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are thyroid nodules usually benign
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are thyroid nodules usually benign

watching this forum and I see thyroid nodules are common and usually not a concern. Are nodules that have grown and have micro calcification usually benign as well?  Waiting to have a biopsy next week.  My thyroid is normal size but have just started taking meds for possible Hashimotes with a TSH level of 10.7
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Avatar_m_tn
Yes Most thyroid nodules are benign, I don't know enough about calcified nodules to give an opinion, but I am sure others will respond, but nodules are pretty common. I do have Hashimoto's but have never had nodules and my right side was 2.5 X the normal size, although it went back down when I had another ultrasound 21/2 years after the first one. I had a TSH of 12.5 then and now I am at 0.055 on Armour Thyroid. Best Regards FTB4
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649848_tn?1357751184
http://www.ncbi.nlm.nih.gov/pubmed/12112538

"Calcification within the thyroid gland may occur in both benign and malignant thyroid disease, and its detection on ultrasonography is frequently dismissed by many clinicians as an incidental finding of little significance. As a tertiary referral center, most of our thyroid patients will have had thyroid ultrasonography before being referred to us, and in our experience, the incidence of malignancy in a thyroid nodule containing calcification seems to be higher than that in the average thyroid nodule. To assess this risk, we conducted this retrospective review.

When calcification is noted within a solitary thyroid nodule, the risk of malignancy is very high. Surgery should be recommended regardless of the result of fine-needle aspiration cytologic findings."

Just remember, calcification can be found in both benign and malignant nodules.  It may depend on the amount of calcification.

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Avatar_n_tn
Thanks from everything I hear my nodule should be biopsied as the radiologist suggested and then my doctor said lets wait so it was confusing.  I got a copy of the radiologist report and went back to my dr and and asked for referral for biopsy.  The report said the nodule is small but has grown and has micro calcification and ill-defined margins.  Also it said something about inferior lymph nodes. Does that make sense?  Is there any questions I should ask the doctors when I go.  I just started taking levo .50. don't know if its the med but I feel a little anxious and dizzy. My TSH was only 10.7 which doesn't seem very high compared to what I've seen on this site
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Avatar_n_tn
Even if turns out to be thyroid cancer I'm under the impression it's not to big a deal because it is so slow growing  does it ever spread to other areas
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649848_tn?1357751184
A nodule with "ill-defined" margins is suspicious, and should definitely be biopsied; however, if it's too small, they won't be able to get a good sample.  I think most of the time, they wait until the nodule is 1.5-2.0 cm. Your report should say how large it is.

If you were started out on 50 mcg levo, that may be too high a starting dose and could be causing the anxiety and dizziness.  It's always best to start at a very low dose and work up slowly, in order to avoid adverse reaction.  

A TSH of 10.7 is high enough to warrant replacement medication, but your doctor needs, also, to be testing Free T3 and Free T4, along with it, as those are the actual thyroid hormones; whereas TSH is a pituitary hormone and should only be used as an indicator of a thyroid condition.  It should not be used as the sole criteria for diagnosis/dosing.

You should also get tested for thyroid antibodies to determine if you  have Hashimoto's Thyroiditis.  The tests you need for that are TPOab and TGab and you need them both, not just one.

You should ask your doctor to test the FT3 and FT4 and if he refuses, you might have to find a different one, as this one will most likely keep you ill.

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649848_tn?1357751184
We were typing at the same time, so I didn't see your second post until I posted mine.

"Even if turns out to be thyroid cancer I'm under the impression it's not to big a deal because it is so slow growing  does it ever spread to other areas "

No, that's not true.  Any type of cancer needs to be taken very seriously, and not all thyroid cancers are slow growing.  It's also not true that thyroid cancer doesn't spread to other areas.

