Thyroid Ultrasound

[Tishy420]

Ok. I was diagnosed Oct 4, 2011 with hypothyroidism. I had an ultrasound done in the hospital, which confirmed I had a goiter. I've made an appointment with an Endo, but cannot get in until the end of March. Meanwhile, I found a new internist which I will be seeing on the 23rd (Monday) since my Dr I have now is incompetent. I went to his office today for copies of the testing I had done while in the hospital back in October. I'm going to write exactly what it said:

FINDINGS: Thyroid lobes are enlarged the right measures 5 cm greatest sagittal dimension and the left measures 4.7 cm greatest sagittal dimension.Thyroid isthmus is at upper limits of normal and 4mm greatest AP dimension. Inhomogeneous echogenicity within the thyroid lobes noted.
There is a calcified nodule measuring 7 mm identified in the upper pole left thyroid lobe. There is a 1cm x 1.1 cm solid nodule in the left thyroid lobe mid pole with inhomogeneous echogenicity within it. There is a third well marginated hypoechoic nodule in the inferior pole measuring 1 x 0.8 cm with inhomogeneous echogenicity within it.
IMPRESSION:
Goiter
3 thyroid nodules. Given the ultrasound appearance of the nodule in the midpolar region and in the lower pole, consider fine-needle aspiration with ultrasound guidance of the 2 larger nodules in the left thyroid lobe.

Now, considering it suggested a procedure to check for cancer, shouldn't my Dr have made some sort of referral or appointment for me to have this done? He has done nothing but check my TSH and free T3 and 4 levels. And, since my TSH level has gone from 5.35 when diagnosed to 1.28 last month, he says I am fine and to keep taking the levothyroxine. What do you all think?

[Tishy420]

Thank you for the responses. I am no expert on anything medical, so opinions are what I am looking for!! :)

[Barb135]

Many of us have goiters (swollen thyroid) w/nodules that are nothing to worry about.  Many doctors won't even do FNA on anything smaller than 2 cm because it's too hard to get adequate sample.  

The impression said to "consider FNA"; it didn't say "recommend" or "it's needed right now" or anything like that so your doctor probably figured it was not necessary at this point.  

All of that said, I'm far from an expert on ultrasound results, however, I do believe that calcification is cause for concern and should be checked out. You should definitely show this report to the internist that you will be seeing on Monday and see what s/he says.  I think the nodules are still too small to be biopsied, but I could very well be wrong.

[898_1]

The report must be more specific about type of calcification found in the nodule.
The report failed to provide other dimensions of lobes - there should be 3 for each lobe
All nodules had to be tested with Doppler color flow;  based upon the results of these additional tests the choice has to be made which nodule to probe.