really scared

I have hashimoto's and I was diagnoses in the summer of 2001. When living in Tx. My endo would do an ultrasound when I went in because I have a nodule on my thyroid. Lately I have been suffering from a hoarse voice and my new endo in our ne state we live in ordered a ultrasound last week. I went and have now been told I need to have  a FNA. Is this usually just to rule cancer out, I guess what I mean is do most people with nodules gwet and FNA? Also, can benign nodules cause hoarseness and feeking of fullness in throat? My thyroid levels were normal when they checked them.

[898]

If nodule is solid, larger then 1 cm, and/or has increased blood flow [vascular], then the biopsy is the next step. If nodule is large enough to be seeing/ palpated it can cause the symptoms, but even the smaller nodules can cause the same issues, if they impir movement of voice box.

[MMKK37]

I just talked to dr. and evidently I have two nodules. So you can have large nodules that cause hoarseness that are benign? I don't have any pain or swollen lymph glands.

[898]

The large benign nodule composed of fibrous [scar-like ]tissue can also cause hoarse voice. What are the sizes and where nodules are located [lobe, ishtmus]?

[MMKK37]

Not sure, I have a call into him now, he di9dn't mention that. I  know I had one before, and now I have two. Should these have shrunk since I am on levoxyl 100 mcg once a day, and have been for years?Is it possible to have large nodules that don't shrink that are benign? I thought the hospital when they called said I had nodules on either side, whatever that means.

[898]

The levoxyl is not effective to shrink the nodules, it can in some cases slow down their growth. the term nodule is used to describe variety of thyroid lesions, made from different tissue, so not all nodules can respond to the hormone treatment. For example that benign cold nodules composed fropmfibrous tissue can grow, and usually cannot shrink.
In longstanding case of chronic autoimmune thyroid inflammation, the nodules can form from thyroid tissue 'debree'. Most likely uo have one nodule in each lobe.
Last but not least during the thyroid inflammation the areas of inflammed tissue can form pseudo-nodules which also loking like nodules on the ultrasound.

[MMKK37]

Thnaks so much for all of the info. The endo. I went to felt the nodule, but didn't say much about it. I am in the process of finding a new Dr., I am just not crazy about this guy.Si if I have a nodule in each lobe is that indicative of cancer?

[d022767]

i had 5 nodules and have been monitoring them for 3 years...had 2 different FNA's done on them 6 months apart. First one was indeterminate and the other benign.  I was put on Levoxyl 50mg daily to see if they would shrink and they were still growing.  So just last week I had a Total Thyroidectomy to rule out cancer and my thyroid was very enlarged.  Everything came back benign.  So that is good news.  FNA is done to rule out cancer.  

[MMKK37]

Thanks so much, I am just so distraught over this and I don't know why. I have four little kids and the thought of anything being wrong with me scares me. I just got nervous because he ordered a ultrasound first and I just don't understand why he didn't go right to the fna. I have been hoarse forever and was concerned that it automatically meant cancer.

[898]

Well, the nodules are tend to grow during pregnancy;also post-partum thyroid inflammation may take place.

[MMKK37]

I had babies in 1995,1998,2000, and 2004. So, 898, people can have nodules with hoarseness and it can be benign is basically what you are saying? Do you think they will biopsy both nodules?

[898]

If both nodules are greater then 1 cm, cold and solid , both of them can be biopsied, if one nodule is small 5 mm [.5 cm], let say, they may do biopsy on the largest nodule

[MMKK37]

If they are benign is there a way to shrink them without surgery?Or keep them from not getting any bigger?

[MMKK37]

OK. I just talked to the doctor, he did not have my chart at home with him, but he told me that the bigger of my two nodules is not very big. He said it is big enought to warrant a biopsy, though. I have been hoarse and feel like a golf ball is stuck in my throat, but he said my nodule is not big enough to cause that. I do have chronic sinutitis so maybe that is the problem with the hoarseness. I am still nervous about the biopsy, just wanted to know others peoples outcomes with FNA?

