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To Biopsy or Not Please Help! - 7mm Vascular Solid Hypoechoic Calcified Nodule
Hi everyone, I would really appreciate if someone can advise me on what to do. 6 months ago I was found to have an enlarged thyroid ( mildly) with a finding of 6 mm well defined cystic nodule on isthmus, hypoechoic with coarse calcification. Vascularity was normal and so was everything else.
Now I had a follow up scan yesterday which shows that vascularity of the entire gland in general has increased. Both lobes are reaching upper normal limit of size ( left is 19x14x43 mm, right is 15x21x44 mm). Isthmus is approx 4.1 mm now.
In addition I have a new Solid Ill defined Hypoechoic Calcified Nodule 7mm approx with peripheral and central vascularity. Pretty much the worst kind of nodule to have. The previous nodule has grown by 6mm ( in previous scan) to be 7 mm ( the radiologist actually believes it hasn't grown and its just operator bias due to the small difference)and USG considers it benign even though it has peripheral vasculairty
Now coming to the results. They just say Thyroiditis is highly likely. The new nodule , the radiologist wasn't overly concerned but suggested repeat follow up in 3 months OR a biopsy. Now the specialist is not concerned at all and says to come back after 6 months. According to him a FNA is most likely to be inaccurate and will mostly come back interderminate at this point due to the size of the nodule being small and will result in overtreatment. I got a second opinion and they advised me the same.
Im so scared to just simply wait and watch for 6 months. Feel like there is a ticking time bomb inside me. I am surprised my report doesn't mention anything about 'suspicious' nodules rather just says follow up and thyroiditis.
My question is given the odds , how likely is that new nodule to be cancerous? Is wait and watch ok or should I ask for biopsy? How are my TSH levels normal at 2.89 and I still am developing thyroiditis?! Please please help.
Now I had a follow up scan yesterday which shows that vascularity of the entire gland in general has increased. Both lobes are reaching upper normal limit of size ( left is 19x14x43 mm, right is 15x21x44 mm). Isthmus is approx 4.1 mm now.
In addition I have a new Solid Ill defined Hypoechoic Calcified Nodule 7mm approx with peripheral and central vascularity. Pretty much the worst kind of nodule to have. The previous nodule has grown by 6mm ( in previous scan) to be 7 mm ( the radiologist actually believes it hasn't grown and its just operator bias due to the small difference)and USG considers it benign even though it has peripheral vasculairty
Now coming to the results. They just say Thyroiditis is highly likely. The new nodule , the radiologist wasn't overly concerned but suggested repeat follow up in 3 months OR a biopsy. Now the specialist is not concerned at all and says to come back after 6 months. According to him a FNA is most likely to be inaccurate and will mostly come back interderminate at this point due to the size of the nodule being small and will result in overtreatment. I got a second opinion and they advised me the same.
Im so scared to just simply wait and watch for 6 months. Feel like there is a ticking time bomb inside me. I am surprised my report doesn't mention anything about 'suspicious' nodules rather just says follow up and thyroiditis.
My question is given the odds , how likely is that new nodule to be cancerous? Is wait and watch ok or should I ask for biopsy? How are my TSH levels normal at 2.89 and I still am developing thyroiditis?! Please please help.
Definitely biopsy, and check your TGab thyroglobulin antibody. Why wouldn’t you? I wouldn’t wait. If you are in Florida definitely the place to go and get your surgery is wth Doctor Clayman at TAMPA GENERAL HOSPITAL
3 Comments
Hi Bjessy - I have consulted 3 specialists and they have said that biopsy at this stage isn't helpful due to the size of the nodule. If it reaches 9 mm in the next 3 months then they will go ahead and biopsy it,
They are confident that the results will not come back conclusive as the nodule is very tiny - the doctor is concerned that will result in either a result that cannot be relied upon even if it is benign and also if it comes back indeterminate I will have to wait anyway. . Sadly I am not in Florida but I am going on a hunt to find the best in the field where I am to ensure that I have one doctor handling my case. In the meanwhile I am going to push for thyroid antibody test and if this new specialist tells me to go ahead and biopsy , definitely want it done and over with! Hopefully should have more of a direction in the next 2 weeks.
They are confident that the results will not come back conclusive as the nodule is very tiny - the doctor is concerned that will result in either a result that cannot be relied upon even if it is benign and also if it comes back indeterminate I will have to wait anyway. . Sadly I am not in Florida but I am going on a hunt to find the best in the field where I am to ensure that I have one doctor handling my case. In the meanwhile I am going to push for thyroid antibody test and if this new specialist tells me to go ahead and biopsy , definitely want it done and over with! Hopefully should have more of a direction in the next 2 weeks.
You seem very knowledgeable so good luck and I know all will turn up how it’s suppose to. Have faith and be positive no matter whichever outcome.
Thank you so much for the good wishes Jessy :) . I am trying to find the positive .
I had my labs tested for Hashimoto's and TSH was mid 2's with both thyroid antibodies elevated. My TSH was 1.4 to 1.6 with normal thyroid gland function.
Excerpt from Your Thyroid Problems Solved by Dr Sandra Cabot...
"Based on new research, the revised reference range for TSH is 0.3 -2.0 mIU/L.
Research has shown that anyone with a TSH above 2.0 mIU/L is likely to be in the early stages of hypothyroidism!"
***
Excerpt from Radiopedia - Hashimoto's thyroiditis...
"It is difficult to reliably sonographically differentiate Hashimoto thyroiditis from other thyroid pathology. Ultrasound features can be variable depending on the severity and phase of disease 1,5:
diffusely enlarged thyroid gland with a heterogeneous echotexture is a common sonographic presentation 6
the presence of hypoechoic micronodules (1-6 mm) with surrounding echogenic septations is also considered to have a relatively high positive predictive value 3,4. This appearance may be described as pseudonodular or a giraffe pattern
colour Doppler study usually shows normal or decreased flow, but occasionally there might be hypervascularity similar to a thyroid inferno
prominent reactive cervical nodes may be present, especially in level VI, but they have normal morphologic features
patients are at higher risk for papillary thyroid carcinoma, so a discrete nodule should be considered for biopsy
In some situations, large nodules may be present, which may be referred to as nodular Hashimoto thyroiditis 10"
Excerpt from Your Thyroid Problems Solved by Dr Sandra Cabot...
"Based on new research, the revised reference range for TSH is 0.3 -2.0 mIU/L.
Research has shown that anyone with a TSH above 2.0 mIU/L is likely to be in the early stages of hypothyroidism!"
***
Excerpt from Radiopedia - Hashimoto's thyroiditis...
"It is difficult to reliably sonographically differentiate Hashimoto thyroiditis from other thyroid pathology. Ultrasound features can be variable depending on the severity and phase of disease 1,5:
diffusely enlarged thyroid gland with a heterogeneous echotexture is a common sonographic presentation 6
the presence of hypoechoic micronodules (1-6 mm) with surrounding echogenic septations is also considered to have a relatively high positive predictive value 3,4. This appearance may be described as pseudonodular or a giraffe pattern
colour Doppler study usually shows normal or decreased flow, but occasionally there might be hypervascularity similar to a thyroid inferno
prominent reactive cervical nodes may be present, especially in level VI, but they have normal morphologic features
patients are at higher risk for papillary thyroid carcinoma, so a discrete nodule should be considered for biopsy
In some situations, large nodules may be present, which may be referred to as nodular Hashimoto thyroiditis 10"
4 Comments
Red star whoa , I wonder why doctors then don’t straight up ask for antibodies test and just rely on TSH. As a patient I should have to ask them esp when the ultrasound keeps showing I have thyroiditis!
Yup this description sounds like me. The radiologist showed me how the entire gland was vascular. I have also read some interesting research on HT and PTC. Wherein people with HT who are diagnosed with PTC have a lower recurrence largely due to the antibodies present .
I wonder though and don’t get me wrong if any of this research is concrete linking the two. From what I have read around on the internet , there is great precedent but not as strong as other cancers and precancers. The thyroid is one crazy gland lol.
Yup this description sounds like me. The radiologist showed me how the entire gland was vascular. I have also read some interesting research on HT and PTC. Wherein people with HT who are diagnosed with PTC have a lower recurrence largely due to the antibodies present .
I wonder though and don’t get me wrong if any of this research is concrete linking the two. From what I have read around on the internet , there is great precedent but not as strong as other cancers and precancers. The thyroid is one crazy gland lol.
The problem is TSH can be in optimal range and you can still suffer hypothyroid symptoms. So more than TSH needs to be looked at. I agree with the antibody tests since most people with a thyroid condition will be due to an autoimmune disease. Interesting about cancer and antibodies. I haven't even had an ultrasound of my thyoid gland and I've had Hashi's for years. All I know if my gland is..to quote my endo "firm and rubbery". Poor thyroid gland. lol
May I ask why you haven't had an ultrasound for years?! Do you have a nodular thyroid?
I've never had a thyroid ultrasound so I don't know if I have nodules not. I really should have an ultrasound done. I have optimal IGF-1 which calms me down a lot in regards to cancer though.
COMMUNITY LEADER
Wow... are you sure those are the only symptoms you have? I'd be feeling like crud if my Free T4 and Free T3 were that low in their ranges...
Most of us tend to feel best when Free T4 is about the midrange point. Yours is only at 37% of its range. We also tend to feel best when Free T3 is in the upper half to upper third of its range; yours is only at 21% of the range. Free T3 is the active hormone that's used by nearly every cell in the body and if we don't have enough, we're going to have hypo symptoms. If you don't know how the Free T4 and Free T3 work, I'll be happy to explain it.
