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I Just Had A Follow Up Ultrasound 9 Months Later

Hi,

I haven't been on here for over a year and I'm still going through the mental torment of not knowing if my three small thyroid nodules that were found by accident in October of 2006 when I wasw 41 and a half when I had asked  my internist for an ultrasound because I was always thin all of my life,and at 34 I gained it weight for the first time and I had to go on a diet  at 34,and then again at 38 and my blood tests have always been normal.


I just went for a follow ultrasound up on Thursday at The University Of Pennsylvania Hospital 9 months after I had the last one and  none of my nodules grew or changed,but I have no halos going around the nodules,and one of my nodules is  isoechoic and solid and one is hypoechoic and I know that many benign nodules are solid and or hypoechoic too but there is a higher % of cancer that are,and I have read medical study and paper after the next  explaining that thyroid nodules with no halos around them are much more often cancerous and benign nodules often have them! Also my endocrinologist Dr.Kolin Hoff keeps dismissing and minimizing all of my information and concerns,he says he doesn't care if someone has a 5 mm thyroid cancer,or 8 mm because he says thyroid cancer rarely kills people and that I have a better chance of being eaten by a shark at the beach. He also keeps insisting that the round shape of thyroid nodules having a high % of cancer is outdated, but I keep finding recent god medical studies on good medical sites that still list this feature and I know my nodules are round!

Even the American Association of Endocrinologists had a major task force on Thyroid Nodules from January 2006 that is still online,that said a round shape of thyroid nodules has cancer potential and they are not updating their guidlines until 2009!  My endo also said when I asked him months ago when I was there,about thyroid cancer not being as treatable after afe 40,that actually it's 45 and he said but he doesn't say to his patients your over 45 and now your screwed,he said he has treated people successfully in their 50's but I just turned 43 and it really worries me. When I asked him two days ago about one of my nodules being hypoechoic,and that there is a higher % of cancer that are,he said many benign nodules are hypoechoic too,which I already knew,and I asked him if the nodule that is hypoechoic is very hypoechoic,and after only reading the preliminary report that had just been sent to him, all he said was something about  that there are large cystic nodules that are hypoechoic which doesn't even apply to me!

Also there are medical articles online by radiologists explaing that growth and size of nodules are unhelpful signs. Dr.Douglas Ross from Boston Hospital wrote about the epidemic of thyroid nodules and small thyroid cancers in the summer 2006 former Thyroid Association's newsletter and he said there may be as many as 17 million undiagnosed small papillary thyroid cancers many picked up by accident from ultrasound and other imaging tests,and he said they only know about the small % that comes to clinical attention,and they really don't know the natural course and outcome of these small thyroid cancers yet.He also said that in Japan there was a study with over 200 people with small thyroid cancers, and 60% of their small cancers didn't grow in 4 years!  So the fact that my nodules haven't grown in 9 months doesn't mean they aren't cancer and I know many benign nodules grow slowly over time too! What should I do I keep being told my nodules with the largest at 9mm are too small to biopsy now and Dr.Hoff told me that one of my nodules is deeply imbedded in my thyroid that he would have to go through a whole lot of benign tissue to get to it and it would make it seem benign even if it isn't and I know the needle biopsies are not often accurate to begin with! Dr.Lupo told me in December 2006.and I see he has told others on here too,that there would be no point to getting a thyroid scan with a normal TSH but many people on here did to see if their nodules were cold,and I know that 85-90% of cold nodules are also benign thats the problem.
31 Responses
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Avatar universal
Having followed your posts I was concerned that they stopped last year.  How are you.


Helpful - 0
Avatar universal
In an online article called,Thyroid Nodules:When To Biopsy  from the online journal,Applied Radiology two radiologists from the University of Maryland said that the although the halo sign around the nodules suggests benign nodules,the halo sign may be absent in more than 50% of benign nodules and present in up to 20% of cancerous nodules.
Helpful - 0
Avatar universal
Thank you,

Thats a really crazy story about the inexperienced med student performing your biopsy! FNA's are already often not accurate when they are performed by experienced doctors as it is already.

