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Thyroid  (Expert Forum)
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Suspicious Thyroid Nodule
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida Sarasota - FL
Questions in the Thyroid forum are answered by Dr. Mark Lupo. Topics covered include goiter, graves disease, Hashimoto's thyroiditis, hyperthyroid, hypothyroid, thyroid cancers, thyroiditis, and thyroid stimulating hormone (TSH).
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MedHelp Member's Question

Suspicious Thyroid Nodule

by Justin1967, May 06, 2007 12:00AM
I'm confused as what I should do about my thyroid nodule.

Here is transcript from my ultrasound.

There is a large solid nodule arising from the mid to lower portion of the right lobe of the thyroid. This is quite well circumscribed with a halo appearance about its margin. It has dimensions of 4.2 x 2.5 x 2.8cm. It has a slightly heterogeneous echotexture and is entirely solid. Some blood flow was identified within it, although blood flow was more marked around the periphery of the nodule.

No abnormalities were detected elsewhere in the thyroid. The left lobe is not enlarged and the thyroid isthmus is of normal thickness.

This is a solitary solid nodule in the right lobe of the thyroid. This could well be benign but its size and solid nature makes it imperative for this to be evaluated further with FNA biopsies. Surgical referral is recommended.

My blood tests are normal according to my doctors and I have done a FNA biopsy and it came back inconclusive. I assume that I have a non-fuctioning cold nodule.

Are there alternatives beside surgery as I feel fine?
Doctor's Answer

by Mark Lupo, M.D., May 06, 2007 12:00AM
If the TSH is normal, would do FNA - as you did -- if inconclusive means 'follicular lesion' then surgery is indicated.  If it means not enough cells - then repeat the FNA.  It appears to be non-functioning based on the normal labs so surgery is the best bet in most cases.
Member Comments (9)

by lawteddy, May 06, 2007 12:00AM
I had a very similiar situation with a small nodule with irregular margins and an inconclusive fna.  My thyrpid levels were normal and I felt good.  I had my thyroid out and it turned out that the nodule was papillary carcinoma and the cancer was also found in one lymph node.

by Justin1967, May 09, 2007 12:00AM
To: Forum -M.D. Mal
What do you mean by " follicular lesion"?

The endocrinologist told me that not enough cells we taken on the FNA biopsy and the cells they were looking for were not there.

by Domenick, May 10, 2007 12:00AM
To: JUSTIN 1967
My wife is going through the same scenario almost word for word. The FNA results take about a lesion classified as a follicular neoplasm due to the increased cellularity and lack of features suggesting a hyperplastic module. Cytologic  atypia is not  present. Follicular adenoma should be ruled out. Her doctor first told her that means that her nodules were cancerous. After we questioned him about the report he called the pathologist and asked if they would take another look at the samples. The nest day we spoke with our doctor and he said that the pathologist now thinks that it is not cancerous. Our doctor is now sending her to get a PET scan. He said this will give us a better answer. He also told her that if this test results came back negative that he would not remove her thyroid. That even though one side is not working, the right side that has the nodules is doing the job and would not be taken out.

I don’t know if this helps or not, but it sure makes you think. The MD noted above that in most cases they would just go ahead a take it out. Her doctor is not thinking that way.

by Domenick, May 10, 2007 12:00AM
To: Justin 1967
I am sorry I miss read the MD’s note. Half of my wife thyroid is working and doing the job based on normal blood test. I guess if it was not there would not  be any question. He would also take it out.

PS: Best of luck

Try and post how things are  progressing. I am sure it will help me and my wife to see how things work out for you. I will try and do the same.

by Justin1967, May 10, 2007 12:00AM
To: Domenick

Hi,

Thanks for the post. I'm thinking of going for surgery just for the peace of mind. The nodule that I have may well be benign but I just don't know when it might change into something nasty if it hasn't done already.
I'm still reasonably healthy so I should be able to get through surgery ok.
I'm sure if I was alot older or not so healthy they wouldn't done anything about it.  
I also have a satellite nodule which is alot smaller I don't know whether it is a   hot or a cold nodule.

But it is interesting that you got a second opionion from another pathologist.
What is a PET scan? I haven't done a PET scan and it maybe something not yet available in New Zealand.
    

by Domenick, May 12, 2007 12:00AM
To: Justin1967
Hi:

We are told that a PET scan will pick up any cancerous cells. From what I have read about it on the net it is something like a CT scan. You are given a mix of glucose and a radioactive indicator. If you have any cancerous cell in your body they will take in the glucose and show up on this scan. I am sure you can find out more about it if you do a search of the net.

by Justin1967, May 14, 2007 12:00AM
To: Domenick


Hi

It sounds like you are luckly to have a PET scan. Unfortunately I don't think there is PET scan machine here in New Zealand. I suppose that is a advantage is living in the States.

What have you decided in the end? Are you going to watch the nodule and wait?  

Justin
39yr



by Domenick, May 14, 2007 12:00AM
To: Justin1967
I am not sure what we will be doing. My wife goes in for her PET scan tomorrow. From what I have been reading this scan will let her know where she might have cancer cells, but you still must get a biopsy done to make sure. Since we already had a biopsy done (FNA) that came back mixed. The only thing we can hope for is that no cells light up. However with the mixed results from the FNA my wife thinks that maybe she should just get it taken out to play it safe. It will take a couple of days to get the results so I will get back with you when I find out more.

by mae59, Sep 12, 2008 12:04PM
A related discussion, concern was started.
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