Solid thyroid nodules, please help

Question

I had a thyroid ultrasound done yesterday because of my left thyroid felt enlarged.  By the time I had gotten home, there was a message to call the doctor and they said I had an 3.8 cm solid oval hypoechoic nodule on my left thyroid and a 1.4 cm solid nodule on my right thyroid.  There was also a 1.2 cm cyst on my left thyroid as well.  I am waiting for the ENT office to open to make an appt, and the doctor yesterday said to expect a FNA when I do go in.  She also said not to worry it could be a number of things, but of course I was up all night worrying about what it could be!  I have to go in for some blood work, specifically T3 and T4 levels.  I had a TSH done in August which was normal.  Any insight would be much appreciated.  Thank you!

MANmom · Answer

The only way to tell for sure if you don't get a clear result in the biopsy is to take it out and have it tested. Although my sister got her diagnosis after mine in her FNA biopsy, I got a result of "benign follicular clusters" which technically is a "not diagnostic biopsy" (they still could not tell) and I chose to have three nodules on one side removed, I had cancer. I also has a mixed nodule on the other side, that was where the biggest tumor was...in all I had 5 areas of carcinoma. The really struggled to have the surgery, but I am glad I did. My biggest symptom was hoarseness, particularly when I was tired. As a singer, I had to do something. My nodules ranged from .8 up to 2.1 cm. Thyroid trouble runs in families, out of my eight siblings and myself, there are 2 cancer diagnoses, two brothers and myself with Hashimotos and another sister with nodules that are being watched. My father when he was alive also had Hashi's. Keep vigilant, you will eventually get an answer, and even after that you need to keep up on it. And if you have siblings, you should have them get an ultrasound, too.

TamraW · Answer

This site has endos and thyroid surgeon recommendations: 

http://www.thyroid-info.com/topdrs/

The recommendations come from their patients, but call to make sure the endo treats mainly thyroid and the surgeon does at least two thyroid per week.

Some doctors recommend removing anything over 2.0 cm, so be prepared. In the hands of an experienced surgeon, the thyroid patient should have a good recovery. My mom did, and she was in her sixties. Many of these tumors end up being benign, but doctors would rather be safe. 

:) T.

mymeow74 · Answer

Thanks Tamra, I am still waiting to hear on the lab work I had done yesterday.  They didn't mention anything about the TGab or TPOab, but I'll make note of that and mention it to my doc next week.  I don't have the report by me, but I remember the dimensions of the left thyroid being larger than the right thyroid.  Do you think this means anything significant?  My PCP originally had me get the ultrasound because of the enlarged thyroid and she suspected a goiter at the time.

TamraW · Answer

Based on your TSH and your symptoms, plus the nodules, you need to get your antibodies (TGab and TPOab) tested for Hashimoto's Hypothyroidism. 

You also need to get your repeat TSH, FT4, FT3 levels checked. 

:) Tamra

mymeow74 · Answer

As far as symptoms go:

Leg pain - not really
foot pain - yes
ear pain - no
migraines - no
GERD - yes
heartburn - yes
constipation - no
diarrhea - no
depression - maybe mild?
anxiety - yes
dry skin - yes
joint pain - some, but I do have some mild arthritis
brain fog - yes

blsdnsvd · Answer

I recently had a Total Thyroidectomy due to a multinodular goiter....largest nodule being 3.7cm and "cold" and my report also read heterogenous. I had 3 opinions and all said to get it "totally" removed although my fna's all were benign. I am awaitng my pathology report from the surgery. Your situation depends on your fna biopsy results. Although most nodules are benign fna isn't always accurate. My tsh levels were normal but on the low side and i never had any symptoms besides the thyroid enlargement and nodules. You will be fine, the most important factor is to educate yourself and ask lots of questions until you get an answer. Be Blessed.

TamraW · Answer

My last endo told me that heterogenous meant life within the nodule, such as active thyroid hormone, but I am hoping someone else will chime in here. 

All of my nodules were solid and heterogenous. One was irregular. All benign biopsies and after thyroid hormone are now shrunk to the point that they can't be biopsied. 

:) Tamra

mymeow74 · Answer

Okay, I just saw the report and the left thyroid nodule actually reads as a "3.8 cm solid and cystic heterogeneous nodule."  Is this worse than it being totally solid then?

utahmomma · Answer

Some "worrisome" qualities of thyroid nodules are:
- increased vascularization (more blood to it than necessary)
- calcification
- irregular shape and borders (meaning your "oval" nodule isn't as suspicious)
- complex nodules (mixture of solid and fluid/cystic)
- "cold" nodule - meaning it doesn't produce any thyroid hormones (can only tell this on an uptake scan)


Yes, you need more exploration and some answers but don't panic.

HUGS

Utahmomma
papillary carcinoma '03, second surgery '04, recurrence and RAI '06
three sisters with papillary carcinoma
another sister and daughter with precancerous nodules

TamraW · Answer

YOUR TSH WAS NOT NORMAL!!!

FIRE the endo who told you that!!!

I have Hashimoto's and my TSH was a 2.74. lower than yours!!! TSH in a healthy thyroid is 1.1. A good doc will know  that if TSH is over 2.0, to run ALL thyroid labs. Many doctors use the old TSH standards. 

You definitely need to get to an endo who specializes in thyroid. You need your TGab and TPOab tested to see if you have Hashi causing this. Also, get your FT3 and FT4 tested to determine your current thyroid hormone. 

Yes, this is multi-nodular. 

How do you feel? Symptoms? Leg pain, foot pain, ear pain, migraines, GERD, heartburn, constipation, diarrhea, depression, anxiety, dry skin, joint pain, brain fog?

:) Tamra

mymeow74 · Answer

Thank you Tamra for your words of encouragement.  Because I have one nodule on each lobe, does that make it multinodular or does it have to be on the same lobe to have that diagnosis?  My TSH level in August was 3.243.  Are the T3 and T4 blood levels different from the TSH?

TamraW · Answer

What was your TSH? Mine was supposedly normal (2.69 and 2.74), so I went undiagnosed with Hashimoto's disease for a long time because many endos need to get up-to-date with what is normal TSH. 

You should have had your TGab and TPOab tests for Hashimoto's, which commonly causes multi-nodules. My endo said there's not much difference between a cyst and a nodule. 

3.8 is getting up there in size. My largest nodule was 1.0. The ENT might want take out the nodule and adjoining lobe. Be prepared. 

My mom, who is also a Hashi, had a 7 cm solid nodule removed, but it turned out to be benign. Better safe than sorry. She was back to normal within the week. The key is in finding a good surgeon who does at least two thyroid surgeries per week. 

Multi-nodules, like yours, are less likely to be cancerous than the singular nodule. However, if it does turn out to be cancer, please know that thyroid cancer has the highest cure rate. 

:) Tamra