Scared - Opinions please

[awattO]

Just yesterday I did a thyroid scan (as I had been diagnosed with a multinoduler thryoid gland) which indicated that I was suffering from hyperthyroidism, but that I also had several (4-5) cold nodules.  I am now awaiting an appointment with my doctor to discuss these results.

In the meantime, could someone please give me an idea of how there could be cold nodules AND hyperthyroidism?  
And, does this mean there is a higher chance of cancer with respect to these cold nodules?

There is no history in my family and I have never been exposed to radiation.  Swallowing difficulties and voice hoarseness come and go....but, I am also experiencing a lot of stress in my life and have been fighting both sinuses and a cold.

Any advice would be greatly appreciated.

[awattO]

It's been over a month and I am still waiting for my thyroid biopsy.  Every time I call they say that I should get a call any day now.  

In the meantime, my doctor has done blood work and states that my TSH levels are still normal.  Strangely enough, all of the symptoms that I had previously were indicative of hypothyroidism (slow resting heart rate, intolerance to cold, fatigue, brittle nails, etc).  

But, lately I have been experiencing heart palpitations that come and go - with it comes a warm feeling.  

I've asked my doctor for a TPO antibody test...is there anything else that I should ask?  She thinks I'm crazy and her diagnosis is that my thyroid is inflamed.  Period.  This is very frustrating!

[898]

that should be good

[awattO]

I know the head/throat specialist is having an ultrasound-guided biopsy scheduled...is this the same as "high frequency" ultrasound??

Sorry...I'm completely new with all of this terminology.

[898]

While i am not very sure about frequency of blood testsit is not a bad idea; but try to get tested in the morning when TSH is highest. The diabetes patients are measuring their blood glucose level at daily bases.
As for the boipsies, the complex nodules must be biopsied under high frequency ultrasound guiding.
the "welcome to community' post has an article when biopsy is indicated.

[awattO]

I just heard from my doctor who has stated that she still believes that the problem is more "inflammatory" and that the cold nodules would have to be biopsied to be on the safe side...but, she seems to think that, because there were multiple (4-5) cold nodules that this is a good sign?  

But, she has asked that I do more blood work ASAP in order to determine if hyperthyroidism has developed in the past month.  And, she has asked that I get the blood work done on a monthly basis until the biopsy is performed.

Hopefully this is normal procedure in this case?  

[awattO]

With all of my heart, I hope that this is the case.  I guess, at this point, it's more of a waiting game.  Waiting for the doctor's call.  Waiting for the ultrasound-guided FNA.  Waiting for the results.  

Thank you for your knowledge and your quick responses.  It's nice to get some potential answers in the midst of all of the waiting.

[898]

The literature regarding cystic thyroid nodules is confusing because some series report on only simple cysts while others include mixed nodules with both cystic and solid components. True simple thyroid cysts lined by benign epithelial cells are rare. In one ultrasound study of 550 thyroid nodules, for example, only one was a simple cyst [2]. In contrast, mixed nodules are common. In some studies, a nodule was called a cyst only if it was predominantly cystic on ultrasonography, but in others the term was applied to nodules that were predominantly solid but had small areas of cystic degeneration. Thus, depending upon the criteria used, up to one-third or more of thyroid nodules demonstrate cystic degeneration [3,4]. Consequently, it is the nature of the solid component associated with the "cyst" that is of primary clinical importance. The solid component may comprise more than one-half of the nodule, be just a small mass of cells along the wall of the cyst (show radiograph 1), or be just a thickening of the cyst wall [2].
Cystic thyroid nodules


Author
Douglas S Ross, MD
Section Editor
David S Cooper, MD
Deputy Editor
Kathryn A Martin, MD


Last literature review version 16.2: May 2008


Usually the word “cyst” pops up as a result of an ultrasound examination. The ultrasound report says something like “there is a cystic lesion found...etc.” In most cases what is called a cyst is really a tumor of the gland, a portion of which has undergone a process called “cystic degeneration” or liquification. It’s also possible that some bleeding occurred within the tumor and the “cystic” area within the tumor is actually blood that will probably be reabsorbed by the body in time. A more accurate description of these types of thyroid tumors, or nodules, is that they are “complex”. A complex lesion has both solid and cystic components, and they are actually tumors, not cysts.
Usually tumors of this type are benign.

[awattO]

My doctor had mentioned inflammation from the beginning...but, this was without doing any tests - her diagnosis was that I was young and healthy....and that I shouldn't worry about it.  Now I'm scared because that was 3 years ago and I'm wondering what possible damage could have been done over that time.  

I will, without a doubt, ask her what tests were run with respect to my blood work and I thank you for your opinion.  This is a much less scary possible diagnosis than what was running through my mind.

Although, in your description of how the cold nodules could have been formed, I fail to see how they could have become the "mixed solid and cystic" nodules as found in the ultrasound...?

