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  • I just picked up my thyroid u/s report, and I have questions

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    Old 02-09-2010, 07:22 PM   #1
    Lugrita
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    I just picked up my thyroid u/s report, and I have questions

    I have Hashimoto's and had a thyroid u/s on January 27th and they called me two days later to tell me that I have a nodule on my right lobe and they need to do additional scanning. Last week they gave me more info, and they told me that it's a solid nodule and it looks suspicious, and they want to do a nuc med thyroid uptake scan. So I scheduled the scan for next week, as I was told to do.

    I went in today to pick up the order for the test and to get a copy of the u/s report, and I am wondering if they are jumping the gun in sending me in for the uptake scan. Here is the info from the report:

    "A tiny 3mm hypoechoic complex nodule in the right mid lobe. Follow up scans suggested."

    "Mild increased vascularity around the left lobe may be due to thyroiditis. No other dominant nodule"

    Other than that, everything is totally normal on the u/s - size of thyroid gland, etc.

    Do they *really* need to do a nuc med thyroid uptake scan on a 3mm nodule? I want to do whatever I need to do, but at the same time, we have a PPO and these tests are really expensive. I'm wondering if "follow up scans" refers to future u/s scans, and maybe the doctor is being too concerned and jumping the gun?

    I would love input on this. If this is standard stuff for a complex nodule, then I'll be a good girl and keep the appointment for the uptake scan. But if this isn't what is usually done for a 3mm nodule, then I would love to know what the alternatives might be.

    I do have symptoms from the nodule, though I can't palpate anything on the right side. But I started going hoarse before Christmas, and now I'm hoarse most of the time. I feel like I am being choked/gagged, too - like there is a lump in my throat. But in seeing the size, I can't understand how something so tiny could make me feel all of that.

    I have one other question: The u/s report says that the nodule is on the right lobe, but I feel a tender lump on the left side of my neck in the thyroid area. When the tech did the u/s, she spent most of the time in that same area and it was tender in that spot when she was doing the u/s. So I don't have a clue of what I'm feeling in the left side, but I don't feel anything on the right side.

    And one other thing that may or may not be related: I have swollen lymph nodes on the left side around my neck and such, in my armpits, etc. They come and go, and have done so for quite awhile (independent of sickness and such). I read that there is a connection, sometimes, between the swollen lymph nodes and a complex nodule, but I don't know if/how that is the case.

    Thanks for any input. I'm just trying to figure out the best route with all of this, and 3mm just seemed like a tiny, tiny thing to fuss over.

     
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    Old 02-10-2010, 01:12 AM   #2
    Lugrita
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    Re: I just picked up my thyroid u/s report, and I have questions

    Okay, maybe my thyroid isn't as normal as I thought, but I still don't think there is a problem beyond the regular ol' Hashimoto's (but I know nothing about this stuff, LOL). It's "heterogeneous in echotexture", which I ignored before because it seemed to mean nothing, but from what I just came across in my reading it has something to do with the Hashi's?

    Can anybody translate this stuff? ;-P

    Last edited by Lugrita; 02-10-2010 at 01:12 AM.

     
    Old 02-10-2010, 08:55 AM   #3
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    Re: I just picked up my thyroid u/s report, and I have questions

    I can't interpret imaging tests but can help you with the meaning of heterogeneous... "consisting of or composed of dissimilar elements or ingredients; not having a uniform quality throughout." I think that is indicative of a Hashi's affected gland, which can be lumpy, bumpy, and atrophied in spots. Not uniform in texture, as a normal gland would be.

    I have good insurance, but I'm frugal... some would call me "cheap". Board members who have actually dealt with thyroid cancer (unlike me) might be able to give you the best advice; but I tend to think there might be some gun jumping going on here. A 3mm nodule is very tiny. Seems to me that a yearly follow up ultrasound - not a nuclear uptake - would be adequate unless growth becomes rapid.
    ETA: Of course, a nuclear scan would indicate whether the nodule is cold, which suggests cancerous tissue. But still... It's very small.
    I hope Reece or another thy-ca survivor will offer input for you.

    How does your insurer feel about second opinions? I'd be inclined to get one or two more before spending wads of insurance allowance on this right now.

    Last edited by midwest1; 02-10-2010 at 08:59 AM.

     
    Old 02-10-2010, 09:37 AM   #4
    Lugrita
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    Re: I just picked up my thyroid u/s report, and I have questions

    Thank you! That's really what I'm thinking about the whole thing, that a yearly u/s would suffice unless I start getting a noticeable lump in my neck sooner than that.

