Pain in the Neck

[blessed365]

I posted a question in Nov 18 2009 regarding the standard of care for thyroidectomy. I wanted to ask you what to do if the clip(s) hurt, should they be removed?

[nowar]

What percentage of thyroidal ventricular cysts are cancerous?

[mymeow74]

I had a thyroid ultrasound yesterday because I had been feeling a "lump" around my left thyroid area for a couple months now.  The left thyroid showed a 3.8 cm solid and cystic heterogeneous nodule as well as a 1 cm incidental cyst.  The right thyroid showed a 1.4 cm ovoid solid nodule.  I had a TSH level done in August which was 3.4, but had some blood work today for a TSH, T3 and T4, results pending.  I am scheduled for an FNA for the left-sided 3.8 cm nodule next week.  What is your opinion on this?  Is it worse for the nodule to be heterogeneous than solid?  Thank you for your input.

[McMillanNelson]

I am a 47 year old male and I have been diagnosed with Toxic Multinodular Goiter. My TSH is low at .20 but my T3 and T4 are normal. The rest of my blood work was normal except for High cholesterol and low calcium and vitamin D. I have most of the typical symptoms of Hyperthyroidism and most annoying to me is confusion and short term memory problems. I am experiencing a bit of pain on the left side of my neck as well.  I am 5 feet 9 inches tall and currently weigh 290lbs.  In my teens and twenties and even into my early ‘30s I was of normal weight and only gradually became obese in my late ‘30s early ‘40s. I have had great difficulty loosing weight on any diet and I do exercise regularly.  I have had a history of low TSH as far back as 2004. I was never treated for this exhaustion, loosing hair, memory problems etc until now when I had an ultrasound done where the cysts were discovered.  Below is the Ultrasound report.  My Doctor wanted to do a thyroid uptake and scan and then either Ablation or surgery, as a last option and temporary she mentioned Methimzole. For now I opted to only take the Methimzole while I study my options.  I really do not understand the implications of the Ultrasound and the doctor did not explain it.

My Questions are:  1) What does the “Toxic” part of this mean 2) Where can I find a diet to loose weight and help this condition, is it possible to reverse this condition with proper diet? How do I know what I should and should not be eating?

Do I really need to have the Ablation or Surgery ?

- McMillan Nelson
Ultrasound Report

12/2/2009

THYROID SONOGRAM:
Clinical Indication: History of thyroid cyst on a screening exam. Screening is not available for review. No old studies available for review.

Right Lobe: Mildly enlarged, measuring 5.2 cm x 1.9 cm x 2.1 cm. A 0.6 cm x 0.4 cm hypoechoic and I believe predominately cystic nodule is seen inferiorly in the right lobe without coarse or papillary calcification. A 0.3 x 0.3 cm x 0.3 cm predominately hypoechoic nodule containing two echogenic foci which cast reverberation artifacts consistent with colloid seen in the interpolar region. A similar appearing 0.5 cm nodule is also identified in the interpolar region. No evidence suspicious for papillary or coarse calcification is seen in the right lobe.

Isthmus: Mildly enlarged and without evidence of discrete nodule, coarse or papillary calcification.

Left lobe: Enlarged, measuring approximately 5.2 cm x 2.2 cm 2.1 cm. The length may have been underestimated as the inferior pole extends below the clavicle. A 0.4 cm x 0.5 cm x 0.3 cm anechoic and most likely cystic nodule is seen in the superior pole. 0.7 cm x 0.5 cm x 0.7 cm nodule is seen on the interpolar region and it contains a punctuate echo which casts a reverberation artifact consistent with colloid. No coarse or papillary calcification is seen of the left.

Opinion: The thyroid gland is enlarged. Multiple thyroid nodules are present, none of which meets Society of Radiologist’s in Ultrasound criteria for strong consideration to fine needle aspiration biopsy and at least three of which appear to contain colloid.

[JJ1106]

I went to the ER last Friday 12/18/09 feeling fatigued, weak, my hair falling out in clumps, palpitations, shaky and nervous,excessive sweating, difficulty falling asleep, and on top of that, a horrible cold that still wont go away. I've had the cold for about 3 weeks now. Im 31 yr old female and i have 4 children, the youngest being 5 months old.
The doctors did an EKG and ran blood tests. I told them that my mother has thyroid condition and my cousin from my mother's side of the family has thyroid cancer. They diagnosed me with Thyrotoxicosis. The doctors said my TSH was low (0.016) and my FreeT4 was high(4.94) what do these numbers mean?? Im going to Endocrinology Jan8th so they can conduct tests on me. Please advise. Thanks

[Mark Lupo, M.D.]

Would talk to your surgeon about that, typically they are not removed.  But if they are the clear cause of pain, it may be worth considering.