[Dnmh]

I have a multinodular goiter (6 nodules) with one being "complex and dominant" measuring 1.4cm x 1 cm x .8cm. I had an FNA Apr 07 and it came back Not specific so just had another ultrasound. There is a minor chance that I will have cancer, but even still, the odds are in my favor. Most thyroid nodules are benign. I believe it's less than 5%? And it's been said that if you have to have cancer - thyroid cancer is the one you want. Most are highly treatable with a very positive outcome.

[898]

The alternative ethanol ablation is used for cystic nodules [but not very often]; I know that method was tried for solid nodules too, but with low good outcome [30%, for really small sample group]. The laser ablation was put on trial in February of this year.
Most benign nodules are growing up to 15% on it's largest side in 12 months period
[if it was 10 by 10 mm it will be 11.5 by 11.5 next year]

[MMKK37]

I should get the report in the mail from the scan today. Once I find out the size of each noduel I will post it. Is there any thruth to the fact that if you have more than one nodule that it is less likely cancer? He said I have to with one being bigger than the other, but it is also quite small.

[898]

As far as I know the researchers are dropping this theory now.

[Dnmh]

I have read that in some medical publication. I have also read that some experts are believe that if there is a family history of multinodular goiter it increases the chances of thyroid cancer. Have you heard anything like that?
D.

[898]

No

[lola1973]

Ok, and as far as neck pain with thyroid is it ony indicative of cancer or can it be from beinign nodules? Would the neck pain be in the front or the back of neck?

[Dnmh]

From a brochure from the National Cancer Institute:

"Family history of goiters or colon growths: A
small number of people with a family history of
having goiters (swollen thyroids) with multiple
thyroid nodules are at risk for developing papillary
thyroid cancer. Also, a small number of people with
a family history of having multiple growths on the
inside of the colon or rectum (familial polyposis) are
at risk for developing papillary thyroid cancer."

[MMKK37]

OK. I finally have the size of my nodules. The one on the left is 0.62 cm and the one on the right side is 1.53 cm. Any thoughts on this?

[898]

If these nodules having the simlar composition, the FNA should be done only for the larger one.
Hashomoto's patients are always at higher risk of development nodules, as a "by-product of thyroid destruction"

[MMKK37]

He wrote on the prescription that he is only doing the fna on the larger one. So with hashimoto;s you usually have nodules? Also, he kept saying last night when I talked to him that it isn't that big, is that true? He feels my hoarsness is due to my chronic sinusitis and I also have mild reflux. My hoarseness comes and goes along with the feeling of a lump in my throat which I guess are all indicative of reflux, anxiety, and sinus. Do you feel that a nodule the size of mine would not cause these problems?

[selmaS]

what is done to slow the process?.....will all people with  Hashi's need to have FNA's?...how long is the usual growth process?.....I have no idea on the size of my nodules..only that one greww slightly in  6 months....

if u have nodules should or when should u be on meds?


"selma"

[898]

In order to slow growth of the nodules the destruction of thyroid needs to be stopped, this means the level of antibodies needs to be reduced; so far some patients were able to reduce TPO levels by taking selenium supplement [some researches connected selenium deficiency and iodine EXCESS as trigger factors for hashi's].
The ideal solution is to fight this disease at genetic level, which is not done yet.

[MMKK37]

So does having hashi's with the two nodules put me at a higher risk for cancer? Because one is bigger does that matter? Doctor keeps saying it isn't that big, is this true?

[selmaS]

is there an avg number or is that by lab also on the TPO levels?....what's high ect?

what causes salt cravings?

[Dnmh]

From all I have read, no - having two nodules with Hashi's does not increase the risk of cancer. Also, 898 correct me if I'm wrong, any nodule over 1 cm usually gets an FNA. In those with multiple nodules, there is a less than 5% chance that it could be cancer so they have to check it just in case.
In my case -  from what I've read and mentioned in my post above - my father has a multinodular goiter, so do I. That increases MY personal risk for it being either Pappilary carcinoma or lymphoma.

[MMKK37]

Dnmh,
   What is a multinodular goiter? Is this what I have because I have two nodules? So is 1.53cm really big?

[898]

There is really good article about which nodules should undergo biopsy [in welcome article];solid nodules larger then 1 cm need FNA. \
The upper linit for TPO ab is 35, I believe, most people have them at less then 20.
Multinodular goiter is the term which applied to the thyroid with more then one nodule, EVEN if the gland itself is not enlarged.