I would definitely recommend that you get the antibody tests to confirm/rule out Hashimoto's because IMO, your thyroid is definitely not producing optimal levels of hormones, regardless of what your doctor says or thinks.
Most of us tend to feel best when Free T4 is about the midrange point. Yours is only at 37% of its range. We also tend to feel best when Free T3 is in the upper half to upper third of its range; yours is only at 21% of the range. Free T3 is the active hormone that's used by nearly every cell in the body and if we don't have enough, we're going to have hypo symptoms. If you don't know how the Free T4 and Free T3 work, I'll be happy to explain it.
I would definitely recommend that you get the antibody tests to confirm/rule out Hashimoto's because IMO, your thyroid is definitely not producing optimal levels of hormones, regardless of what your doctor says or thinks.
1 Comments
I would be really grateful if you could explain the t3 and t4 ranges. I think I really need to work towards getting a doctor who believes me because till date they are very dismissive and tell me I am just fine.
To be honest as I have been so anxious I have had increased heart rate, migraines, my left trapezium is entirely painful and ortho is putting me on physiotherapy after doing an X-ray ( I'm guessing it could be because as my thyroid keeps increasing in size, my left neck is becoming bigger lol) - he is sure it is bursitis. Everyone keeps saying its anxiety and stress so I don't know what is true haha. Will definitely be pushing to get a full profile done including antibodies, if the doctor doesn't listen I guess I have to find one who will.
From what I have read many people have suffered through years of symptoms with no diagnosis. I will push for this hard and if they refuse, time to find a new doc woohoo.
To be honest as I have been so anxious I have had increased heart rate, migraines, my left trapezium is entirely painful and ortho is putting me on physiotherapy after doing an X-ray ( I'm guessing it could be because as my thyroid keeps increasing in size, my left neck is becoming bigger lol) - he is sure it is bursitis. Everyone keeps saying its anxiety and stress so I don't know what is true haha. Will definitely be pushing to get a full profile done including antibodies, if the doctor doesn't listen I guess I have to find one who will.
From what I have read many people have suffered through years of symptoms with no diagnosis. I will push for this hard and if they refuse, time to find a new doc woohoo.
COMMUNITY LEADER
Free T4 and Free T3 can be perfectly normal but you can still be positive for antibodies. Antibodies can present for years before enough damage is done to the thyroid to cause Free T4 and Free T3 to go out of range. On top of that, simply having Free T4 and Free T3 "in range" doesn't mean you don't hypothyroidism... you're right that all of us are different and because of the way the ranges are set, even if you're in the bottom of half of the range, you can be hypo.
Symptoms of Hashimoto's are, typically, mostly the same as those of being hypo though there are a few different ones.
In many instances, I agree with your doctor about "Dr Google", but there's nothing wrong with doing internet searches if you're using reputable sources to get your information. Many doctors have so much ego they simply don't want patients questioning (or adding to/subtracting from) what they say... Don't let that put you off. The thing with internet research is to make sure you don't go looking for the worst things or let your imagination run wild so you buy trouble that will most likely never come. It's my habit to stop looking/reading if I start scaring myself, especially if it's way off from what my doctors have said, though I will run by my doctor what I read in order to get an explanation of why that doesn't fit my case.
If you'd like to post your Free T4 and Free T3, with reference ranges, I'll be happy to take a look at them and give you my opinion. Also, provide any additional symptoms you might have besides being cold and/or dizzy.
If nodules aren't really suspicious, etc. many times, they aren't described well. Mine was simply described as a "solid" nodule and the size, so I don't know if it's calcified or not.
Symptoms of Hashimoto's are, typically, mostly the same as those of being hypo though there are a few different ones.
In many instances, I agree with your doctor about "Dr Google", but there's nothing wrong with doing internet searches if you're using reputable sources to get your information. Many doctors have so much ego they simply don't want patients questioning (or adding to/subtracting from) what they say... Don't let that put you off. The thing with internet research is to make sure you don't go looking for the worst things or let your imagination run wild so you buy trouble that will most likely never come. It's my habit to stop looking/reading if I start scaring myself, especially if it's way off from what my doctors have said, though I will run by my doctor what I read in order to get an explanation of why that doesn't fit my case.
If you'd like to post your Free T4 and Free T3, with reference ranges, I'll be happy to take a look at them and give you my opinion. Also, provide any additional symptoms you might have besides being cold and/or dizzy.
If nodules aren't really suspicious, etc. many times, they aren't described well. Mine was simply described as a "solid" nodule and the size, so I don't know if it's calcified or not.
3 Comments
My T3 level is 3.86 and T4 is 15.67. I have just been feeling dizzy and sensitive to cold with migraines off and on. Now I can attribute that to anxiety or something is really behind this. You are very right in that there is no harm in being educated. Doctors don't like being negated thats for sure.
I hope everything turns out well. I guess thyroid disorders are a life long waiting game.
I hope everything turns out well. I guess thyroid disorders are a life long waiting game.
What are the reference ranges for your T3 and T4? Ranges vary from lab to lab so have to come from your own report. Also are they Free T3 and Free T4? The Free's are the same as Total T3 and Total T4 nor do they give the same information.
Honestly, patience is definitely a virtue when it comes to thyroid...
Honestly, patience is definitely a virtue when it comes to thyroid...
Hey Barb, range for free t3 is 3.1 - 6.8 and for free t4 is 12 - 22. Yes they are free.
COMMUNITY LEADER
TSH has very little to do with nodules, so don't let the fact that it's "normal" bother you in relation to the nodule... TSH is a pituitary hormone and all it does is signal the thyroid to produce thyroid hormones. As long as, both, the thyroid and the pituitary gland are working properly, TSH will be in the normal range.
What happens is that sometimes the body, for whatever reason, sees the thyroid as foreign and produces antibodies to destroy it. The antibodies can be at work for many years, diminishing thyroid tissue and output, before the pituitary gland realizes what's going on. Besides TSH, you also need to have Free T4 and Free T3 tested. Those are actual thyroid hormones and will tell you what thyroid output really is. TSH is only an indicator, and should never be used as the sole determinant of thyroid status, though many doctors use it as such because that's what they learn in med school.
I'm sure your doctor probably lectured you on doing too much internet research, huh?? lol
You can go back and let him know you've been doing more research and that you'd like to have Free T4 and Free T3 tested to determine actual thyroid status, along with thyroid antibodies, Thyroid Peroxidase (TPOab) and Thyroglobulin Antibodies (TgAb) to confirm or rule out whether you have Hashimoto's.
In theory, TSH only goes out of range, when thyroid hormones become too low. That theory doesn't work for all of us, because there are things other than thyroid hormones that can affect TSH so it can vary by as much as 70-75% over the course of a day. Without having Free T4 and Free T3 tested, you don't know if your thyroid is working well or not.
Is the large neck the only symptom you have that might indicate a thyroid condition?
What happens is that sometimes the body, for whatever reason, sees the thyroid as foreign and produces antibodies to destroy it. The antibodies can be at work for many years, diminishing thyroid tissue and output, before the pituitary gland realizes what's going on. Besides TSH, you also need to have Free T4 and Free T3 tested. Those are actual thyroid hormones and will tell you what thyroid output really is. TSH is only an indicator, and should never be used as the sole determinant of thyroid status, though many doctors use it as such because that's what they learn in med school.
I'm sure your doctor probably lectured you on doing too much internet research, huh?? lol
You can go back and let him know you've been doing more research and that you'd like to have Free T4 and Free T3 tested to determine actual thyroid status, along with thyroid antibodies, Thyroid Peroxidase (TPOab) and Thyroglobulin Antibodies (TgAb) to confirm or rule out whether you have Hashimoto's.
In theory, TSH only goes out of range, when thyroid hormones become too low. That theory doesn't work for all of us, because there are things other than thyroid hormones that can affect TSH so it can vary by as much as 70-75% over the course of a day. Without having Free T4 and Free T3 tested, you don't know if your thyroid is working well or not.
Is the large neck the only symptom you have that might indicate a thyroid condition?
11 Comments
Hi! I did the free t3 and T4 scans and those were normal too lol. But I think I will do the antibodies test as you have suggested. I have many symptoms of Hashimotos like sensitivity to cold and dizziness. I did a MRI all clear .
The large neck, these two nodules and a goiter in essence is all that’s going for me.
Yes the doc gave me a huge lecture on internet research! Dr google. I do trust him but my anxiety overrules everyone else. Believe it or not I managed to question the radiologist a lot. The Radiologist was all like ‘ I have done many biopsies don’t worry I’ll do yours’ . My doc was very unhappy that he said that. What concerns me about this radiologist is he didn’t even describe what type of nodule it was?! So the nodule which was ill defined I actually got in contact with him as the hospital allows this and he was like it wasn’t majorly ill defined just slightly . I don’t know what is going on with me.
Thanks so much for guiding me!!! I will definitely get these antibodies tested. If the T3 and T4 are normal are these likely to be normal too, or could these be the hidden clue to the issues I have? Also I have read you can have hashimotos despite everything being normal as everyone’s ‘normal’ is different.
Although doc has said scan after 6 months I think I’ll go after 3 to be on the safe side of things. If anything this is going to teach me a lot of patience.
The large neck, these two nodules and a goiter in essence is all that’s going for me.