[898]

Duting the thyroiditis, the inflammation destroys thyroid tissue which later is replaced by fibrous tissue [same like in the scars], this tissue along with 'broken parts' of the thyroid forms clusters, known as nodules. These are commonly forming during the chronic autoimmune thyroiditis aka Hashimoto's disease [at the fastest rate among the patients whose TPO antibodies level are high].
If full thyroid panel is ordered these antibodies should be checked.
High TPO is the marker  for autoimmune thyroiditis and TSI is the marker for Grave's disease.

[awattO]

But, when researching thyroiditis, I haven't seen mention of nodules.  It just seems to be inflammation of the thyroid gland.  Or, could nodules (specifically cold) be present as well?

And, would the TPO/TG and TSI antibodies be standard when the doctor is testing the thyroid during blood work?  Or, are these further tests, strictly for thyroiditis?

Again, any advice is greatly appreciated.  I've done so much reading that I keep bouncing back and forth between positive and negative thinking.  

[898]

Your uptake is not that high; the HORMONE levels is the key tool to say if you are HYPO or HYPER, based on the description of the ultrasound I would recommend testing of TPO/TG antibodies and TSI antibodies [blood test], as the US echopattern suggests the one sided thyroiditis.

[awattO]

I am dealing with a head and throat specialist - he's the doctor that discovered and decided to send me for the ultrasound.  I just didn't know if I should continue dealing with him or ask to be referred directly to an endocrinologist.  

As for where I live...I am in Ottawa, Ontario (Canada).  Anyone in the area who knows of someone they can refer would be greatly appreciated.

So, I'm assuming that, until the biopsy is done, there is no way of knowing more...

[utahmomma]

If the labs are normal then, technically, you aren't hyperthyroid.  The rest of your thyroid *might* be compensating for all of the area that isn't producing hormones (the cold nodules).  

Many of us have gone into FNAs and surgery without an endocrinologist - just straight to surgery then find an endo later for meds.  Do you have another doctor you trust or can talk to?  Maybe if you give us the city where you live there will be others on here who can help you find a good doctor.

[awattO]

That's the next step, the FNA biopsy.  But, it's extremely scary not knowing and my doctor is NOT someone I can get answers from.  It was actually three years ago that I noticed the larger lump in my throat and she completely dismissed it due to my age at the time (28).  Although, she did do blood work over the past three years...each time she stated everything was normal.  The last blood work being taken only a few months' ago.

It was during a hearing test in August that the specialist felt my neck and decided to send me for an ultrasound.  The results of the ultrasound are as follows:

"Both thyroid lobes are normal in size.  There is a 1.0 x 0.5 cm mixed solid and cystic nodule along with two very small 3-4 mm probable colloid cysts in the lower pole right lobe and the left lobe is more inhomogeneous with mixed solid and cystic nodules seen regionally.  The largest measuring 1.6 x 1.4 cm in the mid polar region.  Impression: suspected developing multinodular gland with asymmetric left-sided predominating involvement".

Then, during the scan yesterday, the doctor reading the results was surprised that my previous blood work did not indicate hyperthyroid, as my thyroid took up 27% of the iodine vs. the normal maximum of 22%.

Any other advice/opinions are greatly appreciated.  I'm trying to put my mind at ease but the hyperthyroidism and the cold nodules seem to be contradicting each other.  ??  

[awattO]

That's the next step, the FNA biopsy.  But, it's extremely scary not knowing and my doctor is NOT someone I can get answers from.  It was actually three years ago that I noticed the larger lump in my throat and she completely dismissed it due to my age at the time (28).  Although, she did do blood work over the past three years...each time she stated everything was normal.  The last blood work being taken only a few months' ago.

It was during a hearing test in August that the specialist felt my neck and decided to send me for an ultrasound.  The results of the ultrasound are as follows:

"Both thyroid lobes are normal in size.  There is a 1.0 x 0.5 cm mixed solid and cystic nodule along with two very small 3-4 mm probable colloid cysts in the lower pole right lobe and the left lobe is more inhomogeneous with mixed solid and cystic nodules seen regionally.  The largest measuring 1.6 x 1.4 cm in the mid polar region.  Impression: suspected developing multinodular gland with asymmetric left-sided predominating involvement".

Then, during the scan yesterday, the doctor reading the results was surprised that my previous blood work did not indicate hyperthyroid, as my thyroid took up 27% of the iodine vs. the normal maximum of 22%.

Any other advice/opinions are greatly appreciated.  I'm trying to put my mind at ease but the hyperthyroidism and the cold nodules seem to be contradicting each other.  ??  

[utahmomma]

Nodules don't always affect thyroid function.  Cold nodules need further evaluation:  http://www.endocrineweb.com/fna.html

These may be "dead" thyroid tissue, scar tissue, fluid, or malignancy.  They will probably have you do an ultrasound guided biopsy of as many nodules as possible.

Can you post more information?

Utahmomma
papillary carcinoma

[estrelinha]

What gives the diagnosis of hyperthyroidism is your TSH levels, free T3 and free T4.
What are the size of your nodules?