Surgery or Not?

[Spring2012]

Hello, I am a 34 years old female diagnosed with two large nodules on each lobe: 5.4 cm and 2.6 CM. No other symtops; although the white blood cell level was a little under the normal range. But my primary physicial says this has nothing to do with my thyroid nodules.  

Results of the Ultrasound as follows:
Right Thyroid lobe measures 5.9 * 2.2 * 2.5 CM. Left thyroid lobe measures 7.5 * 4 * 2,7 CM.  The thyroid isthmus measures 4 MM in thickness.
There is a large, solid isoechoic nodule at the mid aspect of right thyroid lobe measuring 2.6 * 2.1 * 1.1 CM and demonstrates significant blood flow on color Doppler and has not significantly change in size.
There is a large, solid nodule at mid aspect of left thyroid lobe which demonstrates heterogeneous echogenicity and measures 5.4 * 2 * 3.6 CM. This nodule has inscreased in size from 4.7 * 1.4 * 4.1 CM four months ago.

Results of the FNA shows both nodules are benign cellular adenomatoid nodules.  Not sure what it really means by cellular adenomatoid nodules.

Pathology recommend to follow these nodules conservatively, have a repeat thyroid ultrasound in one year to determine if there has been any significant change in the nodule's size.  But endo and two surgeons all recommended me to remove the entire thyroid which will mean life long meds. I am not too concerned about the surgery, but I do worry a lot about the medication. Read a lot of bad stories about the medication.  Any advice is appreciated.

[serenityseeker56]

I AM NEW TO THIS WEBSITE AND ACCIDENTLY POSTED TO YOUR PAGE, SORRY ABOUT THAT.  ANY EXPERIENCE YOU MIGHT WANT TO SHARE WOULD BE WELCOMED.  YOU CAN DELETE MY POST, IF YOU LIKE.

[serenityseeker56]

In the last two months I have experiencing rapid heartrate, excessive body heat, eye problems, lack of concentration.  went to doctor, showed low TSH and raised thyroid hormones.  was put on metoprolol 25 mg to regulate heart rate. Ultrasoundwas ordered, results were right lobe - 3.3 x 2.2 x 2.2 cm, left lobe 4.9 x 1.6 x 1.6 cm. Right lobe has one nodule in the mid lobe measuring 2.4 cm maximal and one in the lower pole measuring 1.7 cm maximal.  Left lobe shows a complex cystic and solid mass in the upper pole measuring 2 cm maximal.  Findings represent Multinodular thyroid with recommendation for nuclear imaging to determine if nodules demonstrate autonomous hyperfunction.  Have been doing lots of research on line and have questions.  Unfortunately, my doc is not in this week to answer any of my questions.  Will the nuclear imaging supply a definite answer as to whether or not cancer is present. Should this test be completed as soon as possible.  Is surgery the best alternative?

[Spring2012]

Thanks Dr. Lupo.   I wish there is a way to remove the nodules and keep my working thyroid. But looks like there is no solution, at least not in the US currently. I did find on internet that Italy has Laser Treatment to remove benign modules.  Do you know if it's worth to go to Italy for this procedure? I don't know why it's not been offered in U.S, is it not safe?

[Mark Lupo, M.D.]

The left 5.4cm nodule is more worrisome.  Many people would have this removed based on size alone but this is not universally agreed upon.  At minimum, we do FNA biopsy two separate times for nodules of this size and then if benign FNA (x2), benign appearing on ultrasound, not growing, not causing symptoms and you have no risk factors for thyroid cancer (radiation exposure or family history), then we monitor them.....