Thyroid Nodule

[siam2009]

Hi, just had a thyroid ultra done..showed a 9.7x7x7 cm nodule adjacent to the left carotid artery (I have lots of cysts which have already been biopsied)..after much discussion we did try to do biopsy, but because I have a short neck, and they were unable to tip my head back enough to do the biopsy without hitting the artery, I was sent home with instructions that I should have another ultra in 6 months..should I be worried, they said its small, but if we can't biopsy it, whats next..I'm off to see my primary doc today..they also asked if I had Hashi's, maybe I should be put on meds to try and shrink the nodule?  Very worried and confused..Thanks

[siam2009]

TPO is normal, however just got weak + for Lupus..my big concern is how do we keep this nodule from getting bigger..wondering if I'm in the Hashi stage again..if my PCP, biopsy doc feel its not suspicious do we do nothing but watch..got lots of ? for my Endo...Thanks

[898_1]

I see so low TSH NOW is not caused by Metformin.
Next question is if your low TSH caused by toxic nodules or thyroiditis flaring -up.
In this case next step (especially if your TPO antibodies are within the limit) to perform Technetium-99 uptake test (this is a lot safer than RAI because later can cause thyroid storm by saturating hot nodules)
Also hot nodules statistically having less than 5% chance of cancer and Ironically, low TSH slows down growth of thyroid nodules.

[siam2009]

No, but I did take it in past, but not for at least 2-3 years..

[898_1]

Are you taking Metformin by any chance?

[siam2009]

Thanks for your help..seeing Endo on 11/14, will ask for thyroid uptake anyway..numbers go 0.27 to 0.52, then 0.31..up and down, up and down..my pcp believes that I have Hashi's, but doesn't think med for it is the way to go, because I'm already borderline hyperthyroid and he feels with meds it will push me over the edge..

[898_1]

Peripheral vascularity is a sign of benign nodule as opposed to internal vasculatrity.
RAI will not work on cold or warm nodules, especially if your TSH is above 0.3

[siam2009]

I made a typo..9x7x7mm heterogeneous hypoechoic nodule with peripheral vascularity..spoke w/my pcp, he didn't think it was suspicious, but I should have a thyroid uptake, will talk w/my endo, and if a biopsy is required, it should be done by my ENT who specializes in thyroid..they could RAI to treat it..

[898_1]

I believe the ultrasound should state 9.7x7x7 MM nodule not "cm"
I recently read an article about shear wave ultrasound procedure that has increased diagnostic capability.
Also the nodule is most likely benign if: there is no internal blood flow; there are no MICROcalcifications in it.
PS short neck and double chin as well as neck injuries are making biopsy very difficult