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Thyroid (Expert Forum)
Are these tests problamatic?
Answered by
Mark Lupo, M.D. - Thyroid Nodules, Thyroid Cancer, hyperthyroidism, hypothyroidism, Thyroid Ultrasound
Thyroid & Endocrine Center of Florida
Sarasota - FL
Questions in the Thyroid forum are answered by Dr. Mark Lupo. