Nodule needs Biopsy

[trixie567]

I recently moved and was seen by an Endo, where I had my first ever ultrasound for my Thyroid which showed a 7.5cm nodule..don't no how long it's been there since I have never had a scan before, Dr. wants to do a biopsy so am nervous about that but my question is can "hyperthyroidism" cause the nodule ? if not, what does cause them and why are some cancerous...Can I put the biopsy on hold ?

My history- diagnosed Hypothyroid 22 yrs now, last 1.5 year it has gone to the opposite spectrum with lowest TSH at .001, so last 1.5 years I have had numerous TSH tests and lowering of Synthroid to try and regulate but it is still bouncing all over the place but staying on the lower side just out of "the range" and I continue to have symptons of it or the nodule that I just discovered, i.e. heart palps, nervous/edgy, slight weightloss, difficulty swallowing at times or more feels like there is food stuck (I brushed it off as bad sinus/allergies) but now realize it may have been my thyroid all along.

I will get antibody & TSH results back wed/thurs.

[trixie567]

Biopsy results, Looks fine to me but just want to make sure. short version cytopath report below

95% success rate 5% false negative- repeat U/S in 6 months.

left thyroid nodule (solid + isoechoic) 7x3.5x4.5mm
hypocellular smears with follicular epithelial cells, hurthle cells and colloid

While I am still having issues with swallowing, hoarseness etc...the endo is aware and chooses to let it be. Will my raised Synthroid meds make these symptoms go away eventually since I am hypo. I have been on .88 for approx. 3 weeks now from .75 and will have to repeat labs in about 5 weeks, hopefully TSH will come down from 10.8 but don't feel any different yet.

[trixie567]

Okaaaay, so I had my biopsy today- took 5 samples and not bad at all, only felt the tiniest amount of pressure so glad that was over now I have to wait a week for results:(

In the meantime have been having difficulty swallowing from time to time and had one incident last week where my whole esophagus/windpipe closed off and couldn't swallow or breathe for a few seconds (very scary) Doc wants to wait for biopsy results before addressing this issue. Wish you could tell by U/S if it is cancerous or not.....

[Mark Lupo, M.D.]

It's clearly not a hot (functioning) nodule if you are HYPO on meds.
Needs FNA biopsy.
The Hashi is not surprising - it is most common cause of hypo.

[trixie567]

Thanks so much for your info. Nurse just called with lab results, I don't have hard copy in front of me so I only have a few numbers but they were def not what I was expecting!
TSH-10.8
Antibodies-over 600
diag-Hashimotos
They are raising my Synthroid from .75 to .88
This is very strange to me as I feel I am having slight symptoms of "hyper"
My last TSH which was done on 10/1/09 came back normal at 1.27 range(0.450-4.5)
I will repeat thyroid 8 weeks and make that biopsy appt. in the meantime.
BTW- what is the difference between hot/cold nodule ?

[Mark Lupo, M.D.]

7.5cm is a very large nodule which needs evaluation.
The low TSH suggests that the nodule may be "functional" - would consider I-123 scan to see if this is a "hot" nodule (particularly if the TSH stays low even with little to no synthroid) These are not usually cancer, but with the size, would still consider FNA and possible removal.