What about blood flow,hypoechoic,isoechoic solid,predominantly solid and cystic etc? Did your ultrasound decribe any of these features?
Helpful - 0
464412 tn?1213225852
My results said complex nodule with mixed echogenicity and echotexture that affects the entire left lobe.  It doesn't mention shape but i would assume more oval based on the dimensions (5x3x2 cm).  The results I have make no mention of a halo.  The results of my biopsy were benign but my GP still wants me to see a surgeon due to the size and the discomfor twhen swallowing.  Plus neither she nor I have any faith in the reults of the biopsy due to the complete idiocy of the endo med student who performed it.
Helpful - 0
Avatar universal
Can you please tell me what the Ultrasound features of your ultrasound  describes? Do you know if your nodule is isoechoic,solid and or hypoechoic ,round shape and has a halo around it? You don't know the results of your biopsy yet?
Helpful - 0
464412 tn?1213225852
My endo told me I didn't need a scan and it would be a waste of my time because it wouldn't matter what it said, the biopsy would give them the definitive answer.  Well it was a little late cause I had already taken the iodine the day before.  Which leads me to another question.  Anyone know if it's possible for the radioactive iodine to affect a biopsy.  I had the scan done about an hour before I had the biopsy.  Endo didn't seem to care... never seems to care.

And for the record all my thyroid labs are within the normal range and I have a 5x3x2 cm complex nodule that is 100% cold on the scan.  My GP was the one who told me to get it.
Helpful - 0
Avatar universal
My endo  is saying and the radiologist wrote on my last and recent Ultrasound report that none of nodules meet the criteria for biopsy and that I don't have calificication and that blood flow is normal. But I know that quite a few people who have had thyroid cancer had no suspicious worrisome Ultrasound features but they still had small thyroid cancer anyway! And Dr.Susan Mandel who is a top thyroid cancer specialist at the University of Pennsylvania Hospital and who works with my endo,has written many articles in medical journals that are online including The Journal of Endocrinology and Metabolism. She was part of a major conference panel of many endocrinologists and radiologists who met in Washington in October 2004 to discuss the Ultrasound features of  cancerous and benign nodules and the diagnoses and treatments of thyroid cancer. The conference is online on the web site for the Radiology Society Of North America and it's called, Management of Thyroid Nodules Detected at US:Society of Radiologists in Ultrasound Consensus Confernce Statement.

They say that solid or predominantly solid nodules have a higher risk of malignancy than do mixed or predominantly cystic nodules.Cystic and almost cystic nodules have a very low likelihood of being malignant.Nodules with mixed composition have an average risk of malignancy.For this reason,the recommended minimal size for US-guided FNA is lower for solid or predominantly solid nodules than the recommended minimal size for mixed and cystic nodules.Yet they are telling me none of my nodules meets the criteria for biopsy when one is described as solid,not even mostly solid,but solid!!!!

They also say,that several Ultrasound features have been found to be associated with an increased risk of thyroid cancer including,presense  of califications,hypoechogenicity,irregular margins,absence of a halo,predominantly solid composition,and intranodule vascularity.However,the sensitivities,specificities,and negative and positive predictive values  for  these criteria are extremely variable from study to study,and no US feature has both a high sensitivity and a high positive predictive value for thyroid cancer.The feature with the highest sensitivity,in the range of 69.)%-75.0% is solid composition;however this feature has a fairly low positive predictive value in that a solid nodule has only a 15.6-27.0 % chance of being malignant.


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Avatar universal
Thank you both for your replies.

I really don't know what to do or what other doctor to turn to and I am very worried and really need peace of mind!  I had asked on here before should I have a thyroid scan to see if any of my nodules are cold? Maybe the combination of cold nodules and round shaped nodules,no halos around them,one solid and one hypoechoic, if will steer me more towards surgery.The only problem is that 85-90% of cold nodules are  also benign.


Dr.Mark Lupo  told me on here in December 2006 and I see he has also told others on here,that with a normal TSH there is no point in getting a thyroid scan  but I see many posters on here did get scans to see if their nodules were cold even though they had a normal TSH and other thyroid blood tests. pep88 utahmomma said that PET scans don't really show thyroid cancer because it's not usually an aggressive type and grows slowly.But a representative at The National Cancer  Institute suggested that I get a PET scan and she said that they have information which she is going to mail me,that uses PET scans to dectect thyroid cancer because the cancerous areas light up.pep88 please read through all of my other information I wrote on here when you get a chance,thanks.
Helpful - 0
280485 tn?1249013844
You gave SO much information.  But in scanning through the thread at what you've written (I can't read it all, I have to go to bed, it's late...), I see no mention of any diagnostics other than an Ultra Sound and blood tests.  If you are concerned, and you seem to be convinced there is something to these nodules, seek out a pet/ct/mri or a new doc who will concent to such or further diagnostics.  