Yes the doc gave me a huge lecture on internet research! Dr google. I do trust him but my anxiety overrules everyone else. Believe it or not I managed to question the radiologist a lot. The Radiologist was all like ‘ I have done many biopsies don’t worry I’ll do yours’ . My doc was very unhappy that he said that. What concerns me about this radiologist is he didn’t even describe what type of nodule it was?! So the nodule which was ill defined I actually got in contact with him as the hospital allows this and he was like it wasn’t majorly ill defined just slightly . I don’t know what is going on with me.
Thanks so much for guiding me!!! I will definitely get these antibodies tested. If the T3 and T4 are normal are these likely to be normal too, or could these be the hidden clue to the issues I have? Also I have read you can have hashimotos despite everything being normal as everyone’s ‘normal’ is different.
Although doc has said scan after 6 months I think I’ll go after 3 to be on the safe side of things. If anything this is going to teach me a lot of patience.
Hi waitandwatch,
Sorry to hear about your thyroiditis and nodules. I was recently diagnosed with multinodular goiter and then last week with Hashimoto's too. My TSH, free T3, and free T4 are in the normal range, so it is possible for all of those to be normal and still have Hashi's. I do have mild hypothyroidism symptoms as well. If you are diagnosed with Hashimoto's, you might try to convince your doctor to let you try "low dose" thyroid medication to decrease your TSH to slow down further thyroid and nodule growth and treat your symptoms. My PCP was willing to do this, unfortunately one of my nodules is suspicious and needs to come out.
Hope all goes well, waiting can be so hard but once I have some answers and more information it gets easier.
Sorry to hear about your thyroiditis and nodules. I was recently diagnosed with multinodular goiter and then last week with Hashimoto's too. My TSH, free T3, and free T4 are in the normal range, so it is possible for all of those to be normal and still have Hashi's. I do have mild hypothyroidism symptoms as well. If you are diagnosed with Hashimoto's, you might try to convince your doctor to let you try "low dose" thyroid medication to decrease your TSH to slow down further thyroid and nodule growth and treat your symptoms. My PCP was willing to do this, unfortunately one of my nodules is suspicious and needs to come out.
Hope all goes well, waiting can be so hard but once I have some answers and more information it gets easier.
Hi Sarah
So sorry to hear of your waiting game as well but you're right answers and an action plan does make it better. The problem often with thyroid is you tend not to get answers which is so frustrating as I'm sure you're aware. I did try to convince the doc but he wasn't convinced. I will look into a low dose medicine for sure.
If you don't mind me asking, what were the characteristics of your suspicious nodule? From my post you can see I may the worst possible type of nodule characteristics possible haha. I have been researching a lot and a lot of seemingly malignant characteristics overlap with benign ones including size, solid, hyper echoic , vascularity , ill defined borders etc. So all hope is not lost - the odds still may be in our favor.
So sorry to hear of your waiting game as well but you're right answers and an action plan does make it better. The problem often with thyroid is you tend not to get answers which is so frustrating as I'm sure you're aware. I did try to convince the doc but he wasn't convinced. I will look into a low dose medicine for sure.
If you don't mind me asking, what were the characteristics of your suspicious nodule? From my post you can see I may the worst possible type of nodule characteristics possible haha. I have been researching a lot and a lot of seemingly malignant characteristics overlap with benign ones including size, solid, hyper echoic , vascularity , ill defined borders etc. So all hope is not lost - the odds still may be in our favor.
My nodule is 1.3 cm, hypoechoic on ultrasound with smooth margins. The hypoechoic part is what makes it "higher risk" and why they recommended a biopsy (and being >1cm). I have a 2.8 cm isoechoic nodule on the other side, that has "some internal vascularity", this one was also biopsied but it was benign.
As soon as I did some research, I suspected my "suspicious" nodule was suspicious due to Hurthle cells even before I had the full biopsy report (I found out that it was suspicious for neoplasm at my biopsy because the biopsy doctor does the pathology himself). People with Hashimoto's often have "Hurthle cell lesions", so I suspected it was that even though I had not been diagnosed with Hashimoto's yet. The biopsy report reads : "Aspirate material and cell block show abundant Hurthle cells with cytologic and architectural atypia. Minimal colloid is present. There is no increase in lymphocytes."
I also had Afirma genetic testing on this suspicious nodule, but Afirma just tells you if it is benign or suspicious, and for Hurthle cells comes back suspicious something like 65% of the time (even though most of those end up benign). The only way to know for sure if Hurthle cell neoplasm is cancer is to have surgery and remove the whole nodule and do pathology on that. I have a lot of things going for me which keeps my risk low: I'm 37 yrs old (ave. age for Hurthle cell cancer is 55, which is 10 yrs older than other follicular cancers), I'm female (I believe males are more likely for Hurtle cell neoplasm to actually be cancer), and my nodule is small for Hurthle cell cancer (average size at discovery of HC is 4cm). All of those factors keep me optimistic that it is most likely not cancer, but it has the possibility to turning into cancer in the future and there is no way to know for sure without the surgery, so I'm going to have the surgery (if it is cancer, I will deal with that too!).
My aunt is also going through the whole nodule diagnosis procedure and is awaiting biopsy results - she doesn't have Hashimoto's as far as I know (and her thyroid is of a normal size, unlike mine), and her nodules are smaller than mine in general, but have been followed for years. (She had a nodule removed in 1975 when she was 15, she's 57 now). I believe she let her regular follow-up ultrasounds lapse for a few years due to changes in her health insurance and not looking for a new doctor. I believe her most suspicious nodule is around 1.8 cm, hypoechoic on ultrasound, and has some vascularity and calcifications. I haven't heard back from her about her biopsy results, but I think her nodules have just been growing slowly for a long time, and she is a whole lot less anxious about this process than I am. (I have no idea how long my nodules have been there, I'm suspecting I've had Hashimoto's for >10-15 years and that's why I have a goiter+many nodules on both lobes and my isthmus gets its own nodule as well :-) !
And you are right, those "malignant" characteristics are often found in benign nodules as well. I believe part of the reason why they hold off on small nodules is it is hard to get enough cells in the biopsy to determine whether it is benign, suspicious, or malignant, and you are likely to get a "indeterminant" result, which means you have to go get another biopsy, or wait and do it all over again in 6 months. And odds are low at your nodule size that it is cancerous, which is why they like to wait until it is >1cm if in the "riskier" category. I just looked up a study of size of thyroid nodule vs. malignancy - at 1 to 1.9 cm, 10.5% of those nodules are malignant.
ooh I just read about your micronodules! My Ultrasound reads: "heterogeneous with diffuse background nodularity" for my right lobe and "There is background diffuse nodularity" for the left - sounds pretty similar to yours. I'm thinking that means there's a very good chance you have Hashimoto's too.
Good luck - I don't know what I would do if I were in your position - whether to push for a FNA because it's so hard not to know, or just to wait it out and do another ultrasound in 3-6 months. Most nodules do not grow by that much in 3 months (I have to wait 2.5 months from my suspicious biopsy to the actual surgery, and I've made my peace with waiting on that already). If you do find out you have Hashimoto's (and it looks like your Free T3 and Free t4 are on the low side according to Barb135, expert of all things thyroid), you may be able to get treatment for your hypo symptoms which hopefully will help with your symptoms and may also slow down your nodule growth (as an elevated TSH -thyroid stimulating hormone - tells your thyroid to keep growing!)
As soon as I did some research, I suspected my "suspicious" nodule was suspicious due to Hurthle cells even before I had the full biopsy report (I found out that it was suspicious for neoplasm at my biopsy because the biopsy doctor does the pathology himself). People with Hashimoto's often have "Hurthle cell lesions", so I suspected it was that even though I had not been diagnosed with Hashimoto's yet. The biopsy report reads : "Aspirate material and cell block show abundant Hurthle cells with cytologic and architectural atypia. Minimal colloid is present. There is no increase in lymphocytes."
I also had Afirma genetic testing on this suspicious nodule, but Afirma just tells you if it is benign or suspicious, and for Hurthle cells comes back suspicious something like 65% of the time (even though most of those end up benign). The only way to know for sure if Hurthle cell neoplasm is cancer is to have surgery and remove the whole nodule and do pathology on that. I have a lot of things going for me which keeps my risk low: I'm 37 yrs old (ave. age for Hurthle cell cancer is 55, which is 10 yrs older than other follicular cancers), I'm female (I believe males are more likely for Hurtle cell neoplasm to actually be cancer), and my nodule is small for Hurthle cell cancer (average size at discovery of HC is 4cm). All of those factors keep me optimistic that it is most likely not cancer, but it has the possibility to turning into cancer in the future and there is no way to know for sure without the surgery, so I'm going to have the surgery (if it is cancer, I will deal with that too!).
My aunt is also going through the whole nodule diagnosis procedure and is awaiting biopsy results - she doesn't have Hashimoto's as far as I know (and her thyroid is of a normal size, unlike mine), and her nodules are smaller than mine in general, but have been followed for years. (She had a nodule removed in 1975 when she was 15, she's 57 now). I believe she let her regular follow-up ultrasounds lapse for a few years due to changes in her health insurance and not looking for a new doctor. I believe her most suspicious nodule is around 1.8 cm, hypoechoic on ultrasound, and has some vascularity and calcifications. I haven't heard back from her about her biopsy results, but I think her nodules have just been growing slowly for a long time, and she is a whole lot less anxious about this process than I am. (I have no idea how long my nodules have been there, I'm suspecting I've had Hashimoto's for >10-15 years and that's why I have a goiter+many nodules on both lobes and my isthmus gets its own nodule as well :-) !
