Do I need surgery?

[bamamom2]

Dr. Lupo, I would very much appreciate your opinion.

As of October, 2008:
Levels:
TSH 2.33 (0.34-4.82)
FT4 .82 (0.77-1.61)

Sonogram:

Findings:  The right lobe is 4.6 X 2.2 X 1.9 c.m. The left lobe is 4.4 X 1.4 X 1.1. c.m.  Multinodular thyroid appearance is seen with 4 mm nodule in the upper pole on the right and 2.8 c.m nodule in the mid aspect of the right lobe noted.  7mm nodule in the right side of the isthumus is seen.
Impression:  Multinodular thyroid disease with  a 2.8 c.m dominant nodule in the mid right lobe of the thyroid.  This has a complex appearance.  Nuclear med I-123 scan to exclude dominant cold nodule here is suggested to exclude malignancy.

Nuclear Med I-123: "cold nodule on the right-neoplastic nodule cannot be excluded"

FNB:
Diagnosis:  right thyroid gland, FNA, smears/autocyte prep. negative for malignant cells. Benign follicular cells with a moderate amount of colloid, hurthle cells and blood.  Consistent with nodular goiter

Present meds:
premarin 0.625 mg
nexium 40 mg
simvastatin 40 mg (take l/2)
glycopyrrolate  2mg tablet (take l/2)

5l year old female
5' l"  approx 165 lbs.
VAP study:  LDL 136 with homocystine elevated at 21 and highly sensitive CRP elevated at 6.9

What would you recommend at this point:

my concerns with surgery:

weight gain
hair loss
emotional imbalance

Also, what is the best way to prevent scarring at the surgery site.  Not the most important concern, but a concern.

Thank you very much,

Bamamom2

[bamamom2]

Thank you.  I think I will do as you advise.  The symptom that initially took me to the doctor is that I clear my throat somewhat excessively.  The ENT I went to is treating me for acid reflux.  I actually asked that he check my thyroid and that is when he found the nodule.  He doesn't think the nodule and the throat clearing are related.  Do you think the throat clearing is related to the nodule?

The reason the doctors here seem to recommend surgery is because of the error rate on the FNB, but I just haven't felt good about surgery.  Of course, cancer is a scary thought.  I do think waiting and repeating the ultrasound would be good.

Thank you again.

Bamamom2

[Mark Lupo, M.D.]

The FNA looks benign.  The thyroid function appears normal.  Unless the nodules are bothering you consistently then would not think surgery is indicated.  Would followup with repeat ultrasound in 6-12 months.