There is a weird little intutition button that each of us has regarding our health.  I followed mine when I accidently found a nodule (1.2cm) on a ct scan for an unrelated issue.  *I* brought it up to my doc (after having a copy of the CT scan report faxed to me, she wasn't even looking at "that" part of the scan results).  And it was *I* who insisted we take a closer look at it.  It was small (the one...), but there were two, and I could see she was waffling.  She almost advised that I wait and see, I could see the words forming to come out, part of it did, but I just knew we found it for a reason.  There was also some calcification that showed up on the scan and that seemed to seal the deal.

I had FNA about 2 weeks later, and then was referred to a surgeon.  For the record, it was cancer.  Papillary with follicular variant.  

Somehow I knew.  I just knew.  Something was pressing "that button".  If that is how you're feeling, make someone listen.  We can pontificate for days/months... make this thread the longest in history...(and although this one is getting there, we'd have a hard time beating the "pub" thread from friday night...), but in the end, if you have "that" feeling...  Make it happen!

I wish you well, good luck with your journey.
Helpful - 0
427555 tn?1267553158
An ultrasound once a year should be fine, but I am not sure. Others may have more info. on that.I don't know the features of the nodules except they were large, I never thought to ask>
Helpful - 0
Avatar universal
Thank you for your reply,

No I meant how long  it should be to tell if the nodules haven't grown or changed from  an ultrasound that had been done 9 months before this one. It's actually a year and half since my nodules were discovered by accident and they are still really small with the largest at 9mm.

Do you know  whatany of your Ultrasound features of your cancerous nodules were?
Helpful - 0
427555 tn?1267553158
I was diagnosed 2 years ago when I was 46.  I had 5 growths.  The largest was 4.8cm. and the rest were between 1.5 and 3cm.  They were discovered because I felt like I had food in my throat so asked my doctor to look when I was in for an annual check up.  She saw nothing in my throat and started feeling it. She sent me for an xray, and when that showed something she sent me for a CTscan for a better picture. That came with the news of some nodules so she sent me to a endocrinologist(my first visit with one) who said multi nodules are rarely cancerous but lets biopsy them anyway. He said he would send me to a surgeon for a  thyroidecotomy regardless of the biopsy, because they were so large. He was surprised the results came back with a diagnosis of cancer. I was not seen locally because of the need for a large neck disection, and went to a hospital 2 hours away. When you have your TSH checked have they also done a thyroglobulin test? I'm not sure what is the recommended time to check blood work when being watched, but I would guess maybe every 6 months.
Helpful - 0
Avatar universal
Thank you,

do you think I should get a thyroid scan to see if any of my nodules are cold?  As I already said,Dr.Mark Lupo told me in December 2006 and I see he said this to others on here as well,that with a normal TSH there would be no point in getting a scan,but I see many people on here have gotten a scan even with a normal TSH. And how long do you think I should wait to be monitor me,my endo wants me to come back in a whole year for an Ultrasound follow up but I'm a little worried to wait that long. The longest I recently waited was 9 months.

How old were you when you were diagnosed  if you don't mind me asking and how many nodules did you have and big were they and how were they discovered? When you say you guess it's good that I have had no change in 9 months,how long do you think I would be for no changes?
Helpful - 0
427555 tn?1267553158
I didn't know anything about thyroid before I was diagnosed, which was by accident.  I had never asked for Tsh tests but probably had them during routine annual blood work. Apparently I never had any problems with levels.  I don't know the shape of my nodules because I never thought to ask.  I had some lymph node involvement.  I guess  if you have had no change in 9 months that is good as long as they continue to monitor you.  As for Shellagh Nolan, I don't know which kind of thyroid cancer she had, but she fought it for 4 years.  
Helpful - 0
Avatar universal
Cheryl,

