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Thyroid Nodule
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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Thyroid Nodule

After a thyroid ultra sound was completed I was informed I had a 6mm solid nodule within the mid-upper pole of the left lobe of the thyroid gland. They said it measured 5x5x6mm. The left lobe measures 4.0x1.5x1.5cm and the right lobe measures 4.1cm length 1.7cm AP diameter 1.5cm transverse dimension. My TSH=1.17,
T-4=0.9,T-3 total 131 with no symptoms. Bloodwork was good. I am a 50 yr old female who is also in menopause. For 10 months I had no menstrual period until now and 3 weeks prior to it starting again I got the pain in my neck of which now has been determined to be a nodule. My questions and concerns are: 1. The ultra sound indicated the left side but the right side is where it hurts. Does the nodule move? 2. Since the ulta sound I have had no neck pain symptoms except when I get in a stressful situation which doesn't happen often. Does stress have a part to play with nodules? And do hormones? 3.My GP recommended a scan and uptake be done but my 'thyroid' only appears to hurt when I get nervous/stressed,which is not often, should I request another ultra sound when it doesn't hurt before going for a scan since 'pain' isn't there as much? 4. Does the scan and uptake cause thyroid symptoms after which could require medication in the future? 5.My GP said he knows nothing about thyroid yet recommending all these tests. Should I change from GP to an ENT or an Endo..? The GP suggested an ENT. I am keeping a journal to track any symptoms for this month but not much to write. 6.Is a biopsy always necessary and how big is 6mm? Thank you for your help.
Related Discussions
97953_tn?1193367871
1 - nodules don't move and the size is too small to hurt
2 - stress unrelated, Estrogen ?related (research is underway)
3 - scan won't add anything to this evaluation
4 - no, but you are not needing  a scan
5 - ENT eval for neck pain makes sense as I cannot ascribe neck pain to what you describe on ultrasound -- the masses are simply too small.  
6 - 6mm is about 1/4 inch - no FNA needed at this time -- repeat US in 6 months.

ADD - check thyroid antibodies.  the thyroid function is fine
8 Comments
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Avatar_n_tn
Hi,
Most thyroid nodules are so small they cannot be felt and I am not sure about size in mm but I don't think that is very big. I'm no doctor but I don't think the pain is coming from your thyroid nodule.  The nodules don't move and I can't see that it would only cause pain when you are stressed.  I think that may be a seperate issue. A biopsy is not ALWAYS done - when the doc answers your question, he'll probably tell you at what size it is best to biopsy a nodule.  It looks like your tsh #'s are in a good range so it is probably nothing to worry about - but U would want to see an endocrinologist just to keep an eye on it since your gp was honest with you when she said she didn't know much about nodules.....be thankful for that - i had a doc who kept telling me that since my tsh and other levels were "within normal limits" that i was fine and she had no idea as to why I was still having hypothyroid symptoms.  My tsh was 5.5 - the highest number "within normal limits"....hindsight is 20/20 - I should have known better than to take her word for it when my body was trying to tell me something.  So I found out my nodules were cancerous and I just got out of the hospital last week following a total thyroidectomy.  I am now preparing for treatment and got the news yesterday, that it has moved to my lymph nodes as well.  It is a very treatable cancer so I am lucky in a way I guess.  Usually, you only have pain when the nodule is large and then it could be felt with your hand.
I hope that things work out well for you and you are able to find out the source of your pain.  Good Luck!
Charley
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Avatar_n_tn
Charley -

You don't know me, but I have been following your posts.  I know things must be difficult for you, and I am saying some prayers that your treatment will go well, and your body will soon be healed.

