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514523 tn?1215832667

Best treatment for Graves and 2 cold nodules ?

Hi Dr Lupo, My hyperthyroidism seems to due to Graves and two cold nodules that were found on my left thyroid gland. I had my right thyroid removed 21 years ago. I was never put on medication, as for my right side of my thyroid had tumors on it and they were not cancerous.    Here are the  results from my ultra sound and if you can shed some light on what it is and what is the treatment for it.

FINDINGS: The isthmus is slightly heterogeneous measuring 4 mm in thickness. The right lobe is absent consistent with previous partial thyroidectomy. There are 2 nodules in the residual left lobe. The left lobe measures overall 2.9 x 2.1 x 4.6 cm. There is a dominant isoechic solid nodule with a halo lucency surrounding the periphery that measures up to 2.2 cm in diameter. There is a adjacent hypoechoic somewhat soild appearing nodule measuring approximately 0.5 cm.

IMPRESSION:

1. Status post right thyroidectomy.

2. Two left lobe nodules.

3. One of these is a dominant solid nodule measuring 2.2 cm. Due to its size, suggests consideration of fine needle aspiration or core biopsy for evaluation. The appearance is nonspecific. Statistically, this could be benign however a
malignant nodule was not excluded.

4. Recommend comparison with prior studies if these are available. This report does not preclude other evaluation and followup ulta sound serial examinations may be beneficial as well.
END OF REPORT...

TSH                0.001

T3 UPTAKE     42

T-4                  8.8


T3 total           267

T-4 free           1.8

TSH 3rd generation  0.01

Thyroid uptake scan    54%

Im hoping I dont have to through another partial thyroidectomy . Is there other treatments for this ?

My endo put me on antithyroid medication and i have a fna in 6 weeks.

Would getting RAI cause my 2 nodules to become cancerous done the line?

Thank you so much !
Nancy
3 Responses
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97953 tn?1440865392
MEDICAL PROFESSIONAL
correction -- if suspicious surgery IS only option (not "if")
Helpful - 0
97953 tn?1440865392
MEDICAL PROFESSIONAL
I assume the scan showed that the 2.2cm nodule was clearly cold....(ie is not "hot" - the cause of the hyper).  Otherwise, there is nothing in the presentation that clearly points towards Graves except possibly the comment of heterogeneity on US.  You may have had antibodies, etc that point towards graves.

So for cold nodule like this, would do FNA -- if benign then options RAI vs antithyroid med (only if graves) vs surgery......if suspicious then surgery if only option.  

RAI is not thought to increase risk of these nodules becoming cancerous down the line, but this minimal risk does exist.
Helpful - 0
514523 tn?1215832667
I meant down the line.

sorry
Helpful - 0

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