Now I know what you asked me, I just read your post to me from last night again and when you had written one ? did my 9mm grow over the last 4 months I didn't understand what you meant at first, I thouht you typed the ? by mistake but now I read it again and I  know you were asking me a question! I haven't got the full written  Ultrasound  written report mailed to me yet but from my endo reading the preliminary on thursday he said that the radiologist who reviwed and wrote it says that all three nodules are stable and have not grown or changed in 9 months since my last follow up ultrasound.
Helpful - 0
Avatar universal
Do you think I should have a thyroid scan to see if any of my nodules are cold?  As I said last night Dr.Mark Lupo said to me in December 2006,and I see he has told this to others on here,that there is no point in getting a thyroid scan done if you have a normal TSH but I see many people on here and other health thyroid boards got scans with normal thyroid function to see if their nodules are cold. The problem is though as I already had mentioned, 85-90 % of cold nodules are also benign so the scan can't really tell you that much either! But with a combination of one solid nodule,another hypoechoic and round shape and no hypoechoic halos around the nodules,cold nodules would increase my likelyhood of thyroid cancer.


Utahmomma,did you read what I said in my post last night about my first cousin who is 8 years older than me and she recently told me that about 9 years ago she was having head aches from a diet pill she was taking because she wanted to loose 10 pounds after her  second baby was born,and she had an MRI that found a thyroid nodule. She had a scan and it was cold and then she had an inconclusive FNA and then had half of her thyroid removed and it was benign,and she always had a normal thyroid function. I spoke to thyroid cancer survivors from thyca  who my cousin was lucky and one woman from thyca said that 99% of thyroid cancers are found by accident. She told me that in 1990 she had a test for problems with neck arteries and 7 years later at  age 48  she had a  5cm thyroid nodule that the doctors kept telling her looked benign, and she had it out because it was causing her swallowing problems, and when she had it removed she found out it was thyroid cancer! She said that she went back and read her old medical records and found out that in 1990 when she had the neck artery test,they had written just a little footnote that she had a half of cm thyroid nodule and never told her about it!
Helpful - 0
Avatar universal
I just noticed I made some typing mistakes! I really wish there was an edit button on here!  

Did any of you also read what I had said in one of my posts last night  about how my endo also keeps insisting that round shape of thyroid nodules having a higher % of cancer is outdated,and I keep finding recent medical studies that still mention it? And I said that even Dr.Mark Lupo , who my endo said he knows just said in March to the poster on here hokiehoo,when she described her thyroid cancerous nodule from thyroid cancer that came back as being an oblong shape,Dr.Lupo said  to her that thats an unusual shape for a thyroid cancer because they tend to be rounded!!!!
Helpful - 0
Avatar universal
THank you all very much for your supportive reponses!!  Utahmomma, you are right on about my endo's cr*ppy attitude, but I have a feeling if he had these three nodules,one solid,one hypoechoic and without hypoechoic halos, or his mother,daughter,wife or sister does,he probably would *still* minimize it because he says breast cancer and colan cancer  are the serious cancers,they kill people!

Did any of you read the info (I know it's a lot) I posted in my above posts,that in Japan out of over 200 people with micro thyroid cancers, 60% of them didn't grow in four years? So it just goes to show it doesn't mean my nodules are not cancerous! Also as I said before there are good online medical studies by radilogists and endocrinologists including one presentation for the Radiolody Society Of North America that found growth and size are unhelpful signs.

Utahmomma, what do you feel about the fact that none of my three nodules one of which is solid,and another hypoechoic hasn't grown in 9  months since the last ultrasound?  And do you know anything about what I posted in my first posts about the round shape of nodules having a higher % of cancer,and also as I said I have sen time and time again in every major medical report on thyroid nodules and thyroid cancer,that in about  80% of thyroid cancers especially in papillary cancer there is an absent or incomplete halo around the nodules,and nothing is mentioned about my nodules having halos!  This really scares me! I asked the ultrasound tech after she finished my ultrasound thursday, why there was no mention in my first ultrasound there in July about halos and a comet tail sign,and she said then they didn't see them,and I asked my endo about this and he said that some thyroid cancers have a halo but as I said I know the cancers only have a complete halo around the nodule in only about 10-20% of cases!

Helpful - 0
362809 tn?1233506554
Maybe you need to see another endo?  I know that nodules smaller than 1cm can be biopsied.  Maybe yours just doesn't want to do it.  As long as yours haven't grown, I don't think you need to be in panic mode, but definitely follow them and if they grow at all, insist on a biopsy.
Helpful - 0
168348 tn?1379357075
Hey, long time no chat, welcome back!!!

