Confusing ultrasound results

[sjnigro]

Hi Dr. Lupo,
I recently had 3rd surgery for Dermatofibrosarcoma Protuberans of the scalp (1-16-08) and now have to have routine CT scans every 3 months.  The last CT scan showed a thyroid nodule on the left lobe so the Dr. ordered an ultrasound.  When he went over the results with me he seemed kind of confused as to what the radiologist report meant, and actually said he was going to have to contact the radiologist because he didn't know what he meant.  The report reads:
"Comparison is made to the recent CT scan of the chest dated 3/17/08 and on that examination at least one thyroid nodule is present in the left lobe.  On today's examination the left lobe measures 4.52 x 1.66 cm.  There is a mederate sized 1.92 x 1.52 cm nearly isoechoic mass in the upper pole of the gland.  This corresponds to the CT abnormality.  The right lobe measures 4.38 x 1.76 cm and contains several subcentimeter hypoechoic nodules.  The isthmus is normal.
Impression:  There is a nearly isoechoic mass in the superior portion of the left lobe of the gland corresponding to the CT abnormality.  On the right several small hypoechoic nodules are seen."
What does this mean and should I follow up with an Endocrinologist?  Thanks for your time!

[Mark Lupo, M.D.]

There is a nodule on the left that needs to be considered for biopsy -- first would test TSH -- if low then I-123 uptake and scan to see if it is a hot nodule (but must wait at least 2 months after CT w/contrast) -- if hot, then no biopsy.  More likely, the TSH will be normal or slightly high and then US-guided FNA is next step.  US is more sensitive than CT for nodules -- so the small nodules/cysts on the right are not unusual.  Would also test antibodies (TPO-ab) as Hashimoto's can give the look of several small nodules.

[sjnigro]

Hi Dr. Lupo,
Just a follow-up question.  I saw the ENT on the 4th and his recommendation was to just do a follow-up US in a year to watch the nodules for growth.  He said majority of nodules are benign and not to worry about them.  No blood tests or biopsy.  Should I push my primary physician to at least test TSH as you suggested in your earlier post?  

[tish4130]

Do calcifications in a cyst or/and a nodule determine malignancy in every case?  At the time they were doing a biopsy on a 3.2 cm complex cyst, they found an approx 1 cm solid nodule near it. They said both had calcificiations.  They spent more time going after the solid nodule than the complex cyst.  I'm more worried about the cyst as it seemed to be get larger quickly, giving me trouble swallowing, aching, and numbness on that side of my neck, and face.  The solid nodule was missed on initial exam report.  It's located at the middle of my neck,in the indented area at the base of my throat.   I'm wondering if this is the Pyramidal area and if so, a pyamidal nodule?

[sjnigro]

Thanks for your quick reply.  As it turns out my primary physician called me just before I read your reply, and apparently she also received the above noted US report.  She is sending me to an ENT for consult, which I go to on April 4th.  I will ask for the tests you mentioned above.  The CT scan I had was w/o contrast so that shouldn't be a problem.  I had a TSH test done back in July 2007 and it was 2.15 which they said was in the normal range of 0.40 - 5.50 if > 20 years.  Thanks again!