Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
Cold Hypodense Nodule
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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Cold Hypodense Nodule

My CT scan says there is a 3 mm hypodense nodule in the lateral aspect of the right lobe of the thyroid gland. There is a borderline prominence of the roght lobe of the thyroid with transverse dimension of 2.2 by 1.8 cm.
There is a mild enlargement of the right lobe of the throid gland. I had a nuclear scan plus an ultra sound. The nuclear scan found the nodule to be cold and hypodense. The next step is a biopsy for me. My question is nodules seen like this, what is the percentage for malignancy and what stage are most of these seen in?  Thankyou
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97953_tn?1193367871
Ultrasound is the best way to evaluate nodules.  A 3mm nodule is too small to see on nuclear scanning, but CT often underestimates the size.  So if the ultrasound shows a nodule that is at least 1cm in size and the TSH (blood test) is not low - the next step is ultrasound guided FNA biopsy.  About 10% chance of cancer and most are very treatable.
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Hi, Thankyou for answering back with my concerns. I was just looking at the results for my ultra sound.

Findings: The right lobe measures 4.8 x 2.6 x 1.2cm and the left lobe is 4.9 x 1.7 x 2.1 cm.

On the right there is a heterogeneous mass density measuring up to 7 mm, laterally.

On the left there is no distinct mass visible.

Impression: Small nodule on the right lobe. Consider aspiration. Size may be limiting. Follow up to show stability can also be considered.

No mass lesion indentifiable on the left. In the setting of a palpable lesion on the left, consider additional evaluation with CT or MRI.

Can you tell me what a heterogeneous mass is and what are chances for malignancy and do you think they can biopsy?     Thankyou
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97953_tn?1193367871
This is smaller than what we would usually FNA.  Would repeat US in 5-6 months to make sure it is stable.  Heterogeneous nodules are usually benign.  Would consider TPO antibody levels -- as hashimoto's can give the impression of heterogeneous areas that appear like nodules but really are "pseudonodules"
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Thankyou for your help.

What does TPO stand for? And could you tell me what Pseudonodules are?

Thankyou.
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97953_tn?1193367871
Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
Sarasota, FL
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