And you are right, those "malignant" characteristics are often found in benign nodules as well. I believe part of the reason why they hold off on small nodules is it is hard to get enough cells in the biopsy to determine whether it is benign, suspicious, or malignant, and you are likely to get a "indeterminant" result, which means you have to go get another biopsy, or wait and do it all over again in 6 months. And odds are low at your nodule size that it is cancerous, which is why they like to wait until it is >1cm if in the "riskier" category. I just looked up a study of size of thyroid nodule vs. malignancy - at 1 to 1.9 cm, 10.5% of those nodules are malignant.
ooh I just read about your micronodules! My Ultrasound reads: "heterogeneous with diffuse background nodularity" for my right lobe and "There is background diffuse nodularity" for the left - sounds pretty similar to yours. I'm thinking that means there's a very good chance you have Hashimoto's too.
Good luck - I don't know what I would do if I were in your position - whether to push for a FNA because it's so hard not to know, or just to wait it out and do another ultrasound in 3-6 months. Most nodules do not grow by that much in 3 months (I have to wait 2.5 months from my suspicious biopsy to the actual surgery, and I've made my peace with waiting on that already). If you do find out you have Hashimoto's (and it looks like your Free T3 and Free t4 are on the low side according to Barb135, expert of all things thyroid), you may be able to get treatment for your hypo symptoms which hopefully will help with your symptoms and may also slow down your nodule growth (as an elevated TSH -thyroid stimulating hormone - tells your thyroid to keep growing!)
That's just the reality of thyroid problems, until the gland comes out even FNA biopsies can't provide a definitive answer. I like your Aunt's spirit. My mom too has thyroid issues and barely cares. Its so hard not to be anxious especially when younger because I guess you always think of worrying about cancer as something you get when old, boy was I wrong lol.
I guess ultimately we will have to get our thyroids out. A part of me has made peace of that and in a way wants that because the constant surveillance and what ifs truly stresses me out. Yet thyroid surgery is no joke. I wish so many times I never had that ultrasound 6 months ago because I was happy then and now all I think of is nodules, TSH , calcifications and what not haha. But I remind myself then we are lucky we were vigilant enough to monitor it. I am just scared because I read of horror stories of people who left nodules and then they spread to other parts of they lymph nodes etc. but my doctor has told me that is extremely rare and should a cancer be that aggressive it would show in nodule growth rate and on the thyroid.
My left lobe of thyroid is definitely bigger and its caused that side of the neck to be big too. To top it all off my left shoulder has bursitis and inflammation lol. Recently visited the ortho specialist and now I have physio. I started thinking of bone mets and what not.All of this at the ripe old age of 27.
If you don't have calcifications I would worry even less and even with the biopsy results at worst its probably a microcarcinoma. Still chances of it being benign though! In thyroiditis from what I have read the entire gland can become vascular therefore they tend to worry not as much about vascularity in nodules. I will be praying for you and you will be just fine in either case. We just need to keep up with our monitoring appointments.
Just wondering at what age did your thyroid issues begin? What made you take the ultrasound to begin with?
I guess ultimately we will have to get our thyroids out. A part of me has made peace of that and in a way wants that because the constant surveillance and what ifs truly stresses me out. Yet thyroid surgery is no joke. I wish so many times I never had that ultrasound 6 months ago because I was happy then and now all I think of is nodules, TSH , calcifications and what not haha. But I remind myself then we are lucky we were vigilant enough to monitor it. I am just scared because I read of horror stories of people who left nodules and then they spread to other parts of they lymph nodes etc. but my doctor has told me that is extremely rare and should a cancer be that aggressive it would show in nodule growth rate and on the thyroid.
My left lobe of thyroid is definitely bigger and its caused that side of the neck to be big too. To top it all off my left shoulder has bursitis and inflammation lol. Recently visited the ortho specialist and now I have physio. I started thinking of bone mets and what not.All of this at the ripe old age of 27.
If you don't have calcifications I would worry even less and even with the biopsy results at worst its probably a microcarcinoma. Still chances of it being benign though! In thyroiditis from what I have read the entire gland can become vascular therefore they tend to worry not as much about vascularity in nodules. I will be praying for you and you will be just fine in either case. We just need to keep up with our monitoring appointments.
Just wondering at what age did your thyroid issues begin? What made you take the ultrasound to begin with?
Hi Waitandwatch,
I'm not entirely sure when my thyroid issues actually began - I have always been cold sensitive since I was a child, and pretty much since I can remember (teenage years on), the only time I really feel warm is when I'm moving around (hence my love of running). I gained a lot of weight (went from probably 130 to 175) from ages of 16-20. At 20 (year 2000), I was feeling depressed and unhappy, blamed the weight gain on being a teenager and then starting college, not being that active, eating unhealthy. I was also a vegetarian from 16-20, so I wasn't really eating that unhealthy. I had a lot of hypo symptoms during this time but did not know they were hypo symptoms. At 20, I decided to start eating "non-mammals" again (fish, seafood, chicken, and turkey), started swimming to get back in shape, and then eventually started running. I ran my first half marathon at about 22 (and weight was back down to around 150, at 5'9" this is a good weight for me), anxiety and depression were gone, and I was feeling a lot better. Since then, if I don't go running every 2-3 days I start to get antsy/anxious - is this a hypo symptom? I don't know. Anyway, after I lost the weight the running became more about keeping my mood regulated and less about weight control.
Up until about 30-31 years old, I think my running/active lifestyle kept a lot of the symptoms at bay, main symptom being cold all the time (except when I'm running), and starting to have heavier/longer lasting periods. In 2011, I moved to the UK for work. I was under a lot of anxiety from culture shock/new job/difficult boss, and that probably triggered me to swing more hypo (I did not know it at the time). I just felt sluggish and drained all the time except for when I was running and when I was working. My periods also became a lot heavier, lasted a lot longer, and at the time I thought this was due to the fact that I was training for a marathon which also puts a lot of stress on the body (first marathon March 2012). I didn't know my periods were actually considered abnormally heavy until about a month ago, and that this could be a hypo symptom. In 2015 I moved back to the US, and in about a year put on 25-30 pounds (from 155ish to 180ish). I assumed this was from a change in lifestyle of not being in the UK, more stress (I left my job in UK because of boss difficulties and eating more. I was still running this whole time, so this doesn't make a whole lot of sense but was what I would say to explain my gain. I was running a whole lot slower (15 minutes a mile when I usually do 10-11 min miles - why? I don't know, either weight gain slowed me down, or maybe a hypo symptom. In March 2017, I was shocked about my weight around 180, because I had been averaging over 100 miles per month in 2015 and 2016 - that's ridiculous to put on so much weight while running, but possible if I am eating more than I'm burning. In March 2017 I started keeping track of my calories, and from March to about September last year managed to drop my weight from 180 back down to 155. From September to now, it's only dropped to 150, but that is a very good weight for me, so I'm trying to keep it around there while we get my thyroid issues worked out. Main symptoms currently are: cold insensitivity, problems concentrating/brain fog, and heavy/longer than normal periods. I did have a lot more hair coming out when I was losing weight, but that is also a symptom of "weight loss", so it didn't concern me too much. I also have very thick, coarse hair and dry skin - but these are very subtle symptoms and I'm not really sure if they are due to hypo or not.
What triggered my ultrasound? In November, I was brushing my teeth in a hotel where the lighting is different than at home, and noticed my neck looked lumpy and asymmetric. I have seasonal allergies pretty much year round, so thought it could be swollen lymph nodes, and decided to "just ignore it". In March, I was stressing out because that's when I learned it's not normal to have such a heavy menstrual flow and decided to visit a PCP. Two days later (I tend to get anxious about 3 days into my period - no idea why), I realized the lump in my neck was still there, did some googling, and learned if it moved up and down when you swallow it's probably your thyroid, not your lymph nodes. I talked to my mom and she told me my grandma had her thyroid removed for unknown reasons and that my aunt also had nodules removed and that I should get it checked out. What followed was PCP appointment where she diagnosed my "non-toxic multinodular goiter", told me my thyroid hormone levels were normal (despite telling her my symptoms), ultrasound, appointment with the ENT who was more concerned about the nodules than possibility of Hashi's, biopsy, Afirma test, scheduling for surgery, and antibody blood test, then finding out I have Hashi's (all from about March 18 to April 28th - pretty quick in the scheme of things).
Do I wish I had picked up on these symptoms a long time ago and got treatment/changed my diet to lower my chances of getting a multinodular goiter that needs to be removed? Yes, of course I do - I just didn't know until now. I'm sure the lumps have been in my neck/visible for a long time before I noticed them, but I've lost significant amount of weight in the last year and can probably just see what's going on in my skinny neck better. I can see the large (2.8cm) nodule on my left side, it's low and right behind my carotid and jugular, and when the U/S measured it at 2.2 cm, I thought that was a lot smaller than what I had measure holding a measuring tape to my neck - the biopsy doctor said it was 2.8cm, and I was like "that sounds a lot closer to what I thought it would be". I'm pretty sure it didn't grow that much in the 2wks between U/S and biopsy.
As for worrying about your shoulder - this comment is long so I will write another comment below with my own shoulder problems.
