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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 He also keeps insisting that the round shape of thyroid nodules having a high % of cancer is outdated, but I keep finding recent god medical studies on good medical sites that still list this feature and I know my nodules are round!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.
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.
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.
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.
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.
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.
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.
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.
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>
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?
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?
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.
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