Multinodular goiter symptoms

[LuLuna]

Dr. Lupo,
I was diagnosed with a non-toxic multinodular goiter 4 years ago. I've had 3 FNA's done in some of the nodules and they came back benign. My TSH blood tests come back normal, and the last one was normal with readings on the high side, according to my Endo. She mentioned that thyroid medication would not help reduce the size of my nodules for this same reason.
This last time the FNA was done, my Endo mentioned that one of my nodules from the left lobe went from .6 to 1.2 in volume in a 2 year period with another benign result. Lately, I have been noticing a random stabbing pain in the front of my neck that lasts for a few seconds. Sometimes it radiates to the bottom of my jaw, and left ear.  When I turn my head sometimes I feel "things" moving in the front of my neck, as if the nodules where getting caught somewhere. Also, I think I have swollen glands on the top part of my neck as well. I have a scratchy throat sometimes, but it may be because I'm blaming my thyroid for every little discomfort I have.
My Endo told me to come back in March of 2011 to re-check this nodule when a new FNA may be done. She mentioned that she may recommend surgery in case it has changed.
My questions are:
1- Is it normal to have stabbing pains on a benign goiter or is this maybe a sign of thyroid cancer?
2- Are ultrasounds able to determine if a cancerous nodule has spread outside the thyroid or not?
3- My Endo doesn't seem to care about my swollen lymph nodes, shouldn't they be checked as well?
4- Even with 3 benign results, what are the odds that it could be cancer taking my symptoms into consideration?
5- Should I get a second opinion now or wait until I am referred to a surgeon, in case that happens?

Thanks for your assistance and support.

[Linda355]

The sharp pains could also be cystic fluid leaking from one of the nodules.  

[LuLuna]

Thanks for the information! Honestly, I can't tell if the other tests were done or not, I've always stressed so much about it being cancer that I ignored all the lab tests and their results and focused on the FNA.
You made me realize that they are in fact important. I'll dig them out to see what it's been tested.
So, do you think it's normal that over time, and with aging (I'm 45 by the way) that new  symptoms show up and old symptoms get worse? The sharp pains started a few month ago, and they seem to be happening more often.

[Barb135]

It sounds like you could benefit from a low dose of thyroid hormone.  Has your doctor ever tested anything besides TSH?  You need also to have Free T3 and Free T4 tested.

Have you had antibody tests to determine whether or not you have Hashimoto's Thyroiditis?  Hashi's is an autoimmune disease in which antibodies attack and eventually destroy the thyroid.  As the destruction process progresses, your thyroid is able to make less and less hormones, and you will become more hypo as time goes on.

Hashimoto's is diagnosed via the presence of nodular goiter and antibodies.  You have the nodules; you need to get antibodies tested. It's not unusual to have pain in the thyroid area when the antibodies are raging.  Scratchy throat is a symptom of hypothyroidism.

Ask your doctor to test your actual thyroid hormones - Free T3 and Free T4, along with TSH, as TSH is a very poor diagnostic for thyroid disease.  In addition, ask for Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TGab); those will tell you if you have Hashimoto's or not.  The Free T3, Free T4 and TSH will tell you if you are beginning to go hypo.  With your TSH currently in the upper end of the range, my guess is, you are.

While thyroid med (synthroid, levothyroxine, etc) won't shrink the nodules, it can certainly make you feel better; and there are other things you can do to help your symptoms.

[debrabee]

I'm sorry I cannot answer your question as I have the opposite, an underactive thyroid.  Thyroid problems run in my family on my father's side and I have a cousin and aunt who have thyroid problems. She had a goiter, but now takes meds for an undertative thyroid, so I guess she had treatment for this and now the situation has reversed and she has an underactive thyroid now.