I'm not entirely sure when my thyroid issues actually began - I have always been cold sensitive since I was a child, and pretty much since I can remember (teenage years on), the only time I really feel warm is when I'm moving around (hence my love of running). I gained a lot of weight (went from probably 130 to 175) from ages of 16-20. At 20 (year 2000), I was feeling depressed and unhappy, blamed the weight gain on being a teenager and then starting college, not being that active, eating unhealthy. I was also a vegetarian from 16-20, so I wasn't really eating that unhealthy. I had a lot of hypo symptoms during this time but did not know they were hypo symptoms. At 20, I decided to start eating "non-mammals" again (fish, seafood, chicken, and turkey), started swimming to get back in shape, and then eventually started running. I ran my first half marathon at about 22 (and weight was back down to around 150, at 5'9" this is a good weight for me), anxiety and depression were gone, and I was feeling a lot better. Since then, if I don't go running every 2-3 days I start to get antsy/anxious - is this a hypo symptom? I don't know. Anyway, after I lost the weight the running became more about keeping my mood regulated and less about weight control.
Up until about 30-31 years old, I think my running/active lifestyle kept a lot of the symptoms at bay, main symptom being cold all the time (except when I'm running), and starting to have heavier/longer lasting periods. In 2011, I moved to the UK for work. I was under a lot of anxiety from culture shock/new job/difficult boss, and that probably triggered me to swing more hypo (I did not know it at the time). I just felt sluggish and drained all the time except for when I was running and when I was working. My periods also became a lot heavier, lasted a lot longer, and at the time I thought this was due to the fact that I was training for a marathon which also puts a lot of stress on the body (first marathon March 2012). I didn't know my periods were actually considered abnormally heavy until about a month ago, and that this could be a hypo symptom. In 2015 I moved back to the US, and in about a year put on 25-30 pounds (from 155ish to 180ish). I assumed this was from a change in lifestyle of not being in the UK, more stress (I left my job in UK because of boss difficulties and eating more. I was still running this whole time, so this doesn't make a whole lot of sense but was what I would say to explain my gain. I was running a whole lot slower (15 minutes a mile when I usually do 10-11 min miles - why? I don't know, either weight gain slowed me down, or maybe a hypo symptom. In March 2017, I was shocked about my weight around 180, because I had been averaging over 100 miles per month in 2015 and 2016 - that's ridiculous to put on so much weight while running, but possible if I am eating more than I'm burning. In March 2017 I started keeping track of my calories, and from March to about September last year managed to drop my weight from 180 back down to 155. From September to now, it's only dropped to 150, but that is a very good weight for me, so I'm trying to keep it around there while we get my thyroid issues worked out. Main symptoms currently are: cold insensitivity, problems concentrating/brain fog, and heavy/longer than normal periods. I did have a lot more hair coming out when I was losing weight, but that is also a symptom of "weight loss", so it didn't concern me too much. I also have very thick, coarse hair and dry skin - but these are very subtle symptoms and I'm not really sure if they are due to hypo or not.
What triggered my ultrasound? In November, I was brushing my teeth in a hotel where the lighting is different than at home, and noticed my neck looked lumpy and asymmetric. I have seasonal allergies pretty much year round, so thought it could be swollen lymph nodes, and decided to "just ignore it". In March, I was stressing out because that's when I learned it's not normal to have such a heavy menstrual flow and decided to visit a PCP. Two days later (I tend to get anxious about 3 days into my period - no idea why), I realized the lump in my neck was still there, did some googling, and learned if it moved up and down when you swallow it's probably your thyroid, not your lymph nodes. I talked to my mom and she told me my grandma had her thyroid removed for unknown reasons and that my aunt also had nodules removed and that I should get it checked out. What followed was PCP appointment where she diagnosed my "non-toxic multinodular goiter", told me my thyroid hormone levels were normal (despite telling her my symptoms), ultrasound, appointment with the ENT who was more concerned about the nodules than possibility of Hashi's, biopsy, Afirma test, scheduling for surgery, and antibody blood test, then finding out I have Hashi's (all from about March 18 to April 28th - pretty quick in the scheme of things).
Do I wish I had picked up on these symptoms a long time ago and got treatment/changed my diet to lower my chances of getting a multinodular goiter that needs to be removed? Yes, of course I do - I just didn't know until now. I'm sure the lumps have been in my neck/visible for a long time before I noticed them, but I've lost significant amount of weight in the last year and can probably just see what's going on in my skinny neck better. I can see the large (2.8cm) nodule on my left side, it's low and right behind my carotid and jugular, and when the U/S measured it at 2.2 cm, I thought that was a lot smaller than what I had measure holding a measuring tape to my neck - the biopsy doctor said it was 2.8cm, and I was like "that sounds a lot closer to what I thought it would be". I'm pretty sure it didn't grow that much in the 2wks between U/S and biopsy.
As for worrying about your shoulder - this comment is long so I will write another comment below with my own shoulder problems.
You said you were worried about bone metastasis because of inflammation/bursitis in your left shoulder.
I have a bone spur on my right hand, on the palm just below the ring finger. I think it is likely related to hypothyroidism, as hyperthyroidism can cause bone weakness/osteoporosis, and I've found some people talking on-line about bone spurs and being hypo. It hasn't even crossed my mind that it might be a bone met until now (I still think it could be hypo related but prob. is not cancer related and will choose to believe that until I am told otherwise). As long as I don't start getting bone spurs on my feet that screw with my running, I'll be fine with one on my hand.
I know muscle weakness, especially in your thighs or upper arms/shoulder is a hypothyroidism symptoms. I used to (from about ages 20-31) get a prolonged "delayed onset muscle soreness" (DOMS) in my thighs every time I took a 2wk break from running and then went for my first run. It would take three days for this to go away (in general DOMS should peak around 48hr then be much better after that). I don't get this anymore (but I rarely take 2 week breaks either), and it made sense to me that my muscles would be sore after running on them, so again another ignored/unknown symptom, or maybe I just run too much :-)
I have never been that strong with my upper body, but as I was losing weight last year (in July, I was already down to 157ish), I would lift weights pretty frequently to help put on calorie burning muscle (nothing more than 12 lb/arm). I was doing some weight lifting (12lb x 12 reps shoulder press, tricep behind the head 8lb each arm) and then a side-plank, heard a pop, and knew something had gone wrong in my left shoulder. I had sprained my acromioclavicular joint, the ligaments that hold your collar bone to your scapula. I didn't get it x-rayed right away because I assumed it was a sprain, and made a solid effort to immobilize the joint and not go running for about a week. I gave in (because I get antsy not running), and a couple of days back running, I was feeling a lot of pain on the sternoclavicular side of the collar bone (where it attaches to the sternum), as well as left side chest pain in my pectoral muscles. Dr. Google scared the heck out of me because the sternoclavicular joint is an awful location to have a joint problem (you have a lot of important blood vessels and nerves right behind this location), and I gave in and got it x-rayed at UrgentCare to make sure it wasn't broken. They told me it was a sprain at the AC (shoulder end) of the collar bone, gave me high dose ibuprofen for the inflammation, and told me to wear a sling for 2-3 weeks and ice it. More weeks of not running, but I did it and would go for about 2-3 mile walk instead, with a sling on. I rehabbed it myself starting with some "pushing on the wall" exercises and then exercise cords, and I've started to lift weights with the bad shoulder, working my way up from 3lb up to 8lb now shoulder press over several months, so I'm taking it slow with the recovery. My sternoclavicular joint sometimes still feels a little achey, so I think I must have sprained that too, but it is such a strong joint and only gets torn completely in car accidents/impact, so I think it's probably ok.
What I didn't get was how I sprained it in the first place - I have done tons of side planks in my life, and at the time was in better shape than I had been in years, and my weight was down. My left arm is definitely my dominant arm (I'm left handed), so that was odd too. Usually people sprain or tear their AC joint falling on an outstretched arm or doing tricep dips. I told myself maybe I was just trying to do to much with the weight lifting and then the side plank, but it is also likely my thyroid issues have weakened my shoulders.
Anyway, inflammation and bursitis could be related to a thyroid issue - but I would try not to worry that it's due to cancer! I hope your shoulder feels better soon - I don't know much about bursitis or the treatment - it sucks having a shoulder injury, and the recovery can take a long time. Do you need surgery for your shoulder? I was very lucky that mine was just a sprain and all it really needed was time and rest to heal.
Try not to get too down on having a thyroid condition - I plan on continuing to be just as active after the surgery as I am now (well, after the compulsory post-surgery recovery period), and I am hoping medication may help with my hypo symptoms so I might be feeling even better than before! (That's my hope anyway, I know it takes some work to get the levels right - if these heavy/prolonged menstrual cycles would go away, I would be thrilled).
PS - sorry I've been writing so much - I've always been too wordy - and I've had a lot of time to think about all the missed symptoms over the years. Could I have had some symptoms at 16? Maybe? Definitely by 31 there were big red flags that I missed, including extreme fatigue/tiredness. I am trying hard to not beat myself up for not knowing, and I can help make sure my family members (siblings, nieces, cousins) all get their thyroid antibodies checked so they know early on if they have Hashi's too! My sister is 32, and has some mild hypo symptoms (cold insensitivity, anxiety/low mood, and fatigue), so I'm hoping she gets hers checked out soon.
