Thyroid Cysts w hoarsness and ear pain

[NanaJME]

I am a 45yof w/severe hoarsness, R ear pain, fullness in the throat-rapid pulse-palpatations-insomnia-exhaustion-extreme nervousness-and inability to think clearly X 7 weeks. My GP ordered an US & it showed multiple cysts w necrosis I was then sent to an ENT & he ordered a CT which showed 3-4 small cysts. He has scoped my throat twice & states that there is some iritation to the vocal cords & put me on Prilosec for acid reflux which I have been on for 3.5 weeks. I have taken a round of Levaquin & multi dose pack of Prednisone. The ENT stated from the beginning that my hoarseness & ear pain have nothing to do with the thyroid & that the CT is a much more definitive test than the US, he assured me that my thyroid was fine, but he & the radiologist wanted a 2nd US to match their CT so I have had a 2nd US. The nurse stated that it shows multiple cysts, nothing to worry about though, but would have to speak to the ENT prior to giving me a full report. All blood work shows normal thyroid levels & that I have Mononucleosis for the 2nd time in my life. Previously diagnosed w Hemochromotosis, & after a breast reduction they found A-typia cells. I have been a smoker for many years & am trying to quit. Everything I read points to the thyroid & I am frightened of a misdiagnosis. My symptoms came on very suddenly & have not improved with the treatment thus far. What should be the next step in my workup or if he tells me that everything is fine should i accept that? I can't get into an endocronologist until Nov or Dec (HMO). Could this be thyroid cancer & is it safe to wait that long?

[melissa493]

A related discussion, one nodule was started.

[NanaJME]

My ultra sound from 8-9-06 came back as a Multinodular Goiter. Multiple bilateral nodules on both lobes w/largest on the L 1.4cm & R is 1.5 cm, both have a heterogeneous echo texture & multiple small cysts. The solid nodules demonstrate flow on doppler. Left lobe is 5.2 X 1.8 X 1.9 cm & right is 5.4 X 1.9 X 1.9 cm. Blood work: TSH 1.47 - T3Uptake .96 FTI 9.3 - T4Free 1.10 - T4 Thyroxine 8.9 - ESR 12 - antithyroglobulin Ab <20 - Peroxidase (TPO) Ab <10. The ENT will not see me but has ordered an I-123 Nuclear Uptake scan for 8-29-06. My last CT w/contrast was on 7-21-06. I advised the nurse that I now have a shallow cough-inspir wheezing & pain radiating to R jaw. She advised this is not related & referred me to my GP who states that my chest is clear & admin steroid injection for noted inflamation in throat. My question: Please tell me what this info means & Has there been enough time seperating these 2 scans w/ me taking the iodine contrast a month before (How can it effect the outcome of the test) & is this the appropriate next step in the diagnosis process or should it be a FNA?

[Mark Lupo, M.D.]

The next step is FNA, not a scan -- if the doc insists on a scan, I usually wait 6 weeks at least after a contrasted CT.  

Thanks for the details -- the solid nodules >1cm need FNA.  I would have thought the antibodies would have been positive given the heterogeneous texture on US.

Multiple nodules do not decrease the chance of having cancer.  But the chance is still quite low (5%).

[Mark Lupo, M.D.]

CT is not more definitive than US -- these are not likely "cysts" but areas of inflammation.  Would test ESR (marker for inflammation) and thyroid antibodies.  The ESR may be normal at this point.  Repeat the Thyroid function tests (TSH, T4 & T3) in 4-6 weeks to ensure that you are not going through the phases of thyroiditis (ie, the previous lab captured the normalizing phase after the HYPER).  I do not think this is thyroid cancer from what you describe.