Aa
Can someone please help interpret my recent Ultrasound, for peace of mind.
EXAM: ULTRASOUND THYROID
HISTORY: xx-year-old with nontoxic thyroid nodule. Right hemithyroidectomy in 2016. Previous diagnosis of lymphoma.
History of FNA or ethanol ablation:
3/12/2015 ultrasound guided right FNA. Results = follicular neoplasm (favor adenoma).
2/12/2015 ultrasound guided left side level 3 lymph node FNA. Results = no tissue received.
TECHNIQUE: Realtime sonographic imaging was performed of the thyroid gland assessing grayscale and color Doppler flow appearance using a high frequency linear transducer.
COMPARISON: 2/12/2020 thyroid ultrasound, 3/12/2015 ultrasound guided right FNA.
FINDINGS:
The right lobe is surgically absent. No residual tissue is seen within the right thyroid bed.
The left lobe measures 4.7 x 1.4 x 1.7 cm.
The isthmus measures 0.3 cm.
Overall thyroid parenchyma demonstrates coarse echotexture with normal vascularity.
NODULES:
RIGHT LOBE NODULES:
None.
LEFT LOBE NODULES:
Nodule location: Left lobe, lower pole labeled #1, image #50 .
Size: 2.0 x 1.3 x 1.4 cm . Previous measurement 1.8 x 1.0 x 1.7 cm. No significant change.
Composition: Almost completely solid (2)
Echogenicity: Hypoechoic (2)
Shape: Wider-than-tall (0)
Margin: Smooth (0)
Echogenic foci: None (0)
TI-RADS category: TR4
Nodule location: Left lobe, lower pole labeled #2, image #53
Size: 0.6 x 0.5 x 0.4 cm . Previous measurement 0.9 x 1.0 x 0.8 cm. Slight interval decrease.
Composition: Solid (2)
Echogenicity: Hyperechoic (1)
Shape: Wider-than-tall (0)
Margin: Ill-defined (0)
Echogenic foci: None (0)
TI-RADS category: TR3
ISTHMUS NODULES:
None.
Survey images of the neck demonstrate :
Right side level 2 lymph node measuring 1.4 x 0.6 x 0.9 cm. Image #19
Right side level 3 lymph node measuring 2.1 x 0.2 x 0.7 cm. Image #22.
Left side level 3 lymph node measuring 1.4 x 0.2 x 1.0 cm. Image #59.
IMPRESSION:
1. Patient is status post right hemithyroidectomy. No residual tissue visualized in the right thyroid bed.. The specimen revealed benign findings
2. The left lobe demonstrates coarse echotexture with normal vascularity.
3. Left lower pole 2.0 cm nodule, ACR TI 4, meets criteria for biopsy.
4. Subcentimeter left thyroid nodule, ACR TI 3, does not meet criteria for biopsy or follow-up.
5. Bilateral benign-appearing lymph nodes, likely postinflammatory.
American College of Radiology TI-RADS Categories and Recommendations (2017):
TR1: 0 points, Benign, No FNA
TR2: 2 points, Not suspicious, No FNA
TR3: 3 points, Mildly suspicious, FNA if > or = 2.5 cm, Follow if > or = 1.5 cm
TR4: 4-6 points, Moderately Suspicious, FNA if > or = 1.5 cm, Follow if > or = 1.0 cm
TR5: 7+ points, Highly Suspicious, FNA if > or = 1.0 cm, Follow if > or = 0.5 cm
Follow-up ultrasound guidelines:
TR5: yearly for 5 years, if no growth or change in TI-RADS level
TR4: at 1, 2, 3 and 5 years, if no growth or change in TI-RADS level
TR3: at 1, 3 and 5 years, if no growth or change in TI-RADS level
If change but below threshold for FNA, repeat in one year.
Source: ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. Tesler et al., J Am Coll Radiol 2017;14:587-595.
HISTORY: xx-year-old with nontoxic thyroid nodule. Right hemithyroidectomy in 2016. Previous diagnosis of lymphoma.
History of FNA or ethanol ablation:
3/12/2015 ultrasound guided right FNA. Results = follicular neoplasm (favor adenoma).
2/12/2015 ultrasound guided left side level 3 lymph node FNA. Results = no tissue received.
TECHNIQUE: Realtime sonographic imaging was performed of the thyroid gland assessing grayscale and color Doppler flow appearance using a high frequency linear transducer.
