My Year Thyroid Ultrasound Found 2 Nodules Grew About 2mm Should I Be Concernced?
On April 30, I had my follow up thyroid ultrasound for 3 small thyroid nodules that had been found by accident in 2006. This is the first time I waited a whole year and it seems like 2 of my 3 nodules which are the smallest ones, did grow about 2mm . Even though the technician told me that the radiologist told her that everything was the same. And then I got my report in the mail that my endo mailed to me and I found that this isn't really true.
It says that the nodule on my right lobe( which is described as mixed cystic and solid as it was a year ago but at the same exact place by a different radiologist was desribed as predominately cystic in July 2007!)) a year ago was 5 x 7 x 7 mm and is now 6 x 7 x 9 mm. And the nodule on my isthmus was 3 x 6 x 6 mm and now is 4 x 8 x 8 mm.
In June 2008 I had an ultrasound guided needle biopsy of all 3 nodules and had the samples looked at by 2 pathologists including a top one at Upenn and they didn't see cancer. Now I'm wondering if I should have another FNA.
The last follow up I only waited 9 months and these 2 nodules had grown very slightly only my largest predominately solid nodule on my left lobe was exactly the same size last follow up and still is.
One of the 2 small nodules which is one my isthmus (which concerns me since it's not a common place for nodules to be, they are usually on either lobes) was described last time as mixed solid and cystic and hypoechoic, but this time it's described by the same radiologist as nearly entirely cystic and doesn't mention hypoechoic at all.
The last follow up described all 3 nodules as stable but it doesn't use this term now. And my thyroid, in 3 ultrasounds before 2 of which were done at University of Penn also had always desribed my thyroid echotexture as *homogeneous* and now this new one describes it as *heterogeneous* ! It also says my thyroid is slightly small which was never said before either.
I have always had normal thyroid blood tests with no thyroid conditions.Does anyone know how much nodule growth in a year is something to be concerned about? I would really appreciate any member's info.
You said you had normal TSH levels, but what range did the dr. use to test your levels. Since 2003 endo's suggest labs use the target range between 0.3 and 3.0. Most labs still use the old range of up to 6.0 and if you fall below 6.0 they say your levels are ok. This is not true. I also have a small nodule on the right side of my thyroid. I have had 2 ultrasounds, but no FNA because my 2nd ultrasound showed the nodule had shrunk and they also showed cystic nodule. I do take .50 mgm of levothyroxine daily. Meds usually shrink nodules. I think I would question my dr. as to what range they used and if they were not willing to use the new range I would find another dr. Even the best drs. sometimes use numbers instead of a patients feelings. We are not a number, we are human. Do you have any symptoms of hypothyroid such as fatique, constipation, muscle soreness, dry eyes, weight gain, depression, acid reflux, loss of hair (thin outer eyebrows)? I would be concerned about a growing nodule. The FNA is supposed to be a very accurate test, but sometimes the results are indeterminate and surgery is necessary. I would talk with my dr. about the range he used for your TSH levels and go from there. He should be willing to talk with you and discuss your options of shrinking these nodules.
The measurements are not really too much difference...I just had another ultrasound, my Endo told me how big the last nodule I have left is, by his measurements it was 2 mm larger than before. I asked him about it, he said that it really depends who is doing the ultrasound and where they place the measuring devices, they can be off a couple millimeters depending on where they start measuring. None of your nodules are over 1 cm, they don't see anything that concerns them yet. Do they have vascularity on Doplar? I would still watch and wait, especially since you have good thyroid function. An FNA is only accurate if they get the right cells...my FNA did not get anything cancerous, but could not rule it out. I had a lobectomy and they did find incidental cancer, but the FNA said "benign follicular clusters" in my nodule, the cancer was found in the actual thyroid tissue. My tumors were only 2mm or smaller, they would have had to put the needle directly into the tumor. I would not worry too much about it, (easier said than done, I know!) but keep vigilant, follow up.
