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My Year Thyroid Ultrasound Found 2 Nodules Grew About 2mm Shou...
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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.

Thank  you.

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Hi,  how large were the other nodules?  These are the ones that grew?  

Welcome to the community!

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 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,

Dear Dr.Lupo

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?

I  would  really appreciate your  reply.

Thank You.

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...
Quit stressing yourself.....

Just do a follow up for the growth in another six months.
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.

Yours Truly,
Cindy Richelle
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