Thyroid Ultrasound Results - Please help me understand.

[UndercoverShyGirl]

Hi there, my first post. I'm one of those people that likes information and my doc doesn't seem to know much about the thyroid. Just had my first ultrasound - have been struggling for two years with weird issues at 43 years of age (irregular/heavy menses, anxiety, joint pain, lots of chest pain) and finally a few months ago this strange strangling feeling. My doc said she would prove i had anxiety and ordered a thyroid ultrasound and chest xray (haven't done the latter yet).

Thyroid ultrasound results are "mildly heterogeneous echogenicity. Vascularity felt to be decreased. A focal hypoechoic ill-defined nodule is seen in the inferior right thyroid lobe measuring 1.0 x 0.x x 1.o cm. Rest of thyroid shows no discrete nodules. No enlarged lymph nodes. (thyroid measurements overall seem fine at 1.5 x 1.6 x 5.2 for right lobe and 1.4 x 1.3 x 4.7 for left - isthmus at 3mm)

I understand the heterogeneous echogenicicity means probably scar tissue of some sort (never had any thyroid issues or tests before and all blood test for thyroid stuff have always been normal - i'm obese so we've tested that before). I know that most nodules are not cancerous, but i'm curious as to the decreased vascularity finding as i have read that most hashi patients, etc. have increased vascularity....

I am going to see an endo of course, but am curious as to if this seems to be more on the "possibly cancerous" or "possibly hashimotos" side, or if this is very normal stuff....


Any comments or things i can research (i like to be an informed consumer) are much appreciated, thank you!

[UndercoverShyGirl]

Thank you so much for your quick comment, i will definately talk to my endo about that today. I think the hardest time i'm having is finding people that know things about thyroids, and the limited access to them via my primary/hmo.

Do you feel it is important to only get an FNA from someone that has a lot of experience doing them (i've read that it can be tricky to get worthwhile samples, and my nodule - if it is that - is not palpable so it might need to be US guided)?

Also, with something like Hashimoto's - would i be experiencing chest pain - needing to get my heart checked out - i know there is a connection (or at least i've read) between undetected thyroid issues and heart function, and have been battling with chest pain for over a year now, so wondering if i should have another echocardiogram (had one two years ago)...my doc referred me, but only after stomping out with a "fine, i'll refer you so you don't blame me when you have a heart attack"....and i don't know if i'm overreacting, or she is (she's insisting everything is in my head and I'm not so keen on anti anxiety meds since i'm happy, sleep well, etc...but have a lot of chest pain and constant high bp)....thanks!

[Mark Lupo, M.D.]

The heterogeneity is most commonly thyroiditis - Hashimoto's - would test TPO antibodies to confirm and consulting with an endocrinologist (preferably one who does his/her own ultrasound to evaluate the "nodule" to see if it is a real nodule that may need biopsy or an area of inflammation) is a good idea.