The "good" part of thyroid cancer, if there ever would be a good part, is that it's the most curable cancer there is.  Typically, the thyroid is removed and the cancer with it; sometimes, RAI is the chosen option.  Either treatment will leave you hypo and dependent on replacement medication for life, but you're already on that, so that won't change.
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Avatar_n_tn
I just had regular physical and that's when the TSH levels were discovered so I don't think those other tests you mentioned are included. I think I'm going to try and find a new dr in that I had to push for both the ultrasound ...( my gastrologist  is the one who found a nodule about a year ago ...  I have Barrett ) and my dr forgot to order the glucose test.  I have been pretty lucky so far thoracic surgery for lesions in stomach and esophagus and everything is good now.  Hope to go to and endo next year.  Can levo make your skin itch?  I was thinking about cutting my pill in half.
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649848_tn?1357751184
Once TSH was found to be high, the other tests should have been done.  I had a doctor who tried to control my levels based only on TSH and I, truly, thought he was going to kill me.

Barrett is caused by GERD; GERD is often a symptom of hypothyroidism, so I'd have to wonder if you've been slightly hypo for a long time.  Symptoms often show up before blood work indicates an issue.

Levo doesn't cause the itchy skin.  That's caused from being hypo.
How long have you been on the medication?  It takes at least 4-6 weeks for the medication to reach full potential in your blood and it's not unusual to have new or worsened symptoms once medication is started, because your body has to get used to having the hormones again.

You could try cutting your pill in 1/2 for a few days, just to let your body get more used to it and see if your anxiety and dizziness go away, but you will remain hypo.  You should discuss that with your doctor, first, because it's never a good idea to self-medicate.
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Avatar_n_tn
Thanks so much for your input. I guess it was GERDs on steroids. I had a bad dr back then too he was treating me for sinus infection even when I was vomiting night and day after a year being on mega antibiotics I switched drs. After trying to keep me from vomiting without meds he sent me to a surgeon who sent me to a thoracic surgeon. Turns out the sphincter that most people have a problem with cause it doesn't close properly .... Mind was actually dissolving. He said it is more a genetic thing. I had a hysterectomy when I was 21. Another bad doctor. Now I try to research everything as much as possible so I am so grateful for these type of forums and people like yourself that seem so knowledgable  
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649848_tn?1357751184
I know what you mean about GERD on steroids....... lol       I had it for years, but fortunately, my ENT got me to an endo to get my thyroid straightened out, before I ended up with Barrett.  I was on aciphex for years to keep the acid under control, and even still, I'd wake up, sometimes, in the night choking on it.

You're right, most/many of us with GERD have a malfunctioning sphincter - I do too.

Sounds like you've been through the mill.  I had a hysterectomy, too, but not as young as you.  Always a good idea to research things and with the internet, today, it's so much easier.

How long have you been on your dose of levo?
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Avatar_n_tn
I've been on levo for about two weeks. If I still have the issue thar may be related to dosage ill ask the surgeon who's doing the biopsy Wednesday if I could adjust it..  I'm not feeling confident in my .dr to give me accurate info.  Did you say you had your thyroid removed?    Just curious if it comes to that for me is it a hospital stay or out patient same question if they just need to remove nodule. And how long are you out of work if there is no lifting?  I thought if anything I was having more sugar regulation problems ..... so  this has kind of caught me off guard. I think I may be obsessing its just I have had so many close calls hysterectomy, severely dsyplastic nevi (father had melanoma, mother ovarian cancer) the thoracic thing, gallbladder, and now this.  And every time I had to push the doctors to do the proper tests or biopsy.  
Know what you mean about the waking up in the night choking .... When the surgeon did his endoscopy he was more afraid of me efixiating and there was already damage to bottom of the lung then when he got into the surgery he said it was good I let him do surgery because of the precancerous lesions .
So in a lot of ways I have been lucky and except for these type of th Inge I am pretty healthy.  Did you take hormone therapy ... I didn't   Do have adrenal issues like I see some people have on this site. .
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Avatar_n_tn
I forgot.  Is there any good questions I should ask or things I should be aware of.  It is one nodule about. The size of a pea.  I think the report said even though the thyroid was in normal size there was some vascular something and  something else  indicative of  hashimoto thyroid   I left the report at my office so I am going from memory.  You probably know what that all means
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649848_tn?1357751184
I haven't had my thyroid removed, but I do have Hashimoto's and multiple nodules.   While my thyroid has been destroyed by the antibodies, we do have members who have had removal.  My ENT discussed it with me and it's my understanding that it would be an outpatient surgery.  I'm not sure of the time required time off work, though; that would be one of the questions to ask your doctor/surgeon.