It's me formerly fanofthefab4. I have a new internet service provider and a new email address so I also have a new user name.
The nodules that grew are the 6 x 7 x 9 mm which was 5 x 7 x 7 mm and 4 x 8 x 8 mm which was 3 x 6 x 6 mm a year ago.
It's the 1cm predominately solid nodule that only grew in the past a little since the 2 and half years since it was found, but did not grow at all in a year this time.
The other nodules that are more cystic than solid are the ones that did grow. I will be 45 next April and I know The National Cancer Institute and other sources says that under age 45 the thyroid cancer prognoses is better. And this growth has got me so frightened because I'm really totally petrified of the possibility I will have to have thyroid surgery.
In October 2006 when my 3 small nodules were found accidently, I had a TSH of 1. something. And all of thyroid levels are always normal. In May 2008 my TSH was 3.53 and I was surprised but my endo says it can go up and down.
He ran a whole bunch of extensive tests (including testing antibodies which I asked him to do ) and everything was totally normal. In early December I had my TSH and T4 etc tested again and they were all normal, my TSH was back down to 2. something.
This is what I posted to Dr.Mark Lupo on the Thyroid Expert Forum in December,
On June 24th I had an FNA of 3 small thyroid nodules that were found by accident In the Fall of 2006 when I was 41 and a half, because I have a very slow metabolism and my thyroid blood tests have always been normal and I gained weight for the first time at age 34 and had to go on a diet for the first time in my life. So I asked my internist for a prescription for a thyroid ultrasound.
The sizes of my nodules are one on the right lobe, 0.5 x 0.7x 0.7 cm on the left lobe, 1.3 x 1.3 x 4.5 cm and on my isthmus, a 0.3 x 0.6 x 0.7 cm, biopsied by a very good endocrinologist with a good reputation, Dr .Anthony Jennings and the first pathologist at Quest Diagnostics described them as unremarkable follicular cells with
colloid and are diagnosed as colloid nodules. I have normal TSH and other thyroid blood tests. I wondered why 1 of my 2 small nodules was written as 1 nodule on my FNA results paper and Dr.Jennings told me he put both samples from both nodules into the same container because it costs less this way.
I'm not happy he did it this way and I have never heard of it done like this but I'm not an endo and don't know everything endos do. How can they tell how many cells are in both nodules if they were combined? So I was wondering what you know and think about this. I asked Dr.Jennings if it would taint each nodule's results by doing this and he said it doesn't and he's done it this way before and he said he thinks even Dr. Susan Mandel the top thyroid cancer specialist at the Unniversity of Penn Hospital has done it this way. He knows her well and he's heard her speak. Dr.Jennings also biopsed my largest 1 cm predominately solid nodule twice that day because first fluid came out.
I also asked my endo to please send my report and slides from Quest Diagnostics to a top thyroid pathologist that Dr.Mandel uses Dr.Zubair Baloch at University of Penn for a second opinion.
Dr.Baloch says in his report of my nodules, that in his opinion based on cytomorphology he will favor a diagnosis of hyperplastic/adenomatoid nodule for both specimens. He says interestingly the specimen from the right thyroid nodule shows oncocytic cells and few lymphocytes percolating among the follicuar groups suggesting an element of chronic lymphocytic thryoiditis. He says he does recommend clinical follow up and repeat FNA if there is an increase in the size of any of these nodules.
He says in summary then, my diagnoses are :1. Thyroid, right lobe nodule (size not indicated) FNA:Hyperplastic/adenomatoid nodule with oncocytic change. Focal chronic lymphocytic thryoiditis. 2. Thyroid left lobe (size not indicated) FNA: Hyperplastic/adenomatoid nodule.
