Multinodular Goiter - Approx 1.8 Nodule

[grgmals]

Hi Dr Lupo,

I am a 36 yr old male who had thyroid lobectomy and isthmus removed in Sept of 2010.  The pathology was Chronic Thyroiditis. I had a a 3cm nodule on my left lobe and a 2 cm nodule on my isthmus. The 3 cm nodule was a hot nodule and the right side of my thyroid was suppressed from it.  I have been getting thyroid function tests and my TSH has ranged between 1.5 and 2.0. At the time of surgery my right lobe had a couple of nodules with the largest measuring 9x9x9 mm.  Over the past 2 months the right side of my neck has felt full and i have had a bit of fullness when swallowing.  My right shoulder has also been stiff and sore. My endocrinologist  did an ultrasound and the what they found were as follows
R Thyroid Lobe measures 1.7x2.2x5.1 and contains multiple nodules including solid isoto hypoechoichypervascular nodule in the inter polar segment measuring 5x7x7, solid isoechoic nodule without abnormal vascularity 4x5x5, and solid hypo echoic minimal vasc measuring 4x5x6. They are grouped together in a cluster.  There is an addt nodule that is 4x4x5 heterogenous.

yr ago ultrasound was lobe 5x1.5x1.8 and a 2x2x2mm and a 9x9x9mm nodule. they did not say the 9x9x9 was 3 nodules grouped together.


my question is, could a lobe this size with these nodules in it cause compression symptoms? Im 5'8 weight 185lbs.
also, should they be biopsied? the lobes that were removed we fna'd twice and were benign.
my dr said there was no change in size in the nodules but I think he is mistaken. the ultrasounds being compared were done at 2 diff places.
my reading of it is if i read the recent ultrasound the way the previous one was which measure the 3 lumped together nodules as one it would be 1.1x1.7x1.8cm? or am I mistaken?

last TSH was 1.8 with range of .3-4.2 being normal
free t4 was .8 in a range of .6-1.2 being normal.

is there anything i can do to prevent this from getting bigger?

[Mark Lupo, M.D.]

The TSH is normal.  However with the history of the lobectomy as well as documentation of Hashimoto's, there is a higher risk of developing hypothyroidism and requiring thyroid medication in the future.  The right lobe of the thyroid is the same compared to prior ultrasound in terms of overall size and is within the normal limits.  There are small nodules noted that are less than 1 cm.  I would not interpreted this as a significant difference.  Commonly in Hashimoto's we see "pseudo-nodules" which may be the case in your situation.  Given the small size, these would typically be monitored without biopsy but do need periodic ultrasound followup.  I would not think that these would cause compressive symptoms.  With the hoarseness as well as some of the symptoms you're having, acid reflux should be considered or ENT evaluation to further clarify the cause.

[grgmals]

Thank you Dr Lupo. I appreciate the response.  I had a chest and neck CT and they were clear.  Looks like this may be acid reflux. I am going to try PPI treatment for it and dietary changes.

Again I really appreciate your response.  

Have a great evening.

[grgmals]

one more piece of information for you.  my last tsh was done end of september. it was 1.8 with range of .3-4.2

I have not had it rechecked.  I have been a bit more tired lately and my eyelids seem to be a bit puffy. could tsh rise over the span of a few months with someone who only has one lobe left? if it could, could this be causing the gland to enlarge? for context, I live in the northeast. does the change of season affect tsh and thyroid performance or is that a myth?
my voice is also a bit hoarse and it tends to be get sore by the end of the day. I talk a lot during the day.

thank you very much for reviewing my post.  I really appreciate any input you could provide.

[grgmals]

addtl info....the nodules on the right lobe were never biopsied.  They only biopsied what they considered the "dominant nodules" which were removed in surgery.  The span of time it took for the left lobe nodules to grow was about a year from first being noticed to the time of surgery.  

I have been tested for every possible related condition and all negative (lupus, RA, etc etc)