[MMKK37]

Ok, so I have a multinodular goiter with hashimotos. So is there a chance that this can be benign, even if the one is bigger than the other?

[Dnmh]

Until you get the FNA, there is no real way of knowing, but yes, having nodules with Hashimoto's means there is at least 95% chance that it's not cancer - remember, lees than 5% are cancerous.

Now I'm going to check out that welcome article and get myself more educated!
D.

[898]

Also the localized inflammed areas commonly found during the thyroiditis, appearing on the ultrasound similar to nodules [thus, they called pseudo-nodules] and commonly confused with real solid nodules; these pseudo nodules can disappear and not palpable compared to the real solid  nodules.

[MMKK37]

My doctor was able to feel the one that I have. Does that mean it is solid?

[Dnmh]

Being palapable doesn't mean it's solid. As 898 mentioned above it could be scarring, it could be a cyst, it could be part solid/part cyst or solid. Did you ever get that copy of your ultrasound report? There are certain characteristics of the different nodules that would be indicated on that report that helps your doctor make the determination to do an FNA.

[MMKK37]

All I got from the Docotor was the script to have it done and the letter telling me there is one on left and one on right. The one on the right is bigger so that is the one they ared oing the biopsy on. It was funny, when I had the ultrasounf the tech afterwards said we will see you when you are due for your next ulttrasound. She didn't act strange at all, I have had ultrasounds for other things when the outcome isn't good and you can read it on the tech's face. My doctor kept saying on the phone that it was small, could they just be doing it because of the size?

[Dnmh]

Yes, it's most likely because of it's size. It is relatively small - if you read through the posts here, you will see that some have much larger ones and even they are benign.
If nothing else remember - less than 5% of nodules are cancer. And for those that are - thyroid cancers are one of the most treatable.
Funny you mention that about the sonographer! I just had my second ultrasound (first one was Mar 07) and I know the tech saw something. First she asked me if I had an overactive thyroid, I told her it was possible Hashimoto's, and a few minutes later she asked "When was your FNA?" We discussed my first ultrasound, the size of my largest nodule, how many I had in March (6) and the FNA being non-specific when I first walked into the room. Just because she asked those questions, I know she saw something. I've had many, many tests and you know when it's nothing or something. I'm trying my hardest to wait the week out before I call the doc's office!

If you're still really concerned, you could ask your doctor what it is about the nodule that made him decide to do an FNA.

[MMKK37]

I am going to pick up mu report from the hospital right now. Check on this in a little while, I will post the report.

[MMKK37]

Ok I have the report and now I am even more nervous. Heres is the info, also I do have Hashimoto's.

The right lobe measures 4.3 x 1.0 x 1.3 cm and the left lobes measures 4.2 x 1.1 x 1.3 cm.
At the inferior aspect of the right lobe is 0.47x 1.34 x 1.53 cm nodule is seen. Color doppler evaluation demonstrates intrinsic flow.
a 0.54 x 0.62 x 0.34 cm hypoechoic nodule is also present in the left lobe. Color doppler evaluation demonstrates intrinisic flow.
IMPRESSION: BILATERAL HYPOECHOIC THYROID NODULES.

[Dnmh]

This one I'm not entirely sure how to answer. 898 and others have more experience in this area.
Sorry I can't be of much help!
D.

[MMKK37]

Thanks, hopefully 898 will be on today:)

[898]

Thyroid lobes are normal size;
hypoechoic means they reflect LESS ultrasound then surrounding tissue.
the  nodules have  internal blood flow detected.
In many cases internal blood flow caused the nodules to be hypoechoic.
due to internal blood flow the larger nodule needs biopsy.
IT MUST be done under US guiding, in order to :
take tissue sample, not the blood
avoid larger blood vessels.
about 50% of benign nodules have internal blood flow

[MMKK37]

They are doing it by ultrasound. Is it a good sign that my thyroid lobes are a normal size? Is there anyway it could be cystic, or is that ruled out? And last but not least, do I have a ok chance of it being benign?

[898]

the ultrasound does not say that nodules are solid, sothey still can be cystic [black on the image screen];
they have a good chance to be benign
normal size of the thyroid does not really matter in this case.

