Nodules...what next?

[Emarray]

During a check for flu, the NP said, "Did you know your thyroid is enlarged?" I'd felt a funny bump with some itching on the skin a few months ago but had recently lost a lot of weight (planned) and wasn't convinced the bump wasn't a tendon I hadn't been able to feel before. I also have a bit of a lump feeling at the base of my throat, but thought that might be a bit of reflux. Apparently not. My TSH and FT4 were within normal range, FT3 was .1 below normal range. Ultrasound report says: "The largest nodule on the right measures 1.6cm and is mixed solid and cystic. There is peripheral blood flow with no distinct central blood flor or associated calcification. No other distinct nodules are seen on the right. On the left, there is a 2.1cm dominant mixed cystic and solid nodule with mostly peripheral blood flow in the mid pole. A smaller 9mm mixed solid and cystic nodule is also present in the upper pole with minimal central and peripheral blood flow. There are multiple bilateral sall lymph nodes within the neck. Impression: Bilateral mixed cystic and solid nodules. The right nodule measures 2.8cm and the largest on the left measures 2.2cm in maximum diameter."

The NP suggested I see an endocrinologist. My PCP doesn't seem to think I need to see one as my blood values are normal (.1 below doesn't warrant concern, he says) and he hasn't yet responded to my voicemail question about the ultrasound results.

Does this warrant further investigation at this point?

Thank you!

[Mark Lupo, M.D.]

The blood levels and nodules usually are evaluated independently.  The labs are normal, but that does not mean the nodules are benign (90% of nodules are benign, but this needs to be confirmed).  So yes - see an endocrinologist - preferably one who does his/her own ultrasound and FNA in the office.

[Emarray]

Thank you. I have an appt. with an endocrinologist on Feb. 7th for a probable repeat ultrasound and then FNA. Eeek! For what it's worth, my blood values are here:

3rd Gen TSH -- 0.587 (0.358-3.74 mclU/ml)
FT3 -- 2.3 (2.4-4.2 pGm/ml)
T4 Free -- 0.92 (0.66-1.38 nGm/dL)

I have a bunch of symptoms that could reasonably be attributed to any number of other things, but hey also happen to be on the list of typical hypothyroid symptoms...except that my TSH isn't elevated at all. Looking forward to hopefully getting some answers at my appt.

Thank you very much!