When to look into thyroid surgery?

[Marybell1923]

I had an appointment with an ENT yesterday to discuss FNA of my nodules.  I have 3 total.  I am also have symptoms of compression of my esophagus where I feel like I have something large caught in my throat and feel a strong urge to gag or choke, which will make me nauseous at times as well.  No issues swallowing or breathing though and so far my hormone levels have been stable.  At what point would you discuss removal?  I have days that are better and days that are not great.  I did not get to discuss any of the with this ENT, he was pretty terrible and didn't want to discuss my symptoms; I am in the process of getting in with a different doctor.

[ChitChatNine]

I truly believe in seeing an Endocrinologist before the ENT when it comes to nodules.  They don't do surgery and usually tell it like it is.  I had a few opinions before my surgery for nodules and weighted the Endo's opinion fairly heavy in the mix.  In my case they all agreed I needed surgery.

Please keep us posted . You've received some great advice above.

C~

[Marybell1923]

Thanks!  I will call to get a complete report with sizes of the nodules.  All I had was just a note indicating there were three, two in my right lobe, one on the left with calcification and he suggested FNA of the left and one of the right.  I am on levithyroixine, 75mg.  I got my dose increased 6 weeks ago to see if we could increase my FT4 some.  No blood test yet to see where I'm at.  

I had asked the ENT about the gagging symptoms (he had not even asked about symptoms I was having and was about the end the appointment, and was already pretty lacking in bedside manner throughout the appointment, he spent more time looking at my deviated nasal septum when he looked in my nose which was not why I was there), and asked at what point do they do surgery.  He flew off the handle about it like I was just there looking for surgery and pretty much berated me, when I really wanted to know what could be done to manage the symptoms and what the prognosis was if this was benign, where this would go.  I gave up and left and won't be back to him.

[Barb135]

If your levels are being kept constant, are you currently on a thyroid replacement medication?  If so, which one and what dosage?

I find it hard to believe that size of the nodules were not listed on the ultrasound report... you should contact the lab that did the ultra sound and ask for a complete report that includes the sizes and characteristics of the nodules; you wouldn't be having an FNA if the nodules weren't large enough to get good samples from (typically, more than 1+ cm).  Calcification is usually not good, but doesn't necessarily mean cancer, either... less than 5% of all thyroid nodules turn out to be cancer, so that's a positive.

My first choking feeling was caused by swelling/inflammation of my thyroid, but after that went down, once I was on medication, I had it again and it did turn out to be caused by anxiety that I had no idea I  had... it took some real soul searching to realize what it was.  I was in a work situation that I couldn't control, plus a personal situation I had not control over, even though I thought I did... both were causing a lot more anxiety than I ever dreamed possible.  Once I faced the issues, I did ask my doctor for anti-anxiety med, which I took for a couple of years.  After I retired, the work situation resolved and a year later a beloved family member I'd been caring for passed away and I was able to get off my anxiety med... I thought I had it all under control, but it doesn't work the way we think it should... go figure... lol

All of that said, your FT4 is pretty low in the range - only 27%, when the recommended level for FT4 is mid range (50%); you're falling quite short.  Hashimoto's does destroy thyroid function, so meds have to be increased to keep up with that destruction.  That could account for the choking feeling, even if the ultrasound shows no constriction.

What did the ENT blow up in your face about?  He had no right to do that and it's good that you're getting an FNA to rule out malignancy...

Please keep us posted...

[Marybell1923]

As for my nodules, one of them is showing calcification, but I am getting an FNA next week of them to rule out malignancy.  

[Marybell1923]

I don't have a recent T3, my T4 is 1.07 (0.8-1.8)  I am trying to get it up around 1.5 as that is when I am the most symptom free. TSH is 0.55 (0.4-4.0).  These are the levels they have essentially been kept at for years with no issues, but I do have Hashimoto's.  I don't know the sizes of the nodules, the sizes were not given with the ultrasound results.  Good to know that the feeling can resolve.  I am fairly sure it's not anxiety related, however.    I tried to talk to the ENT yesterday but he blew up in my face about it rather than talk to me about the symptoms and how they could be managed.

[Barb135]

How large are the nodules and did the ultrasound actually show something compressing your esophagus?  Many of us have that choking feeling when our thyroid gland is swollen/inflamed, but if there's not actual compression that's affecting swallowing or breathing, there's usually no need to have they thyroid removed.  Many of us also have nodules and most of them are nothing to worry about, unless they are very large or have unusual characteristics.

What are your actual thyroid hormone levels?  Please post them, with reference ranges, which vary from lab to lab and have to come from your own report.  Even though they're within normal ranges, they may not be adequate for you.  Often once hormone levels are adequate, swelling/inflammation will be reduced and that choking/gagging feeling will go away.

It's important to note that anxiety can also cause the choking feeling.  Anxiety can be present even if we don't "feel" anxious...