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    Old 04-07-2006, 09:17 AM   #1
    azmomof2
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    Question thyroid ultrasound

    Does anyone happen to know what it means when a nodule doesn't appear to be "hot" or "cold"? I had went to my endo last week for an ultrasound guided fna and returned to her yesterday because I have been having some pain since the procedure. After doing some research, I had asked her if the nodules that she had discovered were hot or cold and she said niether. Has anyone ever heard of that? And to top that off, the fna had come back as undiagnostic meaning I have to have it done again in 3 months .


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    Old 04-07-2006, 11:09 AM   #2
    ksosno
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    Re: thyroid ultrasound

    undiagnostic usually means they did not get enough of a sample. This occurs when the FNA is not done with a guided sonogram and there isn't a lab tech looking under the microscope to to tell the radiiologist if more fluid is needed.When I had mine done it was at a major teaching hospital done by a radiologist with guided sono and lab tech waiting outside checking samples. The radiologist was told by the lab tech to go back in and get more samples right there. My endo advised me to go to a teaching hospital and not a local community hospital for this reason. Even though they got enough samples the type of cells that they pulled out were determined to be suspicious and that they could only tell for sure what they were by having surgery to remove Thyroid. At the advice of my friend I got another opinion at Sloan Kettering Hospital. Brought the exact same slides and their pathologist interpreted the cells as inflammed absolutely none were suspicious but rather inflammed due to my Hashi's disease. Surgery was totally avoided just have to go for sono once ayear. Needless to say I will go to Sloan for this as well. The interpretations of thyroid cells are often not that easy. Make sure the pathologist has alot of experience reading thyroid cells. I found out that at the teaching hospital I first went to the pathologist that read my slides thus far had read 130 thyroid cell slides while at Sloan for the same period they were up to 4000. Also at Sloan the patholgists become expert in specific cells for ex. thyroid ,breast etc, rather then just general. My endo advised me to go with the path report form Sloan as she was familiar with the way their lab was run because she did a fellowship there.

    Last edited by ksosno; 04-07-2006 at 11:11 AM.

     
    Old 04-07-2006, 11:40 AM   #3
    azmomof2
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    Re: thyroid ultrasound

    Thank you for you response ksosno. Did you have an fna due to nodules that were found? It was actually my endo who performed the fna in her office using a guided ultrasound. She did tell me that there would be a 15% chance that the test could come back as undiagnostic. She said that for the next fna she will send the slides to a different lab. If that doesn't work, she will then send me to a radiologist.

     
    Old 04-07-2006, 12:02 PM   #4
    ksosno
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    Re: thyroid ultrasound

    Yes dx with nodules felt and confirmed on sonogram. Why doesn't your endo just send you to a radiologist with lab tech right there instead of having you go through this possibly again. Go where you can get a enough of a sample the first time so you do not have to be poked and prodded again and also so you can have some type of DX instead of guessing and waiting. Were your cells determined to be suspicious or did she not get enough sample? These are two different issues. As I stated undiagnostic usually means not enough sample with sufficient cells to be read, in that case you should go to a radiologist to do the proceedure but if the lab's pathologist is having difficulty interpreting the results then you should have the slides sent somewhere were the path has alot of experience with thyroid cells. My endo also gave me a copy of the path report, you should get yours too so you know the reason yourself.

    Last edited by ksosno; 04-07-2006 at 12:09 PM.

     
    Old 04-07-2006, 01:46 PM   #5
    azmomof2
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    Re: thyroid ultrasound

    After she did the procedure, I asked her what she thought and she said that it looked like hashi's to her and that all we could do was hope for the best. I'm still having some discomfort since the procedure and yesterday she told me after she performed another ultrasound that if I'm still in pain in 2 weeks that she'll send me to have a ct done. I can not believe all of the hair I have started to lose in the past few weeks. On top of that, my hair is starting to grey. I'm 28years old and have more grey hair than my sister who's 4 years older than me. At this rate, I feel like I will be grey (if I still have hair left) within another 5 years. I did do some research though for the hair loss and they say that taking evening primrose oil will help. If there was one thing that I could change about having hashi's, it would be to have more energy. I feel like the lives of my children are passing me by. I have a 2yr old son and a 4yr old daughter, both of whom are adopted and I can't even keep up with them.

     
    Old 04-07-2006, 03:33 PM   #6
    hyperkim
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    Re: thyroid ultrasound

    On hot or cold nodules...that is usually seen on uptake scan results.

    With the uptake scan, they give you a small amount of radioactive iodine. Then take xrays of your thyroid. The scan will show if you have nodules and if they are hot or cold.

    I think if they are "hot" the nodule appears more lit up with radio activity than the rest of the thyroid (because hot nodules are absorbing more iodine than the surrounding tissue). And a "cold" nodule appears less lit up (I think, I'm not sure on this one) because it is not absorbing as much iodine as the surrounding tissue.

    So, from my understanding, your dr will not be able to tell if your nodule is hot or cold with a sonogram. Only from an uptake scan. Having said that they get more info from the FNA. The sonogram will show if you have nodules. With that knowledge, a dr can order and perform an FNA. The FNA results will show "what" the nodule is made up of (hashi's, graves, cancer, harmless fluid, etc.) If you can get all this info from sono and FNA then you do not need to have an uptake scan. The also use the uptake scan to see how much your personal radio active iodine uptake level is. They use this info to administer RAI as a treatment for hyperthyroidism.

    So as far as testing, it seems your dr is on the right track. I have no experience with FNAs. So I would go with the other advice already given on that issue.

    Hope that helps some.
    HYperkim
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