Dr.Baloch didn't know my endo combined my nodule's samples into 1 container .He called me and he said when I told him my concerns about the Hurthle cells , he said I don't have a lot of them ( my endo said only when there is sheets of them can they be cancer) ,and that he could have Hurthle cells, children could have Hurthle cells in their thyroids and that it's not abnormal only when there is a large amount. But because my nodules are so small, isn't possible that the needle missed more of the Hurthle cells ( and other cancer cells!) present?
How long a period of time did your nodule increase in size in 2mm? Was it a year follow up like mine? Many benign thyroid nodules grow slowly over time as there are many posts on here from women who had benign nodules the size of golfballs.
And recent research has found that many small papillary thyroid cancers didn't grow in 8 years! So thats why it's really difficult to tell if growth indicates it's cancerous or benign.
Also all nodules whether they are cancer or benign had to grow from nothing to reach a certain size. They all started off as 0 size, and then they were 1 mm and had to grow to get to be 8 mm or 1cm etc.
There is an interview with a top Canadian pathologist Dr. Sylvia Asa in the Fall 2007 Thryvors newsletter which is the Canadian Thyroid Cancer Survivors organization.
And she was asked what is the difference between normal hurthle cells and those that represent cancer.And she said there is no such thing as a "normal" hurthle cell .
She said hurthle cell change is a cellular change (more correctly called oncocytic change) is a reaction to stress or irritation. Oncocytic cells are seen in inflamed thyroids as well as in thyroid cancers.
Dr.Asa then says the basis for the change is thought to be in the DNA of the tiny cellular organelles called, "mitchochondria". This change also is found in some tumors but the genetic changes that cause tumors are not in the mitchondrial DNA , they are in the nuclear DNA of the cells.
And yet Rita Banach the director of Thryvors emailed Dr.Asa a few months ago and asked her for me if I need to worry because I have some hurthle cells and because I have read on this board and on Cancer Compass and ************ people saying that their Dr.'s told them that if they have hurthle cells even if they are not cancer now they are likely to turn cancerous and get them out, and Dr. Asa wrote to Rita that it doesn't increase my chances of the cells turning cancerous. So I don't know what to make of this contrary comments by Dr.Asa.
You know what really bothers me is that my endo recently said to me on the phone when I asked him about mailing me my recent follow up ultrasound, which he didn't even have in front of him when he called me back, is that he said that I had dozens of Dr.'s look at my FNA results and they said I'm OK.
I said to him dozens? I only had a second opinion from a second pathologist. He claimed that he showed my FNA results to another pathologist, and I said is there a written report and he said no. I don't really believe him and even if he did he never let me know about it.
And also even if he had showed the results to 100 doctors it would still be the same samples from very small thyroid nodules. He said if you want 100% proof they are or aren't cancer I have to have my whole thyroid out.
Yes, to be 100% sure they have to remove at least one lobe to check for cancer. My FNA came out Benign Follicular Clusters...a NOT diagnostic for cancer result. Funny thing is (or not so funny) that my cancer was found in the thyroid tissue itself incidentally, NOT in the nodules they removed. MIne were found incidentally, they were not looking into the thyroid tissue, but they found them. They were very small so my prognosis is very good. My Brother is a Radiologist, he told me they looked like benign adenomas, he was right, but the cancer in my thyroid tissue was so small they could not pick it up on the ultrasound. The nodules can degenerate, turning from predominately solid to cystic, which looks like one of yours. They kind of fall apart if they are not totally solid. The time difference from my second to my last ultrasound was 6 months, the growth was 2 mm bigger, but that could just be where the Endo measured it. Remember, there is only 5-15% chance of it being cancer...but you must keep on it. If it is driving you crazy, then have them take out one lobe, you may have the chance of less thyroid function but at least you will have an answer. I know from my own experience that the NOT knowing drives you crazy more than my diagnosis of cancer. U Penn is probably a teaching hospital, right? Then they should show your results to others, can't hurt to get more than one opinion, and a good teaching tool. Are your TPO ab's high? Do you have any other symptoms? If you have pain, swallowing issues, hoarseness, these can all be signals that something else is wrong. But, don't worry too much, I know that is easy to say, but thyroid cancer rarely spreads, and is usually caught early enough to completely cure it. Just keep asking questions and get regular ultrasounds...