I have a bone spur on my right hand, on the palm just below the ring finger. I think it is likely related to hypothyroidism, as hyperthyroidism can cause bone weakness/osteoporosis, and I've found some people talking on-line about bone spurs and being hypo. It hasn't even crossed my mind that it might be a bone met until now (I still think it could be hypo related but prob. is not cancer related and will choose to believe that until I am told otherwise). As long as I don't start getting bone spurs on my feet that screw with my running, I'll be fine with one on my hand.
I know muscle weakness, especially in your thighs or upper arms/shoulder is a hypothyroidism symptoms. I used to (from about ages 20-31) get a prolonged "delayed onset muscle soreness" (DOMS) in my thighs every time I took a 2wk break from running and then went for my first run. It would take three days for this to go away (in general DOMS should peak around 48hr then be much better after that). I don't get this anymore (but I rarely take 2 week breaks either), and it made sense to me that my muscles would be sore after running on them, so again another ignored/unknown symptom, or maybe I just run too much :-)
I have never been that strong with my upper body, but as I was losing weight last year (in July, I was already down to 157ish), I would lift weights pretty frequently to help put on calorie burning muscle (nothing more than 12 lb/arm). I was doing some weight lifting (12lb x 12 reps shoulder press, tricep behind the head 8lb each arm) and then a side-plank, heard a pop, and knew something had gone wrong in my left shoulder. I had sprained my acromioclavicular joint, the ligaments that hold your collar bone to your scapula. I didn't get it x-rayed right away because I assumed it was a sprain, and made a solid effort to immobilize the joint and not go running for about a week. I gave in (because I get antsy not running), and a couple of days back running, I was feeling a lot of pain on the sternoclavicular side of the collar bone (where it attaches to the sternum), as well as left side chest pain in my pectoral muscles. Dr. Google scared the heck out of me because the sternoclavicular joint is an awful location to have a joint problem (you have a lot of important blood vessels and nerves right behind this location), and I gave in and got it x-rayed at UrgentCare to make sure it wasn't broken. They told me it was a sprain at the AC (shoulder end) of the collar bone, gave me high dose ibuprofen for the inflammation, and told me to wear a sling for 2-3 weeks and ice it. More weeks of not running, but I did it and would go for about 2-3 mile walk instead, with a sling on. I rehabbed it myself starting with some "pushing on the wall" exercises and then exercise cords, and I've started to lift weights with the bad shoulder, working my way up from 3lb up to 8lb now shoulder press over several months, so I'm taking it slow with the recovery. My sternoclavicular joint sometimes still feels a little achey, so I think I must have sprained that too, but it is such a strong joint and only gets torn completely in car accidents/impact, so I think it's probably ok.
What I didn't get was how I sprained it in the first place - I have done tons of side planks in my life, and at the time was in better shape than I had been in years, and my weight was down. My left arm is definitely my dominant arm (I'm left handed), so that was odd too. Usually people sprain or tear their AC joint falling on an outstretched arm or doing tricep dips. I told myself maybe I was just trying to do to much with the weight lifting and then the side plank, but it is also likely my thyroid issues have weakened my shoulders.
Anyway, inflammation and bursitis could be related to a thyroid issue - but I would try not to worry that it's due to cancer! I hope your shoulder feels better soon - I don't know much about bursitis or the treatment - it sucks having a shoulder injury, and the recovery can take a long time. Do you need surgery for your shoulder? I was very lucky that mine was just a sprain and all it really needed was time and rest to heal.
Try not to get too down on having a thyroid condition - I plan on continuing to be just as active after the surgery as I am now (well, after the compulsory post-surgery recovery period), and I am hoping medication may help with my hypo symptoms so I might be feeling even better than before! (That's my hope anyway, I know it takes some work to get the levels right - if these heavy/prolonged menstrual cycles would go away, I would be thrilled).
PS - sorry I've been writing so much - I've always been too wordy - and I've had a lot of time to think about all the missed symptoms over the years. Could I have had some symptoms at 16? Maybe? Definitely by 31 there were big red flags that I missed, including extreme fatigue/tiredness. I am trying hard to not beat myself up for not knowing, and I can help make sure my family members (siblings, nieces, cousins) all get their thyroid antibodies checked so they know early on if they have Hashi's too! My sister is 32, and has some mild hypo symptoms (cold insensitivity, anxiety/low mood, and fatigue), so I'm hoping she gets hers checked out soon.
Interesting – did you find it hard to shed weight after exercising and dieting? Did you feel you had to push yourself to work out twice as hard in order to reach your desired weight? When I turned 13ish I shed weight like crazy and was pretty thin. After university – drinking and eating etc. I put on 7 kilos! But the worst possible weight gain was when I started working, I had a gap between employment and I put on 10 kg. Since then it has been difficult to shed weight and maybe I am not doing enough. I tried a personal trainer and yeah I wasn’t eating TOO healthy but I wasn’t unhealthy either and should have atleast seen a few pounds drop. Even the trainer was shocked. My periods too have become heavier and cramps worse. Its great that you were committed to losing weight and got it done – keep exercising as movement is key and when we give in to our symptoms , it’s a slippery slope to depression.
I get muscle soreness especially in my thighs too. I have always been prone to bone pain as a child even and get aches in my bones and thighs radiating to legs. Eeks your injury does not sound fun and you are right in that once you get a bone injury it can tend to be chronic and never completely goes away. I am starting physiotherapy soon – my left shoulder has been inflamed for years and gets worse in the cold. I live in Dubai – which is a very hot place so my home and office have air conditioning which is extremely cold. If I sleep in that environment – I tend to wake up with a frozen shoulder. I have told my doctor about my concern about mets etc but he laughed me off and said that a 7 mm nodule is not going to spread to my bones esp since I have been having these symptoms for years. My mind is all over the place and paranoia and anxiety is ruling me. I think once I adjust to the new normal and accept that this is the card I have been dealt with ( it could be so much worse right?), then I can stop being all over the place.
Thanks so much for sharing your story and I truly hope all turns out well for both of us! I am sure it will one way or another. Don’t worry about being wordy, it was helpful correlating my story with yours! Are you prepared mentally for removing your thyroid gland?
I get muscle soreness especially in my thighs too. I have always been prone to bone pain as a child even and get aches in my bones and thighs radiating to legs. Eeks your injury does not sound fun and you are right in that once you get a bone injury it can tend to be chronic and never completely goes away. I am starting physiotherapy soon – my left shoulder has been inflamed for years and gets worse in the cold. I live in Dubai – which is a very hot place so my home and office have air conditioning which is extremely cold. If I sleep in that environment – I tend to wake up with a frozen shoulder. I have told my doctor about my concern about mets etc but he laughed me off and said that a 7 mm nodule is not going to spread to my bones esp since I have been having these symptoms for years. My mind is all over the place and paranoia and anxiety is ruling me. I think once I adjust to the new normal and accept that this is the card I have been dealt with ( it could be so much worse right?), then I can stop being all over the place.
Thanks so much for sharing your story and I truly hope all turns out well for both of us! I am sure it will one way or another. Don’t worry about being wordy, it was helpful correlating my story with yours! Are you prepared mentally for removing your thyroid gland?
Waitandwatch,
I've had a hard time losing weight, especially when I was feeling the most anxiety and most fatigue symptoms while living in the UK. I somehow managed to train for and run in 3 marathons (one in 2013 and two in 2014) while maintaining a weight of 160-165 pounds (72.6-74.8kg). I was pretty athletic, so a lot of the weight was in muscles, and it didn't bother me that my weight didn’t change, just surprising I didn't lose weight with all the crazy training I was doing.
When I realized I had gained so much weight (20-25pounds) in 2015-2016, I started counting calories in vs. calories out. I was already running a lot, and gaining weight, which apparently can happen if you are consuming more than you are burning. I have a fitness watch which counts steps, measure heart rate throughout the day, and tells me how many calories it thinks I’ve burned. These watches can be wildly inaccurate, but my “basal” metabolism per day should be 1600, and each mile I run burns around 105-120 calories, so I think it is giving me a pretty good idea of calories burned.
Before “dieting”, I was consuming 2200-2500 calories per day, when I started restricting I brought that down to around 1800-2200 per day, aiming for about 500 more burned than consumed per day. (Usually it would be more like 200 one day, 700 another day, averaging out to around 400ish per day). I lost about 4-5 pounds per month (week to week my weight varies a lot, some weeks no loss, some weeks 3 pounds in one week). I now know just go with the longer overall trend and not worry about week to week fluctuations.
Was losing weight “easy”? Once I had a plan in place and stuck to it the weight came off, consistently, over a long period of time. I made it down to 160 by end of July (19 pounds in 3.5 months), and 155 by end of Septmember, with my shoulder injury briefly slowing down the weight loss.
I also stepped up my running game, made an effort to get both my speed and distance up – so I was definitely doing more exercise than I had before, but I really love running so it wasn’t too hard to push myself to run more – this is not the best solution for everyone – I think my brain is wired differently (my 2 sisters and brother and dad all do distance running – so maybe it’s genetic). Adding an extra 2 miles to my run here and there racks up calories burned, and I made some very minor tweaks to my diet to get the calories down. I started eating oatmeal for breakfast instead of cream of wheat (I know, I have a bizarre diet), started substituting an omelet for lunch some days instead of a normal bagel with cream cheese, and cut way down on snacking throughout the day. I also cut out snacking on cheese entirely because it was too hard for me to figure out how many calories in a piece of cheese I had cut. I tried eating more fruits and vegetables too, because I want to improve my overall health. I don’t eat meat from mammals already, don’t eat fast food (often? Maybe once every 4 months), and try to avoid greasy foods (because it affects my digestive system the next day and is too hard to run! I’m obsessed!). Most days I wasn’t feeling that hungry when I went to sleep, but maybe once I week I would go to bed a little hungry.