[MMKK37]

Oh, so hypoechoic doesn't mean solid? Is it good that the report didn't mention irregular borders or calcification? The reason I am stressing so  much is that my oldest daugter has many health problems and I have so much on my shoulders with her that this is just scaring me to death. I know worrying doesn't do anything, it is just so difficult not to.

[898]

Absence of calcification is a good sign; the irregular borders can be well recognized on larger nodules [most small nodules have regular borders]

[MMKK37]

Good, I am glad to know the absence of calcification is good. What about the hypoechoic, that doesn't mean solid? Is there ever a chance that when they do the biopsy it turns out to be a cyst and not a hard nodule?

[898]

"hypoechoic" does not mean solid there can be hypoechoic complex cyst as well; it can be indicator of blood flow inside the nodule

[MMKK37]

Ok, so then it is not confirmed what kind of hypoechoic nodule I have ? What different kind could it be?Also, isn't it common to have these kind of nodules with Hashi's?

[898]

If nodule is resulted from necrosis [death tissue] it would also show up as hypoechoic.
The small cystic nodules, full of colloid and small solid nodules full of fibrous tissue are common among Hashi's patients who had the disease for several years.[the whole thyroid looks like Swiss cheese
In your case they probably are hypoecoic due to internal blood flow.

[MMKK37]

What would that mean then?

[898]

That means that such nodules have 80 to 85 % chance to be benign.

[MMKK37]

Thanks so much, I had been reading sights that said 50/50 and I was freaking out. My Dr. said 5% chance of malignancy, it kind of irritates me that he said that.

[898]

Several people here on the forum have calcified irregular nodules which turned out to be benign:). The ultrasound is a diagnostic aid, but not the verdict.

[MMKK37]

One last thing , when reading the measurements, what number means what?

[898]

If you mean the lobe size, these are overall dimensions of each lobe L x W x D of the imaginary “match box” where you can "fit" the lobe [the lobe itself has shape of flattened grape, not really the wing of butterfly]; two dimensions of rectangle where you can fit the largest cross-section of the nodule are given for the nodule size

[MMKK37]

Actually, I meant the measurements of the nodule, is it still the same L X W X D ?

Also on another note, I found an ultrasound report from Oct. 2005,
The right nodule was 7 mm x 12 mm
conversion to cm would be .70 cm x 1.2 cm correct? And now it is .47cm x 1.34 cm, so that isn't too much growth correct?
The left nodule was 6mm x 10 mm and now is .54 cm x .62 cm, that isn't too much growth is it for three years?

[898]

It looks like both nodules are stable [the size variation can be due to the different ultrasound machine [low resolution vs high resolution] but most likely the left nodule may have responded to hormone treatment.

[MMKK37]

Great, so that is a good sign? So are measurements on a nodule l x w x d?

[898]

This is a good sign; the dimensions are length by width

[MMKK37]

What is the third number when the nodule is measured like this  # x # x# , is the last one diameter?

[MMKK37]

Ok, So I had my FNA yesterday an dit really wasn't that bad. Whe the nurse did the ultrasound she said it would be up to the radiologist if he would even do the biopsy because it almost didn't look big enough. The radiologist decided he would go ahead and do it, the nurse had said something about in the transverse it was really small, any thoughts on that? Also I asked the radiologist doing it what they usuallyu extract, and he said typically  alot of blood. Is that normal for blood to be coming out of the nodule, or does that definelty mean cancer?

[898]

Small transverse size means the nodule is almost flat, like washer instead of  ball-like; presence of blood in the sample means the needle just hit the blood vessel and pulled blood along with tissue. At the present time there is no guidelines for determining if the nodule has a cancer just based upon its shape [round versus elongated or "flat"]

[MMKK37]

So blood in the sample doesn't mean anyhting bad necassarily? The radiologist acted like it was totally normal for samples to have blood in them.

[898]

it may just "dilute" the sample, but is not indicator of malignancy.

[MMKK37]

So blood itself is not an indicator of malignancy? Do most samples have blood in them?

[MMKK37]

My Doctor got the results, BENIGN!!! Thanks for everything!!!!!

[redheadaussie]

Hooray for that!