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Thyroid Cancer, Nodules & Hyperthyroidism (Expert Forum)
Should FNA or surgery be next step?
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
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.
Should FNA or surgery be next step?
by bama76, Apr 24, 2007 12:00AM
I had a thyroid ultrasound last month after a chest xray revealed my trachea was deviated to the left due to some mass.
It revealed 2 nodules,both hypoechogenic, one on right lobe measuring 1.0 x 1.5 cm, and one on left portion of the isthmus measuring 1.0 x 1.2 cm.
TSH was checked and reported as normal at .45 or .54, can't remember. Was sent for uptake and scan, 24 hour uptake normal at 16%, and no nodules could be seen on scan, but my right lobe is enlarged (both on scan and ultrasound). I'm assuming this means the nodules are warm, and radiologist suggested comparing the images from the scan with ultrasound images to see exactly where the nodules would be on the scan.
I have a maternal aunt that had RAI tx due to a goiter on right lobe and precancerous nodule on left-she was also hyperthyroid. A first cousin, also maternal, who had to have his thyroid removed from some growth that overtook his thyroid. With the size, family history, and the fact that the enlarged right lobe has my trachea deviated to the left, would you recommend waiting for the FNA or going ahead with the thyroidectomy?
Also, which doctor would be a better choice to perform the thyroidectomy if warranted--an ENT or endo?
Thank you so much!!
It revealed 2 nodules,both hypoechogenic, one on right lobe measuring 1.0 x 1.5 cm, and one on left portion of the isthmus measuring 1.0 x 1.2 cm.
TSH was checked and reported as normal at .45 or .54, can't remember. Was sent for uptake and scan, 24 hour uptake normal at 16%, and no nodules could be seen on scan, but my right lobe is enlarged (both on scan and ultrasound). I'm assuming this means the nodules are warm, and radiologist suggested comparing the images from the scan with ultrasound images to see exactly where the nodules would be on the scan.
I have a maternal aunt that had RAI tx due to a goiter on right lobe and precancerous nodule on left-she was also hyperthyroid. A first cousin, also maternal, who had to have his thyroid removed from some growth that overtook his thyroid. With the size, family history, and the fact that the enlarged right lobe has my trachea deviated to the left, would you recommend waiting for the FNA or going ahead with the thyroidectomy?
Also, which doctor would be a better choice to perform the thyroidectomy if warranted--an ENT or endo?
Thank you so much!!
Doctor's Answer
by Mark Lupo, M.D., Apr 25, 2007 12:00AM
, Apr 25, 2007 12:00AM
There seems to be a family history of benign nodular goiter, but not cancer. The nodules are not very large but still there is deviation of the trachea to the left presumable due to the enlarged right lobe and the nodule within. If there are no symptoms, then surgery is not urgent.
An FNA (ultrasound guided, of both nodules) is indicated as it would dictate the extent of surgery if surgery is performed -- ie, a benign FNA would lead to a partial or subtotal thyroidectomy while a suspicious FNA may lead to a total thyroidectomy and lymph node search/dissection.
Endos don't do surgery -- the best person is an ENT or general surgeon who does at least 3-4 thyroid surgeries/month.
An FNA (ultrasound guided, of both nodules) is indicated as it would dictate the extent of surgery if surgery is performed -- ie, a benign FNA would lead to a partial or subtotal thyroidectomy while a suspicious FNA may lead to a total thyroidectomy and lymph node search/dissection.
Endos don't do surgery -- the best person is an ENT or general surgeon who does at least 3-4 thyroid surgeries/month.