As soon as I started having anxiety about my thyroid I stopped calorie counting and am in a “maintain” mode. Trying to keep weight between 145 and 155 until after the surgery. I tend to stop eating completely when I’m feeling anxious, so my weight dipped to 147, it’s back up to 152 and this is a good weight for me.
Mentally prepared for surgery? Yes and no. I think it will sink in that this is really happening after I meet with my surgeon at the end of May. I am trying to “prepare” by keeping my anxiety levels low and continuing to run most days, lift weights, etc. I feel like if the rest of my body is in good shape before the surgery then maybe it will help with the healing afterwards. Right now my anxiety is low, but I tend to stress out about going to the doctor, so going in for surgery I’m sure I will be anxious. I am probably more nervous about taking thyroid hormone and possibility of cancer, but I will handle whatever comes my way!
My aunt heard back from her biopsy – hers is “normal”. (My mom told me, so it is quite likely my aunt said “benign” and my mom just translated that for me :-) ). Her nodule was hypoechoic, with blood vessel infiltration and microcalcifications, I think that one was around 1.8cm – so there is a very good chance your nodule is benign, just keep in mind it needs to be monitored and biopsied if it grows larger
I've had a hard time losing weight, especially when I was feeling the most anxiety and most fatigue symptoms while living in the UK. I somehow managed to train for and run in 3 marathons (one in 2013 and two in 2014) while maintaining a weight of 160-165 pounds (72.6-74.8kg). I was pretty athletic, so a lot of the weight was in muscles, and it didn't bother me that my weight didn’t change, just surprising I didn't lose weight with all the crazy training I was doing.
When I realized I had gained so much weight (20-25pounds) in 2015-2016, I started counting calories in vs. calories out. I was already running a lot, and gaining weight, which apparently can happen if you are consuming more than you are burning. I have a fitness watch which counts steps, measure heart rate throughout the day, and tells me how many calories it thinks I’ve burned. These watches can be wildly inaccurate, but my “basal” metabolism per day should be 1600, and each mile I run burns around 105-120 calories, so I think it is giving me a pretty good idea of calories burned.
Before “dieting”, I was consuming 2200-2500 calories per day, when I started restricting I brought that down to around 1800-2200 per day, aiming for about 500 more burned than consumed per day. (Usually it would be more like 200 one day, 700 another day, averaging out to around 400ish per day). I lost about 4-5 pounds per month (week to week my weight varies a lot, some weeks no loss, some weeks 3 pounds in one week). I now know just go with the longer overall trend and not worry about week to week fluctuations.
Was losing weight “easy”? Once I had a plan in place and stuck to it the weight came off, consistently, over a long period of time. I made it down to 160 by end of July (19 pounds in 3.5 months), and 155 by end of Septmember, with my shoulder injury briefly slowing down the weight loss.
I also stepped up my running game, made an effort to get both my speed and distance up – so I was definitely doing more exercise than I had before, but I really love running so it wasn’t too hard to push myself to run more – this is not the best solution for everyone – I think my brain is wired differently (my 2 sisters and brother and dad all do distance running – so maybe it’s genetic). Adding an extra 2 miles to my run here and there racks up calories burned, and I made some very minor tweaks to my diet to get the calories down. I started eating oatmeal for breakfast instead of cream of wheat (I know, I have a bizarre diet), started substituting an omelet for lunch some days instead of a normal bagel with cream cheese, and cut way down on snacking throughout the day. I also cut out snacking on cheese entirely because it was too hard for me to figure out how many calories in a piece of cheese I had cut. I tried eating more fruits and vegetables too, because I want to improve my overall health. I don’t eat meat from mammals already, don’t eat fast food (often? Maybe once every 4 months), and try to avoid greasy foods (because it affects my digestive system the next day and is too hard to run! I’m obsessed!). Most days I wasn’t feeling that hungry when I went to sleep, but maybe once I week I would go to bed a little hungry.
As soon as I started having anxiety about my thyroid I stopped calorie counting and am in a “maintain” mode. Trying to keep weight between 145 and 155 until after the surgery. I tend to stop eating completely when I’m feeling anxious, so my weight dipped to 147, it’s back up to 152 and this is a good weight for me.
Mentally prepared for surgery? Yes and no. I think it will sink in that this is really happening after I meet with my surgeon at the end of May. I am trying to “prepare” by keeping my anxiety levels low and continuing to run most days, lift weights, etc. I feel like if the rest of my body is in good shape before the surgery then maybe it will help with the healing afterwards. Right now my anxiety is low, but I tend to stress out about going to the doctor, so going in for surgery I’m sure I will be anxious. I am probably more nervous about taking thyroid hormone and possibility of cancer, but I will handle whatever comes my way!
My aunt heard back from her biopsy – hers is “normal”. (My mom told me, so it is quite likely my aunt said “benign” and my mom just translated that for me :-) ). Her nodule was hypoechoic, with blood vessel infiltration and microcalcifications, I think that one was around 1.8cm – so there is a very good chance your nodule is benign, just keep in mind it needs to be monitored and biopsied if it grows larger
Diet and exercise go hand in hand. One without the other doesn’t work especially when you’re making do with a thyroid that is inefficient. I wonder what dietary modifications would work to reduce the size of nodules! I too have joined the gym late last year and have been making the effort to push myself at least 4 times a week – hard to do because I have to travel a long distance for work! It is impressive how dedicated you have been to shedding off extra pounds.
I think once your surgery is done you will almost feel relieved because either way there is a plan of action. Yes it isn’t easy losing a part of your body, I think people who haven’t gone through thyroid issues (including myself years ago) underestimate just how critical this gland is. For us removing the gland is a no-brainer because the anxiety of 6 month scans and the possibility of cancer later on in life is not a risk I want to take. So don’t worry while you can’t help the anxiety once it is out, and still even if it is cancer, it is more than likely to be contained, and you will never have to constantly be cautious. The worst will be over and then your focus will be just on maintaining the right dose of hormone – which in time should settle.
Wonderful news about your aunt – I hope I am lucky enough to get that result too! I got my thyroid antibodies result shows 66, is this high? – Unofficially told by the nurse that it is normal but won’t know more till Thursday when I meet doc. My thyroid is the biggest mystery to me lol. I will be collecting my results on Thursday though so will know more then. Till then all I can do is monitor it!
I think once your surgery is done you will almost feel relieved because either way there is a plan of action. Yes it isn’t easy losing a part of your body, I think people who haven’t gone through thyroid issues (including myself years ago) underestimate just how critical this gland is. For us removing the gland is a no-brainer because the anxiety of 6 month scans and the possibility of cancer later on in life is not a risk I want to take. So don’t worry while you can’t help the anxiety once it is out, and still even if it is cancer, it is more than likely to be contained, and you will never have to constantly be cautious. The worst will be over and then your focus will be just on maintaining the right dose of hormone – which in time should settle.
Wonderful news about your aunt – I hope I am lucky enough to get that result too! I got my thyroid antibodies result shows 66, is this high? – Unofficially told by the nurse that it is normal but won’t know more till Thursday when I meet doc. My thyroid is the biggest mystery to me lol. I will be collecting my results on Thursday though so will know more then. Till then all I can do is monitor it!
Hi Waitandwatch,
I finally got my antibody results and met with my ENT today.
Thyroglobulin antibodies: ranges: less than 0.90 negative, 0.91-1.09 equivocal, greater than 1.10 positive. Mine is 7.98 H (out of range)
Thyroid peroxidase antibodies: ranges: less than or equal to 250 negative, greater than 250 positive. Mine is >1000 H (out of range), so apparently it is off the charts!
I do not know what the H means.
I was planning on just getting the whole thyroid out, but my ENT recommended a lobectomy to remove the suspicious nodule and leave the remaining left nodule and isthmus. I will need ultrasounds every year on the remaining lumpy thyroid, but not biopsies unless the nodules grow significantly. She won't treat my hypothyroidism symptoms unless my hormones go out of range, which is frustrating because I really hate some of hypothyroidism symptoms I have already. Anyway, I think my plan is to just get rid of suspicious nodule and then talk to my PCP about doing a trial low dose hormone treatment to see if it helps with the thyroid symptoms. Also with Hashimoto's, taking hormone may reduce the size of the thyroid/nodules. The one positive of keeping the remaining lobe is that I will not be 100% dependent on thyroid hormone for the rest of my life (I have been struggling with the "zombie apocalypse" scenario of some disaster where hormone is not accessible for some reason...). Will my remaining lobe produce enough hormone? I don't know... I think I'll probably end up "out of range" sooner rather than later unless I can get some help, but first things first we'll make sure I don't have cancer or get treatment for that.
My weight is definitely fluctuating now - I'm not sure if it's because I've stopped keeping track of calories, reduced my amount of running, or if it's just that it's hot here now (my weight went from 152 to 158 in four days) - I'm going to say it's a combination of water weight from hot temps + maybe a little gain from not keeping track ... I'm still running a lot but reduced miles from 265 miles in January to only 180 in May because I am worried overtraining is hurting my thyroid, but I'm not "overeating" and 180 miles is still burning a lot of calories. Who knows what's going on with my weight. 6lbs is not uncommon with monthly weight fluctuations so I'm not going to worry about it too much right now. I think I am lucky that I have always loved long, slow runs independent of using that as a weight loss strategy, and that maybe the running helps combat some of the metabolism issues hypothyroidism causes, since my heart has no choice except to keep pumping blood to the muscles at a high rate while I'm running.
