Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
hot and cold nodules on scan
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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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hot and cold nodules on scan

what is the significance of hot and/or cold nodules. What is a reasonable follow-up?
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97953_tn?1193367871
With this history, the large nodule could well be "hot" - this would explain the low TSH (indicating hyperthyroidism).  The FNA result of follicular neoplasm is often seen in hot nodules -- these, however, are almost never cancer.  If the nodule is not "hot" then it needs to be removed as 20% of warm or cold follicular neoplasms are cancer.

An I-123 nuclear medicine uptake/scan will determine if this is hot, warm or cold.

Assuming this is a hot nodule,the best treatment options are surgery or I-131.  The TSH can be normalized with methimazole (carbimazole in AZ I believe) but this is a medication with several side effects that we typically don't like to use long-term (which would usually be what is needed with a hot/toxic nodule).
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   Hiya

This pixie is new to this stuff and seeking some explanations...
I am a 38yo girl pixie - living in NZ

a couple of months ago I went to the doctor seeking help for the nasty headaches I get that are becoming more frequent.  The doc noticed a lump on my thyroid - sent me off for bloods and an ultrasound scan...  Since then I have seen 2 specialists and had 2 more blood tests - results below:

22 june
Free thyroxine     7.7 (9.0-19.0) Low
TSH     0.43 (0.35-4.90)

19 Jul
Free Thyroxine     8.7 (9.0-19.0) Low
TSH     .015 (0.35-4.90) Low
T3     6.35 (2.6-6.00) High

8 Aug
Free Thyroxine     13.7 (9.0-19.0)
TSH     .01 (0.35-4.90) Low
T3        7.97 (2.6-6.00) High

19 Jul
Ultrasound:
Findings: the right lobe of the thyroid appears normal.  In the left lobe there is a solitary nodule measuring 29x28x41mm which is part solid part cystic.  Other than the size there are no worrying features.

19Jul
FNA:
Macro: 10mls of slightly cloudy blue fluid submitted together with three AF and two AD smears.
Cyto: The aspirate is cellular and consists of numerous clusters of follicular cells, some of which show microfollicular arrangement.  The background consists of blood and colloid.  There is no papillary differentiation identified.  The cellularity of the smear and the presence of microfollicular arrangements of follicular cells raises the possibility of follicular neoplasm.

Symptoms I have noticed...
tiredness, overheating, heart flutters, muscular weakness and cramps, nervousness, inability to focus for long, soreness around the other glands in my body - eg further up neck and under arms, and of course the nasty headaches that sent me to the doc in the first place...

So - there are a lot of big words i dont understand - the docs seem to tell me I'm weird and bloods shouldnt look like that.  And that half my thyroid is "suspicious" so they want to hack it out :(

The blood tests seem to indicate that my TSH is in danger of becoming extinct.

Will the removal of half my thyroid help?  Are there any other options?  Any that DONT include nuking me with radioactive iodine?

I'm feeling worse and worse - should i have been put on some sort of medication already?

Any explanations/advice?

Cheers
~Fe Pixie~
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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
Sarasota, FL
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