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Thyroid Cancer, Nodules & Hyperthyroidism (Expert Forum)
Thyroid Nodules Biopsy
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.
Thyroid Nodules Biopsy
by Sue Blackburn, Sep 20, 2007 10:48AM
Hello and thank you for being here to help. Over the last couple of weeks I have felt larger lumps on the left side of my thyroid. At one point if I lay my head back you can see it. It goes up and down in growth. I went in for an ultrasound and the left side is enlarged and they found nodules from 3 to 7 mm. I was going in for an uptake but cannot bear to be without my meds for 30 days to take this test. My feelings, base on how bad I feel and the agressiveness of this problem, were to go straight to a needle biopsy to rule out bad cells. My doc agreed. After several panic attacks I made it to the radiology department yesterday for a needle biopsy. The doc there told me I didn't need one and the nodules were nothing and to go home. I had taken a couple of Xanax for the test so was certainly a little loopy and unable to speak up as I usually would. I asked that he at least biopsy the large nodule 7 mm or take some thyroid tissue just to be sure. I think he may have been late for a golf game as they fit me into their schedule! Needless to say I am not happy with this rude abrupt doctor. My question is, does the size of my nodules and the pain and swelling in my neck warrant a needle biopsy? If I am facing cancer, I want to know now. These nodules and this swelling came on very quickly and frankly, I am frieghtened. In your opinion would you recommend a needle biopsy?
Thanks
Sue
Thanks
Sue
Doctor's Answer
by Mark Lupo, M.D., Sep 22, 2007 04:50PM
, Sep 22, 2007 04:50PM
No need for uptake and scan.
This is not likely thyroid cancer. If there are multiple "small nodules" and swelling, my guess is that this is thyroiditis (inflammation -- either recent or chronic -- of the thyroid).
If one does not look at thyroid ultrasounds enough, it is tough to distinguish inflammation from nodules -- sometimes impossible -- so I do FNA biopsy of any area that appears distinctly different from the rest of th thyroid in these cases -- but most of the time (>90%) it's just inflammation. In this case 7mm is a little small for biopsy unless there is something suspicious about this lesion on ultrasound, you have a family history of thyroid cancer or you received radiation therapy as a child/adolescent.
Given that you are on thyroid meds presumably for hypothyroidism, you likely have hashimoto's thyroiditis and may have had a recent silent thyroiditis in addition which caused some additional swelling. Would look at TPO/Tg antibodies to confirm Hashi and check to ensure TSH is ok (around 1.0) - then give it some time for the swelling to come down.
Seeing a thyroid specialist may help clarify this situation.
This is not likely thyroid cancer. If there are multiple "small nodules" and swelling, my guess is that this is thyroiditis (inflammation -- either recent or chronic -- of the thyroid).
If one does not look at thyroid ultrasounds enough, it is tough to distinguish inflammation from nodules -- sometimes impossible -- so I do FNA biopsy of any area that appears distinctly different from the rest of th thyroid in these cases -- but most of the time (>90%) it's just inflammation. In this case 7mm is a little small for biopsy unless there is something suspicious about this lesion on ultrasound, you have a family history of thyroid cancer or you received radiation therapy as a child/adolescent.
Given that you are on thyroid meds presumably for hypothyroidism, you likely have hashimoto's thyroiditis and may have had a recent silent thyroiditis in addition which caused some additional swelling. Would look at TPO/Tg antibodies to confirm Hashi and check to ensure TSH is ok (around 1.0) - then give it some time for the swelling to come down.
Seeing a thyroid specialist may help clarify this situation.
