How Likely Is Hypoechoic Mildly Hyper Vascular Thyroid Nodule Cancer?

January 24th I had a thyroid ultrasound at University of Penn to see if any of my 3 small thyroid nodules have grown and or changed.I had an FNA of all 3 in June 2008 by Dr.Anthony Jennings who isn't at Upenn. I had a second opionion by having my slides reviewed by UPenn thyroid pathologist Dr.Baloch and he didn't see any cancer. Anyway my nodules then were the 1 on the left was a little over 1cm and the one on my isthmus was some 4mm and the one on my right lobe was about 6 or 7 mm I think. The smaller 2 had been described in past reports as mostly cystic,the largest is mostly solid and then cystic.When I had my last follow up in May 2010  I saw Dr.Stephanie Fish,who was leaving soon after for The Sloan Kettering Cancer Center.She wrote me a note that said that my largest nodule only grew slightly and non-significantly and the other 2 were stable and actually had *decreased* slightly. She didn't recommend rebiopsy then,but to come back for a follow up ultrasound in 2-3 years.

  

  












  

[Eric Wang, MD]

Management of thyroid nodules is highly controversial and complicated. You seem to have a good team on your side, and already been biopsied. I would just follow up with what your doctor said.

[ch4165]

All of my nodules had been described in several past reports as being non-hypervascular,but now the one on my isthmus has grown to 8mm and it's the solid part that grew and is now described as slightly hypervascular! The other two have only increased slightly in their cystic parts. I am going to have another biopsy of my isthmus nodule in a few months when they can do it at Upenn.The radiologist Dr.Jill Langer said when I spoke to her that vascularity isn't such a concern,but she recommends rebiopsy of this nodule because it increased about 50% in almost 3 years,and that fits their criteria for rebiopsy.She said she's recommend this even if it was non-vascular.I'm very concerned by the combination of growth and increased blood flow now.I know many benign nodules have some or even a medium amount of blood flow,but I know hypervascular is commonly found with cancers.

If you could let me know what you think about this,I really would appreciate it.

Thank You
  

I forgot to mention that the isthmus nodule has always been described as hypoechoic but not markedly which UPenn radiologist Jill Langer says that and calicification are very concerning ultrasound features.Also my isthmus nodule's former measurement was 4.x 9 x9mm and now is 8 x 15 x17.

  

I also my thyroid blood tests have always been normal for decades although I just had it tested days ago since it hasn't been tested in several years.