Ultrasound result interpretation

[aguna]

When I suddenly realized a swelling in the front of my neck, I visited the doctors who did several standard tests including the blood thyroid tests.  All result were normal including thyroid levels, and a sonogram was performed.
The sonography shows the right lobe to measure 73 x 27 x 31 mm and the left to measure 71 x 20 x 16 mm.  There are multiple cofluent nodules expanding the lower pole of the right lobe.  There is a more discrete nodule a the posterior aspect of the right lobe measuring up to 25 mm, with a nodule more anteriorly measuring up to 22 mm.  Towards the upper pole of the right lobe, there is a more hyperechoic nodule measuring up to 10 to 11 mm.  There is a generally hyperechoic nodule at the lower pole of the left lobe measuring up to 18 mm in diameter with a nodule with a hypoechoic interior in the midpole of the left lobe measuring up to 14 mm.
In summary, in addition to the slight swelling that i had noticed, there appear to be at least five significant nodules of which three have hypoechoic characteristics.  
Does anybody have comments regarding the above and suggestions for questions I might ask during my planned followup. I have no family history of thyroid cancer and have had no issues with swallowing etc.  

[898]

Thanks for sharing the good news; the well encapsulated cysts can be treated with PEI injection; the benign nodules less then 1 cm are not usually treated; the new laser ablation method is undergoing the trial, however I haven't read about success rate or when it would be introduced.

[aguna]

All results from the FNA biopsy tests came back benign. No sample withdrawn tested as either malignant or even "suspicious", but the endocrinologist is recommending surgery to remove all the nodules (the ultrasound report above seems to indicate a total of six or seven in both lobes combined), although I have not experienced any difficulties from the multinodal goiter. He indicates that surgery minimizes any future potential for the nodules to expand or cause other challenges. Are there no other alternatives for a case like mine such as medication, drainage, or other options. Welcome your comments regarding this item and any speculations that you or others would have regarding the extent of this surgery and any side-effects and required followup.Thanks.
- Aguna.

[aguna]

Thanks for reply.

[898]

The pain can be due to tenderness after analgetics wearing out [similar to 'post-dentist' pain]

[aguna]

The doctor did an additional set of ultrasounds and used this mark locations and performed 6 aspirations after 6 novocaine painkiller injections.  The extractions involved two extraction each from two locations on the right side and from one on the left side. I understand my endocronologist will call me when they are ready to discuss results. How long does this typically take?
Subsequent to the extractions, swallowing and laughing is somewhat painful.

[898]

hypoechoic palpable nodule is probably solid

[utahmomma]

Another test that would be helpful would be an uptake scan where you are given a small amount of radiated iodine to see if the nodules absorb it and, if so, in what amounts.  This test will tell if the nodules are "hot" (overproducing thyroid hormones), "warm" (producing normal amounts of hormone) or "cold" (not made up of thyroid tissue and producing no hormones).  Cold nodules are very suspicious.

Here's an overview of the test and information about the FNA:    http://www.endocrineweb.com/fna.html

Utahmomma
papillary carcinoma

[aguna]

How long does it typically take to receive results from the FNA analysis? I have read that the analysis actually takes less than 30 minutes - assume it would take longer for me to receive the results?
Are there any other questions that I should be asking my doctor during the FNA testing to understand more re the situation?  I was told that one of my nodules with hypoechoic character is palpable. Does that have any specific implications?

[aguna]

Thank-you also for the suggestion.  I am now scheduled for an FNA and the endocrinologist intends to focus on one of the hypoechoic nodules in the left lobe. I am also glad to have gone promptly to the doc - looking back at photos taken in the last couple of months, I do notice the slight swelling in some of them.

How long does

[aguna]

Thanks for your suggestion. I am scheduled for an FNA later this week.

[ChitChatNine]

I'm with 898, I'd get an FNA on the largest at the very least.  Glad you noted the swelling and went to the Dr.

WELCOME TO THE COMMUNITY~!

C~

[898]

The largest nodules will need to undergo biopsy; usually when nodules are forming in enlarged thyroid gland they are most likely to be benign.
The report does not specify if the nodules are solid or cystic as this will determine follow up procedure [aspiration/ PEI injection for cysts] or observation/surgery for solid nodules