Does No Growth Of Nodules Mean Less Likely To Be Cancer?

[fanofthefab4]

Dear Dr.Lupo,


Is it true that when you have a normal TSH with nodules they are more likely to be cancer. I would really appreciate your expert input on what my recent 9 month follow up ultrasound  done on the same exact machine for the first time for 3 small nodules found by accident in 10/06 describes. It says,

Impression: Three stable thyroid nodules,as described below,none of which meet the SRU criteria for biopsy. History:43 year old female with thyroid nodules. Comment Ultrasound examination of the thyroid was performed.Comparison is made to the prior study performed on 7/25/07. The thyroid is homogeneous in backround echotexture with normal vascularity. The right lobe measures 1.0 x 1.3 x 4.1 cm. There is a stable,non-hypervasular,mixed solid and cystic nodule within the posterior mid right lobe which measures 0 .5 x 0 .7 x 0.7 cm,previously measuring 0.5 x 0.7 x 0.7 cm.


The left lobe measures 1.3 x 1.3 x 4.5 cm. There is a stable,predominately solid, non-hypervasular  nodule  within the posterior  left  upper pole which measures  0.8 x 0.9 x 1.0 cm,previously measuring  0.7 x 0.9 x 1.0 cm.  The isthmus measures 3 mm in maximal AP diameter. There is a stable non-hypervascular  mixed solid and cystic hypoechoic nodule within the left inferior isthmus which measures 0.3 x 0.6 x 0.6 cm,previously 0.3 x 0.6 x 0.7 cm.

My nodules are round and Dr.Hoff keeps insisting that round shape having higher % of cancer is outdated,but I keep finding recent  medical studies including a major January 2006 Task Force on Thyroid Nodules by The AACE that still mention it,and they aren't updating their guidelines until 2009!  I saw you even told a poster on here who had thyroid cancer that came back,that their oblong nodule is an unusual shape for thyroid cancer,you said they tend to be rounded!  Also there is no mention of any halos around my nodules,and I know that absent halo is found in the majority of thyroid cancers!

[Mark Lupo, M.D.]

This thread has been long and complicated for a fairly simple question.  Although there is not one right answer, what I would do is talk to a thyroid expert who does his/her own ultrasound and consider FNA of any nodule >8mm that looks suspicious.  If none, then consider FNA of the largest nodule for peace of mind and continue to follow along with ultrasound.  Nodule shape is not necessarily suspicious -- most benign nodules are round.  The concept of "taller than wide" being suspicous is debated, but useful in looking at nodules

[fanofthefab4]

My 3 small nodules were found in October 2006,because I asked my internist for an ultrasound  because even though my  thyroid blood tests have always been normal, I had  gained weight at age 34 and had to go on a diet for the first time in my life,and I had always been thin eating almost anything I wanted without any excercise and I went on a diet again at age 38 and lost 20 pounds. But even though I only eat  2 low fat low calorie meals a day and  only drink diet drinks, and even when I  took long walks  4 times a week, for over a year while doing all of this I could only get down to a size 12! My internist said that most peo-le's meatoblism slows down as they get older,but it started when I was only 34 and I'm not old now!
April report that
So I asked for the thyroid ultrasound because I thought that maybe even though my thyroid blood tests were always normal, my very slow metabolism was a combination of  getting older and  my thyroid might not be functioning 100% and is a little off.


I  also know though that  the most common types of thyroid cancers grow very slowly and Ellen Brightly from the former Thyroid Association of America  sent me an article  called,Thyroid Nodules and Thyroid Cancer An Epidemic from their newsletter Summer 2006, by Dr.Douglas S.Ross Co-director of Thyroid Associates Massachusetts General Hospital. And he also says there has been a real increase in finding small papillary cancers by accident from ultrasound & other  imaging tests and that this has resulted in a 2-fold  increase in the # of thyroid cancers detected in women each year.He also says that the true natural history of these small cancers is uncertain  and that they only know about the 2% or less that come to clinical attention.


Dr.Ross also says that in Japan more than 200 people with micro papillary cancer over 60% didn't grow in 4 years!  And a woman on this board had an 8mm that took 8 years to get to 16mm and a thyroid cancer survivor from thyca told me that in 1990 she had a test for a problem with her neck arteries  and then 7 years later at age 48 she had  a  5cm nodule that the doctors told her for several months looked benign and when she had it out it was papillary cancer! She said she went back and read her old medical records, she found out that when she had the artery test,they made a little footnote on the bottom of the page about a half a cm thyroid nodule they never told her about. She told me that 99% of thyroid cancer is found by accident.

  Also 2 radiologists from University of Maryland wrote in Apllied Radiology Journal online March 2007, that halos are frequent in benign nodules,they are absent in over 50% of them and present in 20% of cancer. And one of nodules is predominately solid and I know that they and solid have a higher % of cancer, and that many recommend a biopsy on them even when they are smaller than  the usual recommended size for biopsy.


I have read quite a few posts by women who had no suspicious,worrisome features on ultrasound and yet they still had small thyroid cancer!  And I have read countless posts by people on this board and other thyroid health boards who say they have thyroid nodules and they are really worried they could be cancer,but they are trying to  be optimistic because they were told that thyroid nodules are very common and 90% are benign,and then I click on their follow up posts from a few months later and it turns out they did have thyroid cancer! I have found 7 women who had 3 nodules like me who had thyroid cancer, one on this board who had  3  cancerous nodules smaller than mine, only 3mm,4mm and 5mm! And I have read quite a few posts from people who had aggressive 3mm,or 5mm and 1 cm in their lymph nodes!


The American Association Of Clinical Endocrinologists Task Force On Thyroid Nodules said as Dr.Ernest Mazzaferri  and others report that many small papillary cancers can be just as aggressive as larger ones,and some can take an aggressive course and they say thats why early diagnoses and treatment is important. The National Cancer Institute had a special report on their web site in Febuary and March about the increase in finding these small papillary cancers by accident by ultrasound and other imaging tests. And The Loos Angeles Times wrote in their MD section last month about the Canadian Cancer Society's April report that breast and lung cancer has decreased in women but more women are getting thyroid cancer.