Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
Thyroid removal without biopsy?
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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 removal without biopsy?

My endocrinologist is recommending a complete thyroidectomy.  I have one large-ish "hot" nodule and 3 other "cold" ones - two of which require further investigation.  He claims that fine needle biopsies are often inconclusive or give false negatives and would be "impractical"  given the number of nodules I have.  I am planning to get another opinion because this doesn't seem right to me.  I am concerned about losing my entire thyroid based on nothing more than a need for more investigation, especially since the "hot" nodule can be treated with meds or removed on its own.  I am obese and have been my entire life and I don't want my efforts to lose weight to be further stymied unnecessarily.  In seeking information about this condition I've read the stories of many many people who struggle miserably with the synthetic hormone meds they have to take after their thyroid is removed. My hyperthyroid symptoms started three years ago , a few months after the birth of my fourth child.  The symptoms have been transient and mild, although recently, after starting birth control pills to treat migraines, my heart palpitations and hypertension became much worse.  A low dose beta blocker is managing those symptoms beautifully.

So, would you recommend a complete thyroidectomy, without biopsies, given these circumstances?

P.S. Labs within the last 6 weeks: TSH 0 and 0, Free T4 1.6 and 1.5 ng/dL (range 0.7 to 1.7), Free T3 5 pg/mL (range 2.2 - 3.5). When I was diagnosed with postpartum hyperthyroid three years ago my TSH was low but detectable, my Free T4 was slightly high (1.9 I believe) and my Free T3 was not tested.  No other labs have been drawn.
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This is one of the more complicated thyroid situations we face when there are multiple nodules in combination with hyperthyroidism. This is likely should be treated but it may not need a complete removal of the thyroid/  would try to find a person for the second opinion who does his/her own ultrasound in the office to individually assess each nodule for its potential risk of malignancy.  Then fine-needle aspiration of each suspect nodule could be performed.
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I should make it clear that this is a new doctor for me.  My labs have indicated I have hyperthyroidism for three years now, but I have not received any treatment for it because it was considered postpartum related and mild  The symptoms spiked when I started taking birth control this last August, which led me to this new doctor.
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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
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