Vascularity means there's blood flow to the nodule. Inflammation would indicate Hashimoto's Thyroiditis.  Sounds like you might have both.

If you've only been on the levo for 2 weeks, it hasn't had time to reach full potential in your blood - that takes 4-6 weeks, minimum but can actually take longer for everything to stabilize.

Quite frankly, if you can't get your doctor to do the FT3/FT4 and antibody tests, I suggested above, I don't much faith in him/her either.  This is not a time that you should be struggling with someone who doesn't know what they are doing.

I don't know where you're located, but we do have a list of patient recommended doctors; we might be able to help you find someone appropriate; if we don't have a doctor in your area, we can give you some tips on "pre-interviewing" some doctors, in order to make a more informed choice.
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Avatar_n_tn
Thanks   I live in Central New York one hour from Syracuse. Guess I ll just wait and see what the biopsy says. The surgeons office already set up the follow up for the 31st. Maybe it's just a plain old nodule and I just stay on meds for awhile.  Curious if you have several nodules isn't your thyroid getting bigger and uncomfortable?  What's the advantage of keeping it?
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649848_tn?1357751184
We have one doctor on Long Island, the other in NYC; if either of those would be options, I'll send them to you via PM.

Since you have things set up for now, maybe that's your best bet, but do make sure you get a doctor who test the "essentials".  Some doctors are "trainable", so talk to your current doctor; ask for the tests, and explain the importance.  If he/she still refuses, look elsewhere.

"Maybe it's just a plain old nodule and I just stay on meds for awhile".  It may be a plain old nodule, but since you have Hashimoto's, you will be on replacement med for life, anyway because as the antibodies destroy the thyroid, it will produce less and less hormones and you'll have to replace them with medication. .

"Curious if you have several nodules isn't your thyroid getting bigger and uncomfortable?"  My nodules aren't growing, so, no, for the most part my thyroid isn't getting bigger and bigger, though when I had bouts of thyroiditis (inflammation) it did swell and sometimes, I'd get a choking feeling, but that doesn't happen very often any more, because the antibodies have destroyed it and there's no more healthy tissue for them to "chomp on".  I know, I make it sound like a bunch of little "pac mans" running around in there chomping down, but sometimes, that's easiest to understand.

" What's the advantage of keeping it?"  There is none, but, since it's already "dead" (no healthy tissue, so it no longer produces hormones), there's no advantage to having it removed, either.  My thyroid no longer does anything; it's just "there" and I'm totally dependent on the replacement medication now.  I will need it for life, as will you, eventually, whether your thyroid is removed or not, because if it's not removed the antibodies will destroy it, just like mine and a whole lot of other folks on here.

In some ways, it's easier once the thyroid is destroyed/removed, because you don't have to worry about whether it's making hormones, too, so with a decent doctor, it's not that hard to regulate the med.
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Avatar_n_tn
Long Island is about six hours away.  Will wait to see what info further test provide. Hopefully will find a new dr and or endocrinologist.  Thanks again for all your input and have great night
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649848_tn?1357751184
Sorry we don't have a good doctor in your area.  You can pre-interview doctors, usually, via a nurse, prior to making an appointment - saves your time, and theirs.

Questions to ask are, whether or not they routinely test Free T3 and Free T4, along with TSH, whether or not, they are willing to treat with a T3 medication, (whether it be synthetic or desiccated), and whether or not they treat based on symptoms, not just labs...... those are the main ones, and if the answer to any of those is no, then you probably want to keep looking.  
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Avatar_n_tn
I was able to see my biopsy report that says I do have papillary carcinoma with oncocytic /hurtle cell features.  Don't know what that means. I go to the drs in two weeks. Thanks for all your input  I know I'll be watching this site as I go through this journey.  
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649848_tn?1357751184
I'm sorry to hear this.  I'm sure you know that Papillary Carcinoma is a type of thyroid cancer.  It's one of the most common.  Your doctor will tell you what the next step, in your treatment, will be; most likely thyroidectomy.  

Please do be sure to keep in touch, here; we'll do everything we can to help you through your journey.  I'll, for sure, look for a post after you see your doctor in 2 weeks, but if you need to "talk", don't hesitate to post here or send me a PM.
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