COMPARISON: 2/12/2020 thyroid ultrasound, 3/12/2015 ultrasound guided right FNA.
FINDINGS:
The right lobe is surgically absent. No residual tissue is seen within the right thyroid bed.
The left lobe measures 4.7 x 1.4 x 1.7 cm.
The isthmus measures 0.3 cm.
Overall thyroid parenchyma demonstrates coarse echotexture with normal vascularity.
NODULES:
RIGHT LOBE NODULES:
None.
LEFT LOBE NODULES:
Nodule location: Left lobe, lower pole labeled #1, image #50 .
Size: 2.0 x 1.3 x 1.4 cm . Previous measurement 1.8 x 1.0 x 1.7 cm. No significant change.
Composition: Almost completely solid (2)
Echogenicity: Hypoechoic (2)
Shape: Wider-than-tall (0)
Margin: Smooth (0)
Echogenic foci: None (0)
TI-RADS category: TR4
Nodule location: Left lobe, lower pole labeled #2, image #53
Size: 0.6 x 0.5 x 0.4 cm . Previous measurement 0.9 x 1.0 x 0.8 cm. Slight interval decrease.
Composition: Solid (2)
Echogenicity: Hyperechoic (1)
Shape: Wider-than-tall (0)
Margin: Ill-defined (0)
Echogenic foci: None (0)
TI-RADS category: TR3
ISTHMUS NODULES:
None.
Survey images of the neck demonstrate :
Right side level 2 lymph node measuring 1.4 x 0.6 x 0.9 cm. Image #19
Right side level 3 lymph node measuring 2.1 x 0.2 x 0.7 cm. Image #22.
Left side level 3 lymph node measuring 1.4 x 0.2 x 1.0 cm. Image #59.
IMPRESSION:
1. Patient is status post right hemithyroidectomy. No residual tissue visualized in the right thyroid bed.. The specimen revealed benign findings
2. The left lobe demonstrates coarse echotexture with normal vascularity.
3. Left lower pole 2.0 cm nodule, ACR TI 4, meets criteria for biopsy.
4. Subcentimeter left thyroid nodule, ACR TI 3, does not meet criteria for biopsy or follow-up.
5. Bilateral benign-appearing lymph nodes, likely postinflammatory.
American College of Radiology TI-RADS Categories and Recommendations (2017):
TR1: 0 points, Benign, No FNA
TR2: 2 points, Not suspicious, No FNA
TR3: 3 points, Mildly suspicious, FNA if > or = 2.5 cm, Follow if > or = 1.5 cm
TR4: 4-6 points, Moderately Suspicious, FNA if > or = 1.5 cm, Follow if > or = 1.0 cm
TR5: 7+ points, Highly Suspicious, FNA if > or = 1.0 cm, Follow if > or = 0.5 cm
Follow-up ultrasound guidelines:
TR5: yearly for 5 years, if no growth or change in TI-RADS level
TR4: at 1, 2, 3 and 5 years, if no growth or change in TI-RADS level
TR3: at 1, 3 and 5 years, if no growth or change in TI-RADS level
If change but below threshold for FNA, repeat in one year.
Source: ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. Tesler et al., J Am Coll Radiol 2017;14:587-595.
Best Answer
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2 Comments
Hi, they decided to remove the right thyroid because I have a history of lymphoma. When the went to remove it, the dr. Ended up removing the parathyroid because it was clustered together. It was benign. I just had the
Is biopsy done, and the test results will be sent over to my doctor so I will be meeting with her. Thank you for sharing your feedback. I will make sure the dr. Is on top of it! Btw yes, I’m in levothyroxine.05 mg
Is biopsy done, and the test results will be sent over to my doctor so I will be meeting with her. Thank you for sharing your feedback. I will make sure the dr. Is on top of it! Btw yes, I’m in levothyroxine.05 mg
Sorry I haven’t had a biopsy done with these recent new findings
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Have you talked to your doctor? The lower pole (TR4) nodule should have a biopsy, particularly if you’ve already had thyroid cancer in the right lobe.
Solid nodules are more likely to be cancer than those that are cystic.
Since having the hemithyroidectomy, have you been on any type of thyroid hormone replacement? If so, what medication/dosage. Do you know if you have Hashimoto’s?
What, if any, symptoms do you have?