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  • Ultrasound Report Would Appreciate Input (long)

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    Old 11-01-2007, 08:02 PM   #1
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    Ultrasound Report Would Appreciate Input (long)

    Saw my Endo last week for yearly exam. At end of appt he happen to ask if I had any difficulty swallowing, I said yeah when I cough I get this big lump in my throat that takes a while to go away. Also tickling in the throat, extremely tired, gastro/intestinal issues all summer, heart palps and just a general total lousy feeling. Sent me for an ultrasound. Called me in today w/findings. He was surprised at what they found. Said he wasn't expecting this at all. Listed below is the report:

    Sonographic scanning of thyroid gland is performed. Right lobe measures 4.2x1.4x1.4 cm and left lobe 4.6x2.2x2x1.7cm. Isthmus is normal in thickness at .02cm. Single node is seen on each side, one measuring 9x3x12mm on right and 12x8x4 mm on left.

    Multiple nodules seen. One superioirly on right measures 12x9x9mm and hypoechoic appearance w/minimal vacular flow along its periiphery. No clear cut calcification seen within it. Second nodule just inferior to this area and again anterolaterally located measureing 9x7x6mm. Minimal vascular flow is seen along its periphery.

    There is a third hypoechoic nodule measuring 7x5x4mm laong junction of the isthmus and the right lobe without clear-cut vascularity or calicification. Posteriourly and more inferiorly located is a fourth nodule measuring 11x8x9mm which is heterogeneous and hypoechoic without clear cut vascularity. Finally there is a tiny nodule inferiorly on the right measuring 4x2x2mm again with out any clear cut vascularity, but hypoehoic in appearance.

    Left lobe has a lobulated hypoechoic solid nodule superiorly and anteriorly measuring 3.5x1.5x.08cm in size and some vascular flow is seen within it and there is also a heterogeneous lobulated hypoeechoic area midportion on the left measuring 12x9x5mm which has some vascular flow withing it. Finally, inferiorly on the left is a smoother hypoechoic solid nodule without clear cut vascularity measuring 8x7x5mm.

    Impression: Thyroid gland is at upper limits of normal in size and heterogeneous. A more discrete hypoechoic lobulated solid nodule seen anteriorly and laterally located on the left with some increased vascular flow within it measuring up to 3.5x1.5.08cm and there is another nodule with slight increased vascularity in the midportion of the left lobe measuring 12x5x9mm. Additional nodules are seen bilaterally, the largest on the right superiorly measuring 12x9x9mm in size. Non-enlarged lymph nodes are present.

    So my doctor said main concern are the 2 on the left that contain some vascular flow. He recommended 3 options. 1-biopsy the nodules (the 2 w/vascular flow), 2-stay on Levoxyl and do nothing, and 3 total removal of the thyroid. Said my decision. Said chances of cancer 5-10% but not likely. Told me to take some time and think about it and to let him know what I wanted to do. While he didn't come right out and say it, I believe he is leaning towards taking the thyroid out. I'm leaning that ways too, but really not looking forward to "going under the knife."

    Was dx'd w/Hashi's in 2002. Been on levoxyl since. Currently on 100 daily. Just added cytomel .5ng in morning and .25 in evening. Last labs done a week ago were TSH 2.7, FT3 254 and FT4 1.0.

    Thoughts, layman's explanation of report, suggestions welcomed.


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    Old 11-02-2007, 05:00 AM   #2
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    Re: Ultrasound Report Would Appreciate Input (long)

    Sounds like the typical "multinodular goiter" an enlarged, lumpy bumpy thryoid, probably from thyroid disease, such as hashimotos, nothing deadly, just something you have to figure out.

    You definitely need those larger nodules biopsied, although they are not likely cancer. The ultrasound doesn't say much, there are many people walking around with nodules, and most are vascular because the thyroid itself is vascular, and sometimes things like that calcify in the thyroid, and it is just a red flag to biopsy, not a red flag for cancer (in other parts of the body, those results would be worrisome, the thyroid is different).

    After the biopsy (which is a nothing procedure for most), you can try meds and keep watching the nodules for growth and changes, see how uncomfortable you feel, and then figure out what to do later on.

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