FNA of 1cm internally hypervascular nodule

[CuriousLil]

I have 2 nodules, a 1cm, and another 2cm. The 1cm nodule is hypervascular on the inside of the nodule. Had 6 FNA samples taken of this nodule.

I have had trouble swallowing and nerve pain that radiates from my neck to under my ear for years now. Didn't make a connection that it could be from thyroid until *after* the FNA was done and it subsequently triggered the nerve pain.

I was told the trouble swallowing was reflux Schatzki's ring & hiatal hernia. Had esophagus dilated in Oct. Still have trouble swallowing.

What are the chances this is malignant? Thyroid function tests are normal. I had 5 nasal radium treatments in 1960 for ear and sinus problems. I am 50 yrs. old.

Lil

[cds763]

I have 5 nodules greater than 1 cm.  Should I have a FNA?

[CuriousLil]

I got the results today and it has to be repeated. I am bummed:

DIAGNOSIS: LEFT THYROID (FNA): Predominantly blood with focal colloid. No epithelial cells identified.

COMMENT: The specimen is nondiagnostic. Followup as clinically indicated is recommended.

[CuriousLil]

Thank you Dr. for answering my question. The endo who did ultrasound FNA seemed concerned because the nodule is vascular on the inside of the nodule as opposed to the periphery of it. She said this makes a difference.

So my question is: if the biopsy comes back negative, would they want to remove the left lobe anyway because there are growths on it? Here is what the report said:

"The left lobe measures 4.7x1.2x1.2cm and contains several masses. A solid, hypervascular mass that's in the lower pole and measures about 1.1x.9x.8cm. A second heterogeneous ovoid-shaped mass is in the interpolar region. It measures about 1.1x.6x.9cm. A third small solid appearing mass is in the upper pole on the left side measuring 3x3x2mm. The isthmus measures about 15mm.

IMPRESSION: There is diminished uptake evident in the left lower pole. No clear focus of abnormal uptake is evident in the upper pole although heterogeneity in this area is noted. The findings are not typical for multi-nodular goiter, these lesions should be followed as clinically indicated. Normal I131 uptake and normal TSH indicates overall normal function of the thyroid gland. If neoplastic disease is strongly suspected would suggest biopsy of left lower pole nodule."

My TSH was 2.6.

Thank you once again,
Lil

[CuriousLil]

I forgot to add that both nodules are nonfunctioning and occupy the left lobe.

[Mark Lupo, M.D.]

There is a chance of malignancy - a "normal" FNA is about 98% confidence of benign - the radiation exposure as a child is a concern.  Usually the thyroid has to be quite enlarged and compressing the esophagus to cause problems swallowing.  The ear pain may be some irritation of the nerve by the thyroid.  This is a tough situation - while thyroid surgery would answer the cancer question definitively and remove the thyroid as a cause of the other symtpoms, it is an invasive procedure and you would need synthroid (or the like) for life.