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6 cm. nodule- surgery?
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6 cm. nodule- surgery?

I am a healthy 52 year old female with blood tests revealing a normal funtioning thyroid. However an obvious lump in my neck was examined by ultra sound. Results read:

IMPRESSION: Large solid nodule noted in the inferior aspect of the right thyroid gland measuring 6.22 x 3.84 x 2.81 cm with bloodflow.

FINDINGS: Multiple 2D images were obtained for realtime transneck ultrasound. Grossly the right thyroid measures 4.66 x 0.97 cm. Large nodule noted on the inferior aspect of the right thyroid gland measuring 6.22 cm. This is a solid lesion with blood flow. The left thyroid lobe measures 4.61 x 1.15 and demonstrates a small hypoechoic area measuring 0.52 cm.  

My specialist recommends complete thyroid removal. Is there any good argument for a different course?
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97953_tn?1193367871
Would try for FNA biopsy first - 6.2cm is quite large and a right hemithyroidectomy is probably indicated (especially given young age).  Unless there is a pre-op FNA positive for cancer, would not see the need for total thyroidectomy -- but most surgeons like to have the FNA first to have an idea of what the extent of surgery should be.
5 Comments
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Avatar_m_tn
Hi,  Usually a biopsy is done to help confirm if there is cancer present.   I just had the surgery 5 days ago... Feeling good, recovering nicely.    Papillomal cancer is usually easily diagnosed via a biopsy, which is done with a fine needle.   In fact they use ultrasound to help map the best place to go hunting for trouble.   In my case they found it pretty quickly and I scheduled the surgery after a second opinion from pathology.
One kind of thyroid cancer is Follicular, and that may result in an inconclusive biopsy but 80% of Thyroid Cancers are papilloma type.   If it is confirmed as cancer, find a surgeon that does many thyroidectomies a year, like 30+.   Minimally invasive is performed in some of the larger cities.   A surgeon should explain the potential complications and they should for his office be below 1%.    An early intervention has a very good prognosis.   Following this, you will need to take replacement hormones...
A doctor can and should explain this and more, and if he didn't write you a script for a fine-needle biopsy done under local anesthesia, I'm curious why not.   Perhaps he thought the size of the tumor and its hardness meant better than 50% chance of cancer but you can have the fine-needle biopsy and get better information.   I just went through the whole thing, taking Synthroid, a little sluggish, walking several miles a day but not jogging yet.  Good luck, I know it's a shock to possibly lose an organ that's an old friend, but get the biopsy if you can.   /Paul  - with the racy scar...
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Avatar_m_tn
Addendum.   With a 6cm enlargement, goiter, many doctors will recommend thyroidectomy due to the size.   My 4cm growth was a bit uncomfortable as it was.
So that's probably why they didn't even recommend a biopsy but of course you can ask for one if you want.   They don't want something large in your throat that might grow over vocal cord nerves, trachea, parathyroids, etc, so often thyroidectomy is the best option.
/Paul (TT April 17th at 6pm)
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Avatar_n_tn
If no evidence of cancer is found in the left lobe how often would I need to have it monitored and by what means. Would you anticipate that it would follow a similar growth rate as the mass in the right lobe - (it was first detected at about 1/2 a cm. 10 years ago and was examined with 3 prong FNA biopsy, found negative for cancer.) What are the odds I would not need thyroid medication if the left lobe was left? Finally do the two nodules seem from the ultra sound to be of different types? Thank You Kindly
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Avatar_f_tn
I had a 5.2cm nodule on my right lobe that was discovered back in October. I had a Fine Needle Biopsy (FNA) done that came back inconclusive. They removed the right half of my thyroid and did another biopsy. Luckily, it came back benign. The nodule I had was almost the entire right half of my thyroid. Had it been cancerous they would have removed the entire thing. See if they can do something similar for you. It's better to have some thyroid left than none at all from what I understand.
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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
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