Bet if it was your doctor's own thyroid he wouldn't be so flippant about it!  No matter they type of thyroid cancer, it's still cancer.

I don't think that movie critic Roger Ebert is so happy about "only having papillary carcinoma" - his recurrence cost him his jaw, most of his neck, his voice, his career and he's still not out of the woods.  Here's a pretty recent picture of what he's going through right now (warning, it's not pretty):  [edited by CL Thyr Community:  not graphic ... reveals bandage over wound ]  

(untoldentertainment.com/blog/img/2007_12_14/ebert.jpg)  

The bassist for Duran Duran who died of thyroid cancer is Wes Wehmiller and I've looked all over the web but can't find what *type* of thyroid cancer but from his official bio it sounds like he was going through chemo, not RAI, but I'm not 100% sure:  weswehmiller.net/new/bio  (add http:// to the beginning).  He was so young and so talented but I know that age doesn't really disqualify you from this stuff.  My sister's papillary carcinoma had metastasized to her breasts and she was 24 when this was found.  My son's pediatric endo was telling me about a 3-year old patient of his being  scheduled for a TT because of medullary thyroid carcinoma.

As for the PET scan.  What they told me in my nuclear medicine department is that thyroid cancer doesn't absorb the nuclear tracer as well as other cancers because it isn't as fast growing and doesn't use glucose at as high a rate as other, more aggressive cancers.

Oh, and 45 isn't some magic age for thyroid cancer - it's just when the staging criteria changes and what would have been a Stage II thyroid cancer at age 44 suddenly can be classified as a Stage IV cancer at age 45.   Yeah, makes perfect sense (ha!)

cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_thyroid_cancer_staged_43.asp

Can you get another doctor or, if it is driving you crazy, do what some of the rest of us have done and go strait to a surgeon???

Welcome back - sorry that things haven't resolved for you.

Utahmomma
Helpful - 0
393685 tn?1425812522
I think it is terrific news nothing grew and it sounds pretty good. I know the story of having to deep of a lesion and not being successful getting the biopsy I just had that myself.

So I sit and wonder alot too. I have decided to take the wait and see approach too. I will have another scan in the summer.

Nothing is for sure when a nodule (s) is found no matter how much testing is done.  You have two choices - push to have them removed or continue the wait and see until something changes.

Hard choice - I am in the same boat.
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Avatar universal
Do you have any helpful advice for me? Thats why I came back on here after not being on here for over a year. What do you feel it means that none of my 3 nodules grew in 9 months? And do you know if your thyroid cancerous nodules were round shaped and had no hypoechoic halos around them?  Also do you know what type of thyroid cancer Sheelagh Nolan died from?
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427555 tn?1267553158
I know danny Graham and his late wife. They came into our restaurant when he is here for homecoming.  When I was diagnosed with thyroid cancer in March of 2006 I had a long wait for surgery.  My doctor wanted to do it ASAP but he could not get OR time due to a shortage of Anestesiologists(sp?). I sat by the phone every day waiting for the call. 6 weeks went by with no call. In May the daily paper arrived with the news of Sheelagh Nolan's passing. It was a low point for me, I was very upset.  Within half an hour my phone rang and it was my doctors office with my date for surgery--May8th--.I had written letters to my local MLA and Provincial Health Minister complaining of the terrible wait times, and saying this was unacceptable.I have always felt that her passing, hastened my surgery date due to it making the news.  My surgeon had only I day of OR time that April, and that is not good for him or his patients. I don't know about the U.S., but in Canada there were long wait times in all areas of the country.
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Avatar universal
The woman at The American Cancer Society  also suggested I get an open biopsy where they just take out part or all of the nodules not the thyroid. What does anybody know about this? Also there was a Canadian woman  named Sheelagh Nolan who was the wife of a Canadian politician Danny Graham and she  was a dietician and a beloved wife and mother of two young children and she died from thyroid cancer after a three year battle in May 2006 at only the age of 43!  None of the online articles say what type of thyroid cancer she had,but she could have had a less common aggressive type of  papillary or follicular cancer. And a guy named WEs something who was a bass player for the music group Duran Duran also died a few years ago at age 33 from thyroid cancer  nobody said what type either.
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