I have very good reasons to be stressed about it, I have 3 ultrasound features that are commonly found in thyroid cancer, and I will be 45 next April which according to The National Cancer Institute and others, makes me stage 3 and the prognoses isn't as good!
So by the time my nodules grow to the size that many consider big enough to biopsy and better get a correct diagnoses I could be 50 or older since recent studies found that many small papillary thyroid cancers didn't grow in 8 years!
And it's a radical thing to do with real risks, to have your thyroid removed unless you know 100% that the nodules are cancer ,and the cr*ppy thing is that the only way to know 100% that they aren't cancer is have the thyroid removed!
I am confused as to how the university of Penn pathologist an element of some chronic lymphotic thyroiditis when according to all my thyroid blood tests including my antibodies which I had tested for the first time last year, were normal.
And when I look up on medical sites Chronic Lymphotic Thyroiditis it says it's another name for Hashiomotos Thyroiditis and goes on to describe a bunch of symptoms that I don't have.
Yet I have been struggling with an extremely slow matoblism for the last 10 years even though I don't eat that much, I only usually eat 2 low fat low calorie meals a day,rarely cheat and only drink diet drinks.
I admit I don't get enough excercise
but even 5 years ago when I was walking long walks 4 times a week and only eating 2 low fat low calorie meals a day, and only drinking diet drinks, even though I did lose 2 pants sizes I could only get down to a size 10!
I had always been thin all of my life eating almost anything I wanted and doing no excercise not even walking, and I know many people's
metabolism's as they get older but mine slowed down way too much
and way too soon.
Also, the university of Penn radiologist who reviwed my ultrasound called me back and she left a long message on my voice mail and gave me a phone number to reach her better to discuss in details my recent ultrasound report.
I had asked her on her voice mail what does it mean that my thyroid echotexture is now heterogenous when 2 times before it was described as homogeneous when done on the same ultrasound machine.
She said on my voice mail that the heterogeneous echotexture reflects the lymphotic thyroiditis.
I was found to have a nodule on my thyroid about 6-7 months ago. I was referred to an endocrinologist. He did not seem very concerned, so consequently nor was I. He took measurements and recommended I have another ultrasound in six months.
Today I went to my follow up reading of my six month check; turns out the nodule grew in size ~32%. The endocrinologist felt he should do a fine needle biopsy, but remains optimistic that everything is fine, especially since all lab tests show my thyroid is functioning normally.
I am inclined to believe him. However, I was feeling a bit more concerned now, more so then I had before. So I decided to look my symptoms (almost none, just a carbuncle (I am referring to the nodule in a sarcastic tone) that was accidentally discovered from a CT scan) to check to see if I should indeed be more concerned.
Luckily for me I found the panicked CH4165. After reading their plight/adventures on the journey to learn whether or not they had thyroid cancer I was reminded that life is way to ******* short to worry about a little "carbuncle" that has decided to latch on to my thyroid for the ride, and that I have better things to do than worry about if I have cancer or not.
In a week, I will return to the endocrinologist, and he will either say, "MEH! Nothing to worry about, see you in six months" or "It may be cancer, let’s proceed with the next step".
But I tell you I am not going to lose any sleep over it tonight, or any night hereafter. Honestly, I do not see the point in worrying over it very much, when it is my time, it will be my time. If the end comes as a result of my little carbuncle friend, who I will now forever more refer to as Jerry, or from some other random event, I am going to focus on enjoying what I can in the present and not worry too much about the little things.
Thank you very much CH4165 for sharing your anxieties with the WWW, thank you for helping me to find solace on this night and I hope your carbuncles have all been sorted out.
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