thyroid cancer

[louant]

following surgery and radioiodine treatment for thyroid cancer my next oncology appt after a total body scan I was told that the scan just showed uptake in the neck area and so I would be seen again in 3 months.  I had a blood test and the consultant said to now take three 20mg tablets of tertroxin per day as my tsh level was high.  Since then I have still been feeling tired, can't lose weight and have started suffering from migraines also I keep getting pins and needles in my last two fingers of my left hand and sometimes a shooting pain.  Is this usual and do you think that my dosage is correct?

[Mark Lupo, M.D.]

check TSH again in 6 weeks - may need more medication

[charley1986]

Hey, just wondering what type cancer?  Did you have any symtoms of any kind before diagnosis? I have one hypoechoic nodule and one hyperechoic nodule on the other side.  I guess I am just searching for info.  I will continue to read what dr posts to you.  Thanks for answering my ?.  Good luck to you!

[louant]

I had a lump removed which was diagnosed as follicular carcinoma.

[louant]

Only symptoms I had were that the lump was making my throat dry as it had got bigger since the birth of my son in sept 2004

[Mark Lupo, M.D.]

sounds like an FNA is appropriate -- esp of the hypoechoic nodule if it is >1cm or has any other ultrasound features that are suspicious.

[charley1986]

Thanks louant for answering my ?
Dr. thanks for your advice - have thyroid scan scheduled for July 21.  I am going to post this in hopes that you will see and respond.
Right lobe measures 4.1x1.6x1.8cm. There is a 7 mm hyperechoic nodule in the mid to inferior portion.  The left lobe measures 3.8x1.6x2.0 cm. In the mid portion, there is a 1.7 cm hypoechoic nodule. The thyroid isthmus is unremarkable.
Bilateral thyroid nodules of indeterminate etiology. Further evaluation with a nuclear medicine thyroid scan is recommended.  If the nodules are cold, then a biopsy can be perfromed.  
Thank you for your opinion....know it's not much - guess I am just anxious.

[Mark Lupo, M.D.]

The scan will not add much -- the only time to consider a scan for the nodule evaluation is 1) if the TSH is low OR 2) if the FNA shows a follicular lesion.  Each of these cases are to look for a distinctly HOT nodule -- this is the only scan result that makes an FNA not necessarily necessary.  

In your case I cancel the scan and go with an ultrasound-guided FNA.  This is the standard of care -- unless the TSH is low at this point (provided you are not on thyroid meds which may be causing the low TSH).