re: Question about Cold Nodule and Graves/Hyper

    After 11 weeks waiting, I finally got to the Endo appt.

    I think this appt was very disappointing. I did not even get to see a dr, I saw a Nurse Practioner. She started by asking me if I was on the Premarin when I had the blood tests done originally, and I said yes, now I have researched all this as you can surely guess so I know what she is going to incenuate. Sure enough she said that she didn't think that hormonally there was anything wrong with my thyroid because the Premarin will cause a false reading.

    Then she says, so you had your first blood work done on Oct 10 and they only did the T's and she said they should have done the Free T's for an accurate reading, which I knew too, but did not know why they didn't do it. So then she says--well finally on the 20th someone decided to order the right bloodwork and check the Free T's and it all came back negative.

    So I asked her did she have my TSI test and she said no. So I said well what other blood work are you talking about? I had blood work done on the 10th and they forgot to do the TSI so I went back on the 27th and had that drawn and that is the only blood work I have had done, I have never had the Free T's done. Can you show me the paper where you got that information from?

    So she hands me the blood work results sheets--for a ANDREA S**** ordered by a Dr B*** and not even my Dr!!!

    I just looked at it and then at her and I said--These aren't my blood test results!! So she takes it out of my hand and said Oh your right there Andreas. Well no matter, I don't believe since you are taking Premarin that there will be anything wrong with your thyroid hormones, but I will order more blood work and make sure that we get your Free T's done.

    So I said to her, well if I don't have anything wrong with my thyroid, then why do I have a cold nodule and why did my dr tell me there was a possibility of cancer?

    Well your uptake scan was normal but the thyroid scan did show a nodule and it "might" be a cold nodule. I am ordering a thyroid ultrasound for a more definitive answer.

    So I asked to see the test results and it said
    There is a 9mm nodule that appears to be a cold nodule on the lower right lobe of the thyroid.

    She said that my RAIU results were normal, but I asked to look at them and the 6 hour was 44% and the 24 hour was 33% which I was under the impression was still above the range limit, but I could tell there was no point in mentioning that to her.

    Then I asked her why then has my throat been sore since the very day of the scan and now my voice is so hoarse.

    Well she said, you might have had a reaction to the radioactive iodine and it hasn't worn off yet.

    I said in 3 months time it hasn't worn off yet??

    Well, we just have to wait to see what the ultrasound shows, that is the gold standard for this type of thing.

    She then proceeded to tell me that in her "opinion" the thyroid gets bored and decides that it has nothing better to do so it decides to create some more material in itself and that is where the nodules come from. Sometimes they will just disappear on their own in 6 months.

    I wanted to laugh but forced it back, what an analogy and I have read nothing that says that they just disappear on their own!

    So she made me an appt for the 16th and I asked her if I was going to get to see the dr this next time and she said yes.

    Otherwise, I had no intention of going back there!!!

    So I know nothing more than I knew when I went in there.

    So I called and got an appt for Friday for the thyroid ultrasound and TSH FT4, FT3 and Thyroid Antibodies tests.

     
    Old 01-05-2006, 07:37 AM   #9
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    Re: Question about Cold Nodule and Graves/Hyper

    Oh Missy, what an awful apt!!!! I cannot believe it...............is there anyone else in town you can get to? You do not have to deal with an endo to get the right help. ANY dr can order a biopsy of a nodule and that is what should be done NOW! Do NOT let dr's bully you or blow you off for months. I had an awful hoarse voice for months and when I finally got into the right surgeon he took my thyroid out in 1 week. He said hoarsness is always a cause for concern and means the nodule is pressing on your vocal chord. In my case once he got in there the nodule had grown all around my vocal chord and was very entangled.................

    Make sure you push to get his answered now, it sounds like you are getting awful advice and information................I know it is stressful but you have to take your health into your own hands not rely on drs to take care of you, they just don't do it anymore.

    Keep looking for someone who can take care of this now. The first order of business is getting that nodule biopsied and find out what is going on. Do you have a family dr?

    Please keep us posted on what is going on.
    Karen

     
    Old 01-05-2006, 08:56 AM   #10
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    Re: Question about Cold Nodule and Graves/Hyper

    Bless your heart.
    Have they done a Fine Needle Aspiration yet to check the cells & see if they are cancerous or not? It's really not that big of a deal & the endo should be able to do it in his office the next time you see him.
    So, they have already done the RAI, right? Have you had any labs done since then & what do they look like? I had RAI done to treat Graves in October of 2002 & by January I was severly Hypo. I can't believe how much of a run around they are giving you!! What an absolute mess. I'm confused as to why they would give you the RAI prior to knowing if the nodule was benign or not. I may be missing something though. I, too had nodules, but mine were hot & they shrunk after having the RAI done.
    Please keep us posted. I'm sorry you are having such a tough time!