    I have a PPO so I am free to get a second opinion, but it would likely cost me around $200 to do that since I have a way to go before I meet my deductible. So unfortunately that isn't a feasible option at the moment. I also don't want to blow $1000+ on a nuc med scan when the nodule is only 3mm, and I'm guessing that the nuc med scan would cost at least $1000-$1500 since a brain MRI cost us nearly $1400. Again, we pay all of that out of pocket, and right now we would have to arrange to make payments on it because times are tough (hubby had a pay cut, and I'm a home-schooling mom to four kids) and we just don't have that kind of money to blow at the moment. If it's crucial to take care of this now so that I can better take care of my family, I'll do it. But again, for 3mm, I really think it's safe to just watch it every year.

    I'm going to call the doctor and see if I can talk it out with her over the phone, so that I don't have to make another appointment just for this. I do have a good friend who is a family practice doc, so I will send an e-mail to her with the info from the u/s and see what she thinks.

    Thanks again!

     
    Old 02-10-2010, 10:15 AM   #5
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    Re: I just picked up my thyroid u/s report, and I have questions

    Your plan of action sounds good. Talk it over with those two individuals. Even though it's always best to err on the side of caution in medical matters that have the worst outcome potential, I fully understand your financial situation and wish to be conservative in your spending. (Sending my most positive energy your way that it reverses soon... That the whole economy gets better soon!)

    Keep watching this thread. I'm hoping Reece pops in soon to help.

     
    Old 02-10-2010, 11:20 AM   #6
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    Re: I just picked up my thyroid u/s report, and I have questions

    The uptake scan is an ancient test from the '50's, and it might not be as expensive as you believe, but I think you can wait on it, and if there's growth or changes, worry about it then, as most doctors would just fna this when it was around 1cm, and yours isn't even near there. It's not a crucial test right now.

    Thyroid cancer, which I doubt you have, is very slow growing, and more modern ENT's wouldn't even bother with the uptake scan for nodule purposes (maybe if they were worried about graves or thyroiditis, but not such a small nodule).

    My only concern for you, is that you say you are hoarse? That is a symptom of thyroid cancer, but more when it's advanced, which a 3mm nodule would not represent advanced thyroid cancer.

    It could be acid reflux (you could always try prevacid for a couple of months to rule it out), but with the lymph nodes and the hoarseness, I would not worry about the uptake scan, but keep following that over time with a good ENT (if this is still going on in lets say 3 months) because there may be something unrelated to thyroid that I would be far more worried about.

     
    Old 02-10-2010, 02:53 PM   #7
    Lugrita
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    Re: I just picked up my thyroid u/s report, and I have questions

    Thank you both so much! I called the doctor's office and asked if they would be fine with me canceling the scan and check it later on via u/s, since it's so small. I was going to cancel the scan anyway after reading your replies, but I want to keep things happy with the doctor so that I can start on the meds and finally treat the Hashimoto's (because I feel horrible right now!). She was fine with that, and they want me to do an u/s in 6 months instead of 12 months, but I'm totally willing to do that if I can forget the uptake scan altogether.

    I'm going to keep an eye on the hoarseness and lump-in-throat thing, mainly because it's really annoying. It's at the point where the pressure/lump feeling is so bad that it's making me gag, which then makes me dry heave. Attractive! I'll try taking stuff for reflux to see if that helps, and hopefully that will be the end of it. It if persists I'll definitely have the doctor check things.

    Thanks again! You two just saved me from doing an unnecessary test! Thank you!

    ETA that I finally have the okay to start the levothyroxine tomorrow (starting, and hopefully staying, at 50mcg). So hopefully it won't be long before I start to feel more human again!

    Last edited by Lugrita; 02-10-2010 at 02:55 PM.

     
    Old 09-08-2010, 10:59 PM   #8
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    Re: I just picked up my thyroid u/s report, and I have questions

    By all means have the tests done. Small things can become big things. I have been having all the symptoms of hyperthyroidism for 7 years, gone to doctor after doctor and none could diagnose my problem. I too have a chocking feeling in my throat and last week I found the lumb myself. Went to the doc, he has me scheduled for a test in two weeks. My white blood cell count is very low and am scheduled for a bone marrow biopsy this week. My spleen is enlarged and my mouth and face is turning yellow. I have developed a white film in my mouth and my mouth hurts 24/7. I have been diagnosed with every thing imagineable except thyroid problem. Be glad they found the lump early and do whatever is neccessary to fix it. It could become cancerous. I'm afraid I have gone too long. My lump has grown so that it is actually visible on the right side of my throat.

     
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