Hashimoto's Multinodular hypervascular help

I've just received the results of my ultrasound. The doctor is requesting a biopsy. So I called to make an appt. Waiting for the call back.
But, I would like to understand what I'm reading. The internet searches are too technical.

The Gland is mildly enlarged. The right lobe measures 5.2 x 1.6 x 1.9 cm. The left lobe measures 5.2 x 1.7 x 2 cm. The isthmus measures 3 mm. There are several Thyroid nodules. The nodule in the right inferior lobe measures 0.9 x 0.6 x 0.7 cm. There's also a solid nodule measuring 0.5 x 0.4 x 0.4 cm. In the left lower pole there is a hypoechoic circumscribed nodule measuring 1.5 x 1.1 x 1.3 cm. There is a complex cyst in the lower pole measuring 0.6 x 0.8 x0.8 cm.

Color doppler evaluation demonstrates no internal vascularity to the left lesion. The right inferior pole solid lesion measuring 0.9 cm has internal vascularity and FNA is recommended.

Impression: Multinodular goiter. There is a hypervascular nodule in the lower pole on the right lobe measuring 0.7 x 0.9 x 0.6 cm. FNA of this lesion is suggested.


What's the likelihood that these nodules are not ok?
What steps are important to take and what do I not do?
Thank you,

[Mark Lupo, M.D.]

You have several relatively small nodules, the only one above 1 cm is a 1.5 cm hypoechoic nodule in the left lower lobe that likely requires biopsy.  The rest of them are usually monitored over time with the possible exception of 0.9 cm hyper vascular nodule but this is relatively small.  The chance of cancer is 5-10%.

[M2Benme]

Thank you Dr Mark Lupo,

Just had the FNA yesterday. They only wanted to test the left one and argued the fact that these were all fine and I could come back in a few years to have them rechecked.  But, I was concerned about the one you mentioned the hyper vascular nodule. They still argued their point. I finally asked them to do the one ... so I can sleep at night, peace of mind. My symptoms do not match a typical Hashimoto's (which doesn't run in my family) with normal Thyroid blood levels and extreme symptoms. (some outside the typical thyroid symptoms).
Long story short, they did it..
When they returned to the room they both apologized endlessly for their arrogance.
My endocrinologist gave me instructions to contact a surgeon to set up surgery have  half of my thyroid removed. But, she wants to see me next week. Something about waiting to see what exactly is found in the biopsy... possibly having the whole thyroid removed and lymph nodes checked. and going from there

This is all I know. Does this mean the nodule is cancerous?
I did ask, the Pathologist. but got the words tumor, markers, remove and lets see the results in a week to ten days.
If not.. what are the chances at this point?
I definitely feel better having real answers.

Thanks so much

[Mark Lupo, M.D.]

It sounds like the pathologist found something suspicious at the first on site interpretation.  Sometimes molecular markers can help sort out if this is more likely a benign process or a cancer process.  I imagine this is what they were discussing.  Possibly "Afirma" testing or a mutation panel such as "Asuragen".  Would still correlate with thyroid antibodies for Hashimoto's as Hashimoto's can sometimes cause atypical findings on biopsy that are interpreted as suspicious.  If there is any question, sometimes sending the slides for second expert opinion before committing to surgery is a good idea.

[M2Benme]

It was hard to find where this discussion was. Still new on this site.
I'm scheduled to have a my whole thyroid removed. Afirma testing was benign, but my Endocrinologist wants me in surgery asap anyway. What exactly does this say below? What are the percentages that this is Cancer?
Thanks so much.

The differential diagnosis for the right lobe lesion includes cellular adenomatoid nodule, follicular adenoma, follicular carcinoma and follicular variant of papillary carcinoma. A neoplasm is favored on cytologic grounds, and excision is recommended regardless of the outcome of the Afirma assay.

[Jugabug]

Good for you that you did the research and yea for this site that helps us make informed decisions as it seems to often the dr we see are to busy or non informed.  After pressing my dr dr to order the biopsy recommended by radiologist from ultra sound I found I I have a papillary carcinoma malignancy with hurthles cells. The biopsy was only ordered for my nodule and not for the enlarged lymph that was mention in the ultra sound. Although my situation doesn't look to good at least thanks to this site I feel I have I can at least ask the right questions. There is a Barb on this site who seems really informative as well.  Stay positive and good luck.