Confusing probably inadequate US report

[shellyme33]

38 yr old female - I have been borderline hyper thyroid for about 3 years and have had a large goiter. I just received the results of my ultrasound and I am perplexed by a lack of information. I know when I was being tested by the us technician, she examined blood flow to the nodules however nothing was mentioned in the report: I have a referrel to the top rated endo in ABQ to see him this Friday for biopsy after a physician to physician visit. I have been researching the possibilities via the internet and I think there is a lot of missing information. I am concerned that the other information may have not been mentioned because the US is very suspicious and I need to have cancer ruled out. So here is the US information:

Indications: Hyperthyroidism Goiter

Sonograms demonsrate the right lobe to be upper limits of normal measuring 4.8 x 1.3 x 1.7 cm and the left lobe to be enlarged measuring 5.7 x 2.9 x 4.6 cm. The isthamus is thickened to 5.6 mm. A complex, primarily solid slightly hypoechoechoic nodule is in the lower pole of the right lobe measuring 11 x 6 mm with a 3 mm cystic area centrally that contains a small hyperechoic nodule within this small cyst. In the left lobe no normal thyroid tissue is identified.
A very large nodule occupies most of the left lobe measuring 4.3 x 2.5 x 3 cm. Hyperechoic tissue is capping the upper pole of the left lobe. Tiny nodules are noted within this area. The nodule in the left lobe is somewhat lobulated appearing.

Impression:

Very large solid nodule in the left lobe of the thyroid. The left lobe is enlarged. A small complex but primarily solid nodule is in the lower pole fo the right lobe.

[shellyme33]

I meant to ask for opinions, I lost my daugther to epilepsy in 2007 and I am terrified the odds are against me. It really bothers me that "NO NORMAL THYROID TISSUE IS IDENTIFIED"

ANYBODY'S HELP WOULD BE GREATLY APPRECIATED.

[redheadaussie]

Would appear your left thyroid gland has become basically one big nodule. Thyroid tissue has more than likely been attacked due to an autoimmune issue. More than likely Graves disease.
  Your right side would still be producing thyroid hormone.
Are you having a Fine Needle Aspiration? This is the one finite way of finding out if it is a cancer or not.
It is highly likely it is not cancer. But I suspect you would have to have it removed.
Have you had any hyper symptoms? Do you know what your thyroid blood test levels are?
Cheers

[Smilerdeb]

I agree with Redhead Aussie.

Also its fair to mention that IF (and I say IF) cancer is present, it is one of the most curable types of Cancer and removal should fix it with RAI afterwards.

You have many , many years in you yet.
I am sorry to hear about your daughter....epilepsy runs deep in my family too and I had petite mal epilepsy as an adolescent with my last fit being at the age of 14.I took meds for 5 years after my last fit and am now 50 at the end of this year.
Although all my fathers side of the family suffered with Grande Mal Epilepsy and are all on meds for it.
So I do understand where your fear is.

[shellyme33]

Thank you for your responses...

I do believe I am syptomatic... I have temperature regulatory issues, either hot or cold when others are not. I defineaty have anxiety as well as heart palpitations that are difficult for me to distinguish. Funky hair growth on my face. The huge knot in my neck, and forget swallowing large pills. The pills go down but it is difficult. I used to be able to pop a handful of large vitamins but now I struggle with one. I am definately irritable and snappy at times. I have suffered from fatigue for so long, I try and ignore that one. Also, frequent loose bowl.

My thyroid levels are:

TSH .354 Lab Range .4 to 4.5
FT4 1.4    Lab Range .8 to 1.6

Antithyroglobulin -  < 20 Range 0 to 39
Anti-TPO-Ab -     < 10.0 Range 0 to 34

The hyperechoic tissue with many tiny nodules capping the upper pole of the left lobe, how do I know if that is inside the thyroid or outside the thyroid (extracapsular)?

Thanks again....

