Extremely large thyroid and lump

[mammasluv2]

Hello, I have been referred to and Endo due to having an enlarged thyroid which is 6.4cm x 2.1cm x 2.0cm.  I also have a small lump in the place where a "goiter" is usually found (at base of neck in the middle).  I was told that the enlarged thyroid, which the doctor referred to as a possible multinodular (ultrasound results) was the goiter. I am a little confused on how this is usually treated. When it is this big but not in the form of a goiter how do they treat it? I have been on Synthoid for almost 10 years now (150 for 6 months). This is not working obviously but when I visited the ENT, he said he would like for me to see and Endocrinologist to see if he could treat it with hormones. I have been so worried about this and it seems to be affecting my breathing. How much of the breathing is due to the goiter and how much is due to anxiety is unknown. I go to see the Endo tomorrow and I just want to be prepared as to how he may handle this. Thank you to anyone who responds! I really appreciate the opinions.

[Mark Lupo, M.D.]

Hashi symptoms are due to hypothyroidism - treated with levothyroxine to keep TSH in 0.5-2.5 range (in most cases).  But that won't likely shrink your thyroid.  Surgery does not usually change the hypothyroid management in patients w/ hypothyroid due to hashi.

Would consider (if/when you decide on surgery) to find an expert thyroid surgeon who does more than 100 cases a year - this helps decrease complications and down time after surgery

[mammasluv2]

Thank you SO much for answering my question.  I did see the Endo and he said that he would do the surgery but that for my age (34) and the business that I run (home daycare) he really doesn't want to.  He is going to wait and look at the ultrasound and the labwork and then I am supposed to go back on July 21st.  

He did diagnose me with Hashimoto Thyroiditis.  Is it true that even if you have your thyroid out you will still have the symptoms?

I am just playing a waiting game to see what my Endo says now and then I will decide what I would like to do.  Thank you again for your answer!

[Mark Lupo, M.D.]

It is not likley to shrink with more thyroid hormone treatment.
The goiter is large and most likely should be considered for surgery.
Careful ultrasound and FNA biopsy is usually part of the work-up at this point.