I know you must be tired and exhausted from all you have been through.  If you are up to it, and don't mind, can you share what type of symptoms you had from your nodule(s)?  I have a nodule on the lower left pole of my thyroid, and a few smaller nodules on the right.  I have a myriad of symptoms (way too many to list, but many consistent with hyperthyroid), but all my numbers are "within normal range".  I just had my FNA on the left nodule, and will have the results some time next week.  From your experience, is it possible to have thyroid disease "symptoms" even if your numbers are normal?  My free T3 and free T4 are smack dab in the middle of the reference range.  My TSH is .7.  Thyroglobulin and thyroid peroxidase antibodies are within normal limits.  Can thyroid cancer cause the symptoms, even if the numbers are "normal"?  If you have a chance, any wisdom you can share will be appreciated.  I will keep you in my thoughts and prayers.
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Avatar_n_tn
Hey, Thank you for your thoughts and prayers!
Sorry to hear that you are having symptoms that are causing discomfort...I can relate.
For me, all my numbers were on the very high end and I was having hypothyroid symptoms for over a year....hair loss, weight gain, constipation, menstrual problems, fatigue, dry skin, etc.  It was pure accident that the nodules were found during another neck ultrasound for another issue.  Thyroid cancer itself does not usually cause syptoms (symptoms) until it is either big enough to feel or until it is large enough to cause  fullness feeling in neck or cough or feeling like something is caught in throat.  My endo told me that all my hypo symptoms were not necessarily as a result of thyroid cancer, but of the fact that my numbers were high - although within normal range - and I was having those symptoms due to not being suppressed enough.  I wish more doctors would look at the numbers in one way and take into consideration the patients syptoms (symptoms) as well.  I think had that happened with my doc I would have been done and over with all this and back at work and school.  She was a stickler for not wanting to budge although she knew the 9,000 times I went in there that I was very hypo symptom-wise.  So, I don't know if this has helped any, but if you continually complain with syptoms (symptoms), I suggest that you seek another opinion.  You know your body better than any doctor does and you know if something isn't right.  Push to find the answer.  I hope that you have better luck than me with your general physician.  Good luck to you in finding some answers and post to let us know the results of your FNA.
Charley
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Avatar_n_tn
Hi Charley.  I am having a lot of hypo-thyroid symptoms plus I am worried something is really wrong with my thyroid.  I had a ct done on my neck in July because my lyph nodes are really hurting and have been swollen for 6 months.  A thyroid mass was found.  I was sent to an ENT and he sent me to and endocrinologist.  I had bloodwork done.  My doctors did not tell me the numbers, but said the results were normal.  My ENT said my parathyroid numbers were high.  The endo ruled out what he thought was hashimoto's thyroiditis because my thyroid had areas that would not image on ultrasound. He was looking for high antibodies and it was negative.  I have a few nodules in my thyroid and a mass coming off the of my thyroid and growing down into my chest.  I had a fn biopsy and they said it was benign.  The endo was going to biopsy the thyroid too, but he said there was too much vascular tissue around the nodules.  I guess I would have bled internally.  So, now he doesn't seemed concerned with the nodules.  I had to go back to the ENT to see about surgery.  He is sending me to a thoracic surgeon because it is too deep for him and also surrounded by vessels.  I go to him on the 20th.  I guess they are going to take out the mass in my neck/collarbone area, but do the nodules not need looked at further?  You sound like you have been through it all, so I wanted to know your oppinion.  Thank you for any input.  Oh, also I have a nodule under my jaw that is swollen and sore.  I am feeling horrible physically.  I am on medical leave because of all of this.  My doctors do not listen to me they just kind of blow me off when I have concerns.  I also have a small tumor in my brain that has been "watched" for 2 years.  I don't know where all this stuff is coming from inside me??? I will pray for you to heal.
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Avatar_n_tn
Hi Lori,
Geez, you have been through alot!  My first thought is about your doctors brushing you off.  I know how frustrating that can be.  I felt horrible for almost three years and they kept telling me that nothing was wrong - and that my numbers were "normal".  Come to find out, I had several nodules and ended up with cancer.  I think they are doing the right thing by sending you to a different surgeon - sounds like it will likely be a tedious surgery.  I will be surprised if they don't take your thyroid out.  With all this happening the way it is, I would want it out - espeically if there are nodules present.  Just be point blank with surgeon and tell him you would feel better if the thyroid was out - atleast that would give you piece of mind.  If you are having hypothryoid symptoms, I would definatley talk to doc about taking the thryoid.  Sounds like this will be a very complicated issue - much more in depth than anything I have had personally.  I wish I could help more, but for the most part, if I were in your shoes, I would want it all out.  Since they couldn't biopsy those nodules I would feel better if it came out too!
I wish you luck and we will keep you in thought and prayer.  Keep posting so we know how things are going.
Good luck,
Charley
sorry I kept repeating myself - brain fog is set in pretty good lately!!!
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Avatar_n_tn
Ok I have read all your logs and now I have questions? I just had a biopsy done on two nodules, one on each side of my thyroid. I am hyperthyroid for 3yrs now. Radioiodine threapy was done 3yrs ago but didn't stop the overproduction completely. Then, I go in for scan and ultrasound to prepare for another round of radioiodine and these nodules show up, very small but are there. Biopsy is not something I ever want to do again either!  My questins:
1. do more noduels develope if there are some now
2. if not cancerous now, can they turn that way?
3. will this be a life long sentence of poking and sticking to try to keep the overproduction in control?
4. Why do these nodules develope?
Anyone who can enlighten me would be appreciated. I have to decide my choice of treatment soon as we are loosing our health ins. by Dec.
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