My blood pressure and heart rate at the doctor's office is ridiculous. Today bp was 155/98, heart rate 128 (in office). At home it averages around 106/68, resting heart rates is usually between 55-65 most days. I have white coat syndrome and can't keep it low at the doctor's no matter what I do. But at least anxiety is confined mostly to "test taking" in that I am anxious about the bp test and not necessarily about what the doctor is telling me.
Otherwise, I think I am dealing with this much better now. I wasn't expecting to be told I will just have a lobectomy, but that means no overnight hospital stay. My doctor is very experienced with thyroid surgeries (multiple times a week), and in the unlikely chance it is cancer we can move forward with treatment.
I hope everything is going well with you, I sometimes take a break from MedHelp because sometimes it helps my anxiety, sometimes it makes more anxious to constantly be thinking about my thyroid, but I definitely will be checking in every once in a while and will let you know how the surgery went.
I finally got my antibody results and met with my ENT today.
Thyroglobulin antibodies: ranges: less than 0.90 negative, 0.91-1.09 equivocal, greater than 1.10 positive. Mine is 7.98 H (out of range)
Thyroid peroxidase antibodies: ranges: less than or equal to 250 negative, greater than 250 positive. Mine is >1000 H (out of range), so apparently it is off the charts!
I do not know what the H means.
I was planning on just getting the whole thyroid out, but my ENT recommended a lobectomy to remove the suspicious nodule and leave the remaining left nodule and isthmus. I will need ultrasounds every year on the remaining lumpy thyroid, but not biopsies unless the nodules grow significantly. She won't treat my hypothyroidism symptoms unless my hormones go out of range, which is frustrating because I really hate some of hypothyroidism symptoms I have already. Anyway, I think my plan is to just get rid of suspicious nodule and then talk to my PCP about doing a trial low dose hormone treatment to see if it helps with the thyroid symptoms. Also with Hashimoto's, taking hormone may reduce the size of the thyroid/nodules. The one positive of keeping the remaining lobe is that I will not be 100% dependent on thyroid hormone for the rest of my life (I have been struggling with the "zombie apocalypse" scenario of some disaster where hormone is not accessible for some reason...). Will my remaining lobe produce enough hormone? I don't know... I think I'll probably end up "out of range" sooner rather than later unless I can get some help, but first things first we'll make sure I don't have cancer or get treatment for that.
My weight is definitely fluctuating now - I'm not sure if it's because I've stopped keeping track of calories, reduced my amount of running, or if it's just that it's hot here now (my weight went from 152 to 158 in four days) - I'm going to say it's a combination of water weight from hot temps + maybe a little gain from not keeping track ... I'm still running a lot but reduced miles from 265 miles in January to only 180 in May because I am worried overtraining is hurting my thyroid, but I'm not "overeating" and 180 miles is still burning a lot of calories. Who knows what's going on with my weight. 6lbs is not uncommon with monthly weight fluctuations so I'm not going to worry about it too much right now. I think I am lucky that I have always loved long, slow runs independent of using that as a weight loss strategy, and that maybe the running helps combat some of the metabolism issues hypothyroidism causes, since my heart has no choice except to keep pumping blood to the muscles at a high rate while I'm running.
My blood pressure and heart rate at the doctor's office is ridiculous. Today bp was 155/98, heart rate 128 (in office). At home it averages around 106/68, resting heart rates is usually between 55-65 most days. I have white coat syndrome and can't keep it low at the doctor's no matter what I do. But at least anxiety is confined mostly to "test taking" in that I am anxious about the bp test and not necessarily about what the doctor is telling me.
Otherwise, I think I am dealing with this much better now. I wasn't expecting to be told I will just have a lobectomy, but that means no overnight hospital stay. My doctor is very experienced with thyroid surgeries (multiple times a week), and in the unlikely chance it is cancer we can move forward with treatment.
I hope everything is going well with you, I sometimes take a break from MedHelp because sometimes it helps my anxiety, sometimes it makes more anxious to constantly be thinking about my thyroid, but I definitely will be checking in every once in a while and will let you know how the surgery went.
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You should ask to be tested for Hashimoto's Thyroiditis. That's an autoimmune condition in which antibodies attack the thyroid and eventually destroy it so it can no longer produce the hormones you need.
Cystic nodules are fluid filled and can come and go. The nodule having grown from 6 mm to 7 mm is not a big deal and I doubt you'd even find a doctor willing to do an FNA on that because there's no reason to.
Although solid, hyper-vascular nodules are more likely to be cancer, FNA (biopsy) of nodules less than 1-2 cm is typically not done because it's hard to get enough sample to make a determination as to whether or not cancer is present or not. This is what your endo meant by over-treatment because you will end up "watching and waiting" because the results will most likely be indeterminate.
If you wait 3 months then have another ultrasound to see if the nodule has grown large enough for biopsy you'll have a better chance of getting a good sample the first time and knowing exactly what you're dealing with.
Thyroid cancer doesn't often spread to other parts of the body and is, typically, cured by removing the thyroid.
All of that said, even though you've gotten a second opinion, you should feel free to get additional opinions if you still don't feel comfortable.
To put it all in a different perspective, I have a solid nodule that's 1.1 x 1.0 x 0.8 cm and my doctor refused to even refer me for biopsy... I've had this nodule for almost a year; when/if it reaches 2 cm, which is the American Thyroid Association's criteria for FNA (except in certain situations), my doctor will refer me... because yours is calcified, your doctor should not wait until it reaches 2 cm, but may wait until it reaches 1 cm in order to ensure chances of enough sample during the first FNA so they get a determinate result.
In the meantime, since the ultrasound indicates that you have thyroiditis, have you also been diagnosed with, either hyper or hypothyroidism? Do you take any type of thyroid medication? If so, what medication(s), dosage(s), for how long, etc.
What prompted the ultrasound?
Cystic nodules are fluid filled and can come and go. The nodule having grown from 6 mm to 7 mm is not a big deal and I doubt you'd even find a doctor willing to do an FNA on that because there's no reason to.
Although solid, hyper-vascular nodules are more likely to be cancer, FNA (biopsy) of nodules less than 1-2 cm is typically not done because it's hard to get enough sample to make a determination as to whether or not cancer is present or not. This is what your endo meant by over-treatment because you will end up "watching and waiting" because the results will most likely be indeterminate.
If you wait 3 months then have another ultrasound to see if the nodule has grown large enough for biopsy you'll have a better chance of getting a good sample the first time and knowing exactly what you're dealing with.
Thyroid cancer doesn't often spread to other parts of the body and is, typically, cured by removing the thyroid.
All of that said, even though you've gotten a second opinion, you should feel free to get additional opinions if you still don't feel comfortable.
To put it all in a different perspective, I have a solid nodule that's 1.1 x 1.0 x 0.8 cm and my doctor refused to even refer me for biopsy... I've had this nodule for almost a year; when/if it reaches 2 cm, which is the American Thyroid Association's criteria for FNA (except in certain situations), my doctor will refer me... because yours is calcified, your doctor should not wait until it reaches 2 cm, but may wait until it reaches 1 cm in order to ensure chances of enough sample during the first FNA so they get a determinate result.
In the meantime, since the ultrasound indicates that you have thyroiditis, have you also been diagnosed with, either hyper or hypothyroidism? Do you take any type of thyroid medication? If so, what medication(s), dosage(s), for how long, etc.
What prompted the ultrasound?
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Thanks so much for replying , your advice helps put things into perspective.
I tested TSH levels all normal. This is the baffling part, my thyroid has a mind of its own lol.
The initial ultrasound was prompted by my GP. Thyroid disorders and goitres are common in my family so he was aware of that. Intact I’ve always had a big neck since I was a child but as TSH levels were always normal, no one bothered to do an ultrasound . It’s so hard to wait when I feel like , truth be told , getting rid of this thyroid. The anxiety of tests, biopsy is driving me to a dark place.
Glad your nodule doesn’t seem suspicious! And my doctor confirmed that it is common for 1 cm nodules not to be biopsied in the absence of worrying characteristics .
Hashimotos is what the initial ultrasound suggested and this one too yet TSH levels normal. My mind is jumping to worst case scenario of me waiting and this spreading or me being iodine resistant. Got a nice lecture from doc.
I tested TSH levels all normal. This is the baffling part, my thyroid has a mind of its own lol.
The initial ultrasound was prompted by my GP. Thyroid disorders and goitres are common in my family so he was aware of that. Intact I’ve always had a big neck since I was a child but as TSH levels were always normal, no one bothered to do an ultrasound . It’s so hard to wait when I feel like , truth be told , getting rid of this thyroid. The anxiety of tests, biopsy is driving me to a dark place.
Glad your nodule doesn’t seem suspicious! And my doctor confirmed that it is common for 1 cm nodules not to be biopsied in the absence of worrying characteristics .
Hashimotos is what the initial ultrasound suggested and this one too yet TSH levels normal. My mind is jumping to worst case scenario of me waiting and this spreading or me being iodine resistant. Got a nice lecture from doc.
Ooh and just to add to the info above, the entire thyroid gland is heterogeneous in structure and has several micronodules.
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