Got US results/have questions

[tifleah]

Hi, I'm new to this board, so I hope I am posting this in the right place.  I will try to sum this up briefly.  Years ago I had dysphagia and pain/tenderness in my neck.  At that time, I saw an endocrinologist who did say my thyroid was enlarged, and though my thyroid function tests were normal, she treated me for hypothyroidism.  Fast forward several years, probably about 8, and once again I have had about 5 or 6 flare-ups of neck pain/tenderness.  When I have a flare-up, it is uncomfortable to painful to swallow solids, touch the area, and when it's severe, I cannot even swallow liquid and feel almost like I'm being choked and can't breathe.  The pain would even feel like a burning sensation into my ears.  Also, very interestingly, it comes and goes rather rapidly.  It can be so severe and just gone the next morning and then come back as mild, moderate, or severe.  

Other endocrine-related symptoms that may or may not be relevant:  Weigh changes rapidly.  I can gain and/or lose 20-30 pounds in just a few months easily on several occasions.  I've always had many, many ovarian cysts.  I was considered borderline hypothyroid while pregnant and treated with levothyroxine (currently 10 months postpartum).  Endocrinologist years ago said I had Hashimoto-type characteristics (but again normal blood work).  

So, I went to the doctor recently.  I had normal thyroid function tests and I had an ultrasound done.  The ultrasound report states:  The right lobe measures 4.5 x 1.5 x.2 cm and left lobe 3.9 x 1.2 x 1.5 cm.  Isthmus measures 1.8 mm.  There is a "5 mm well-circumscribed solid complex hypoechoic solid nodule in the upper portion of the right lobe of the thyroid gland."  No nodules on the left.  The impression is "unremarkable thyroid ultrasound.  Small solid nodule is seen in the right lobe most likely incidental in nature. "  Followup was recommended in 6-12 months.  

I realize 5 mm is small, but shouldn't any solid (or complex even) nodule be biopsied, especially given the symptoms?  I felt that my symptoms/tenderness/pain were more centered/left, however, but I guess it *could* be referred pain.  What I have done thus far is I have found an endocrinologist and scheduled an appointment to get a specialist/2nd opinion rather than a radiologist or PCP.  I do understand thyroid malignancies are rare, as I'm aware most believe a subcentimeter nodule does not require FNA, but solid (or complex, having at least partial solid characteristics) is solid and, although rare, malignancies do happen, not to mention small or not, they have to start somewhere.  So my question is should this be biopsied or is it still believed it should not and just be monitored due to it's size?  

I'm a little confused on the "solid complex hypoechoic solid nodule" wording since, to my knowledge, it would have to be either/or or written differently.  The transcriptionist didn't do too well on this report unless it was a verbatim report, so that's kind of scary too.  

Any thoughts/opinions/advice is greatly appreciated, and I thank you in advance!

[tifleah]

Just an update:

I went to the endocrinologist.  She was very thorough.  She looked at the nodule herself in her office on ultrasound, and she did a lot of blood work - a LOT.  She said the nodule is too small to biopsy and usually can't biopsy nodules under 7 mm.  We are taking the waiting-and-watching approach for this.  However, she is looking at 2 diagnoses for me:  Hashimoto's and PCOS.  We should get the results soon, and I go back on 5/17.  Thanks everyone who replied!  

[tifleah]

My PCP and the radiologist who read the report didn't recommend biopsy at all since it was small.  That's really my question.  I've seen some articles that say size doesn't really matter, it's whether it is solid or not.  Another article I read mentioned a study that showed positive biopsies were just as likely in subcentimeter nodules.  I was under the impression solid or complex is what mattered, but they didn't recommend a biopsy, just followup US in 6-12 months; so, I self-referred to an endocrinologist and will see what she says.  

[898_1]

At present time as far as I know, the stable nodules under 1 cm are not treated while the nodules larger the 3.5 cm (or in some sources, 5.0 cm) are suggested to be removed even if the biopsy shows benign results.

[tifleah]

Hopefully I am replying correctly :)

I am seeing an endocrinologist Friday who had good patient ratings (otherwise, I know nothing about her).  Thank you for your reply!  

[whisperwolf]

I have hypothyroidism and have similar symptoms as you, but not as severe.  I have some cysts on my thyroid,slightly enlarged and take a low dose of levothyroxine, 0.25 mcg.  My Endocrinologist told me that it is not a good idea to biopsy cysts when the bloodwork is normal or when the thyroid is not overly enlarged, nor is it worrysome, because the risks are very very small.  

I sometimes have the same problems you do, and often my doctors think "check the thyroid' and it is always within the normal limits.  I am thinking perhaps we may have another problem that mimics the thyroid disorder we have that has yet to be discovered.  

To answer your question, though, I would just keep monitoring your thyroid and not concern yourself with it unless the size increases or the blood work changes with it.