Multinodular goiter follow up

[mmfd]

I originally posted a year ago, having SEVERE thyrotoxicosis from Amiodarone, even though I had been off the drug 3 months.  Antibodies were negative twice.  At that time, an ultrasound showed enlarged thyroid with one solitary nodule, about 9 mm.  It took months but my TSH finally returned to normal.  Repeat ultrasound the end of April showed inumerable nodules, some solid and some not, with the largest ones measuring about 17 mm I think.  I don't have the report with me.  I just had another ultrasound that showed about the same number of nodules and same sizes.  My TSH is still normal, around 1.  Both the internist and the endo say we need to do nothing.  They will repeat the ultrasound in about a year.  I was expecting to have some FNA, although I don't know how anyone could pick and choose which to biopsy with so many nodules.  My concern was because there was such a change between the first and the second ultrasounds.  The internist thought maybe the Amiodarone triggered the thyroid to prduce the nodules?  I am just looking for some reassurance that we are following the correct path.  I know that nodules are very very common and most likely benign, but it just doesn't sound right to me.  Thanks for taking my quesiton, Dr. Mark.

[Mark Lupo, M.D.]

The Amiodarone may have caused some inflammation within the thyroid giving the appearance of (or actually causing) nodules.  These ultrasound cases are often difficult to sort out if the doc does not do his/her own US on patients on a daily basis.  I typically FNA the dominant (size and suspicious US characteristics) nodules among multiple nodules.  95% of nodules are benign.  Good luck -- at minimum would repeat in 6 mos not 1 yr.