Thyroid Ultrasound Report Very Scared!!

[cody12]

Hello Doctor,
Last week,  I had an ultrasound of my thyroid done done and I am so scared. Here are the results:
There are multiple thyroid nodules. On the right, there are two nodules, one measuring 5 by 7 by 7 mm, which is posterior inferior and relatively hypoechoic with a 6 by 4 by 3 mm echogenic nodule in the midpole.
On the left, there are two large nodules, in the midpole an 18 by 13 by 27 mm mixed cystic and solid nodule with an internal vascularity and in the lower pole a 17 by 13 by 16 mm nodule again with internal vascularity. A third midpole measures 11mm.
Interpretation:
Consistant with a multinodular goiter, but there are two dominant nodules measuring 27mm and 17 mm respectively in maximal dimensions and I would recommend that fine needle aspiration be preformed of these.

I am petrified: from what I read internal vascularity can mean an increased incidence of malignancy and the fact that I have two dominant ones on the same lobe; can that mean that the cancer has spread if I have cancer. I am so worried. Thank you doctor in advance. By the way my thyroid tests are TSH 3.59 and Free T4 .86. I am curious about the TSH. My doctor says it is normal, but from what I read it could be abnormal with the new accepted values.

[Mark Lupo, M.D.]

You should have fine needle biopsy of the larger nodules on the left.  The chance of cancer is 5-10% (even with the note of increased vascularity), so most of these are benign.  Also ask to have the TPO-antibody tested as with the slightly high TSH and multiple nodules, there is likely Hashimoto's which causes chronic inflammation and increases chance of nodules.

[Diane1107]

Hi Cody,

I know how scared you must be.  I too had an untra about a month ago now.  Showed 5 nodules on the left with extra "mass" 6cm by 1cm infra medially caudle to the thyroid, means a little to the middle and towards the spine.  I had been having trouble swallowing and felt like a lump in my throat all the time.  My right had 3 nodules with the biggest 1.5cm.  So mine were much larger.  CT scan showed multiple nodules, cystic/solid, one with a necrotic center.  Oh man scared is not the word for how I felt.  CT of my chest was clear.  FNA fine needle biopsy showed benign.  Good.  Well 2/29 I have a total thyroidectomy- Papillary cancer not on the left with all the nodules but the darn middle 1.5 cm one on the right.  Margins of surgery were clear and surgeon said he got it all out.  Wow, what a roller coaster it's been.  So now I'm in the waiting period for all my thyroid hormone to dissipate out of my liver.  approx 6 weeks.  Then take Radioactive Iodine which if there are any microscopic thyroid cells wandering around, they take it up and DIE.  I can start on meds then.  
My thyroid tests have always been normal.  So here is the projection of treatment.  94% cure rate with this cancer.  Continue with good follow up and I think you should see your doctor as soon as possible.  The sooner those little guys go away the better.  You can live without those darn thyroid glands.
Good luck and keep me posted.  

Hugs,
Diane

[tish4130]

Could having autoimmune disease (celiac) lead to a misdiagnosis of positive for Papillary C by way of pathology?  And how long would you guess a nodule would be present before becoming cancerous -- or would it have always been cancer?  What are the possiblities of other medications to take to balance thyroid levels in light of allergies to multiple multiple  medications and their filling/stabilizing ingredients?  Am waiting on input about surgery under these circustances and am feeling very reluctant to have the thyroid removed if I cannot replace the hormones.  Cancer was reported to be in right lobe and Isthmus.  Just read about surgery done through armpit for thyroid nodules.  Would/could this be done for cancerous nodules too? Could a lobe or two  be removed this way?   Thanks for your time.

[Mark Lupo, M.D.]

The TPO status should not influence the decision to biopsy - both of these nodules need FNA.

[cody12]

Wow Dr. Lupo,
You have really given me some hope. Even with un ultrasound report like the one above with two dominant nodules one 1.7 cm and the other 2.7 both mixed with internal vascularity with a multinodular goiter, there are some endo's that would not recommend FNA just because the TPO was 0.9?

[Mark Lupo, M.D.]

The low TPO antibody suggests you don't have Hashi -- it does not mean increased risk of cancer (may actually mean less risk of cancer).  Would pursue expert evaluation to see if FNA biopsy is needed.

[cody12]

Wow Diane,
You have been through a lot!! Thank you for your support!!

[cody12]

Hi Dr. Lupo,
I had the TPO antibody done and it came back O.9  From what I've read that is normal. Does that mean that since I have multiple nodules and it is not caused by Hashimoto's that I have a higher chance of having cancer. Thanks in advance.