     
    Old 01-06-2006, 05:15 AM   #11
    missyb57
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    Re: Question about Cold Nodule and Graves/Hyper

    I have checked and there is 1 other dr that is in my area that is on my insurance plan but her field is listed as Endocrinology and Metabolism. I checked and she is an MD. She is fairly young. I don't know how soon I would be able to get into her.

    Today I am going for the thyroid ultrasound and I hope the radiologist who originally read my RAIU scan will be there to do it. I am going to ask them to send the results to my reg dr as well as the endo. I have an appt with reg dr next Wed and I intend to tell him of my unpleasant visit with his referred to Endo!

    I have not had RAI, I had a Radioactive Iodine Uptake scan done on Oct 10. I have had no treatment from any drs yet.

    Thank you all for your concern and answers. I was wondering if there was any woman that was on Premarin or other HRT and had thyroid problems if they had false readings or problems with readings? I have researched it and I do realize that it can alter the test results, but I can not believe that it will mean that I have nothing wrong with my thyroid.
    Thanks again.

     
    Old 01-06-2006, 07:10 AM   #12
    merrillin
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    Re: Question about Cold Nodule and Graves/Hyper

    missy,

    No matter what other meds you are on the fact that you have a cold nodule is all you need to "prove" to a smart dr that you have something wrong with your thyroid. A cold nodule should always be taken seriously and examined further. The thing is most of us here have had to push and go from dr to dr to find someone who knows what to do. Keep at it, this is your life and you have got to know what that nodule is and if you are dealing with an autoimmune thyroid problem or what kind of cells that nodule contains. Just get any dr to order a biopsy. My family dr is who ordered my biopsy, it doesn't have to be an endo. Just push to get that done.

    Keep us posted,
    Karen

     
    Old 01-06-2006, 10:25 AM   #13
    missyb57
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    Re: Question about Cold Nodule and Graves/Hyper

    I just got home from the thyroid ultrasound which also proved to be disturbing.

    First they wanted to know why my voice was hoarse, if I had a cold. I told them that it had been sore and hoarse since the RAIU scan. This set them all in motion trying to find out if that were possible. They even contacted the manufacturer of the Iodine pill who said that it was not possible that my sore throat and hoarseness was caused from the iodine pill at 3 months after the scan. They suggested that there must be something wrong with my voicebox or something pressing on my voicebox and that I should have my reg dr look into it.

    So then the tech looked at the RAIU scan results and then started to do the ultrasound. She stopped and called another tech. I heard her say to the other tech--Well her uptake was normal. The other tech said-= Well I don't know how it could be.

    Then she said to the other tech--am I supposed to measure ALL of these? The other tech said--Well I would at least measure the largest ones.

    So she did the scan and then went to talk with the radiologist before letting me go home.

    I watched her type on the screen Bilateral Mulitnodular Thyroid. So I said to her--Isn't it odd that the uptake scan showed a single cold nodule and now I have multiple nodules?

    She said the radiologist said that it appeared to be a Mulitnodular goiter but that my reg dr would discuss it further with me.

    I am so perplexed by all this. I just hope that next Wed my reg dr will be able to give me some sort of idea as to what is really going on with me and also my throat.

     
    Old 01-06-2006, 11:50 AM   #14
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    Re: Question about Cold Nodule and Graves/Hyper

    Missy,
    From someone who's had bad experiences with techs reactions, and assistants in doctor's offices-----please try to be patient, and wait until you see your doctor for the real report.{I had an assistant at my dermatologist office say I had skin cancer yesterday---it turned out she was looking at someone else's chart!)

    I remember getting info from techs, (or looking at the screen and guessing) and it was totally wrong. They often have no idea what they are seeing/talking about-they just record the info for radiologist to interpret--but they seem to. And what they say can make you crazy. So don't let it.

    The uptake scan can only see nodules that are either cold (by absense of color) or hot (stronger color) but can't necessarily see all, especially if they are functioning normally.

    The nodule could be pressing on your vocal chord, making you hoarse.

     
    Old 01-06-2006, 09:56 PM   #15
    merrillin
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    Re: Question about Cold Nodule and Graves/Hyper

    Before I had my thyroid out I sounded like I had a terrible cold for about 6 months............the day of the surgery my voice was back to normal. That is a sign something needs to be done. You might have several nodules.

    Keep us posted on what you find out from your dr, ok?

    Karen

     
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