[shellyme33]

Oh yeah.... THE BRAIN FOG and occasional visions problems. Since my daughters passing it has been difficult to think. I definately think that her death was a factor in my brain issues, however the currently seem to be more spell type problems. My memory used to be unsurpassed, now that is a memory. I can tell you I just don't feel good. My lab work in December 2007 (2 months after her passing), was TSH - 1.35 and FT4 - 1.6 (same range as above), so you can see there has been some degenerative function. I used to be able to spell anything, and now sometimes I get confused over simple words (yesterday it was steak). My vision has been checked annually and I do not have any grave's eye problems, but I do get dry eyes (I wear contacts). The brain fog is the worst!

[redheadaussie]

Hi again. I hope your biopsy goes well.
I wonder if you know what your Free T3 level is? Just by your T4 and TSH you would appear hyper, but the level of Free T3 needs to be taken into consideration.
The anxiety and the heart palps all come from the being hyper.  The brain fog may well be due to low Free T3's.
  Swallowing is an issue when the goitre presses upon the esophagus. Which is why I feel you need it surgically removed. In my case it got to the point where I could not breathe without sounding like an emphysema patient. Swallowing food was a night mare!
   With stress of any type, often the thyroid levels go hypo. The body seems to like to try to shut down so we have our time out as it were, to deal with the issues at hand. Sadly, in this day and age, we still have to deal with every day life. So with the stress of your daughter's passing and all that entailed, your Free T3's were probably going into a nice little retirement home.
I know what you mean about spelling. I used to do lots of short story writing.Had a few published too. Lately I am relying more on spell checker. Most humiliating!
   In regards to your funky facial hair (must say, I do like that phrase!) It could well be your either testosterone, or cortisol levels are off. Might be a good idea to get them both checked.
  Cheers!

[shellyme33]

Thank you kindly for your input. I have not had FT3's taken, sadly I have had a laxidazical GP who is only good for daily prescriptions, referrels, and once he did the metabolic profile at my request. Occasional endo visits supplemented the monitoring.

I was reading a study yesterday about CFS / ME (Cronic Fatigue Syndrome and again I don't remember what the ME stands for means essentially the same thing as CFS) and the correlation to thyroid cancer. It was interesting, however before any type of connection can be drawn for a thyroid patient, the thyroid has be under control and either functioning or good hormone replacement. This fascinated me because I think someday the doctors should be able to draw some sort of autoimmune connections with my health history and that of my children. I do have another child with epilepsy. When my paternal grandmother was diagnosed with lupus, I had myself and my son tested, as after my daughter's death prior to the autopsy report, the ER group said that she may have passed from a pulmonary embolism. Lupus is a risk factor for PE. That said I have had a lot of labs done and the report I read yesterday discussed some of the components for the metabolic profile. Just interesting. Any how, thanks again, I will post my doctor's opinion this afternoon.

Cheers to You!  (I love your salutation)

[shellyme33]

I am now really worried... I had my biopsy and the results are supposed to be in on Wednesday of this week. The doctor opened the visit by suggesting RAI, I told him I thought I wanted a total thyroidectomy and he said, "No, people in your condition generally do the RAI." He then told me that we would discuss further after US FNA, I agreed. After he had taken four syringes of thyroid samples, he asked me if I was onboard for surgery. I told him yes, and he said, "Good, Let's get a surgeon, on the phone." He told the surgeon that I needed at least a left lobectomy and possibly a total thyroidectomy, depending on how the cytology report comes out on Wednesday. I am scared, I am at the end of an adoption, and my attorney told me that I could under no circumstance have surgery until the adoption is finished. He said that if I were to die as a complication of surgery that my husband would not get the baby, until my adoption is finished. The endo sent me for labs, and they came back normal, no hypo or hyper. I am sick with worry, I may not be able to have surgery for a month. The endo went from treating me like I was a big worrier to making me an appointment with a surgeon. The only comfort was that he said if I had anaplastic cancer that he would be able to tell me, before the cytology report. Very small comfort, I am not sure what to believe, and limbo is painful.

[MANmom]

Get the cytology results, then you can make some decisions.  Sometimes you don't get a definate answer and the best choice is lobectomy.  That is what I did, all my hormone levels were normal, I still had cancer, then I had a TT and RAI.  You really cannot tell for sure unless they get cancerous cells in the biopsy or they take out half and biopsy that.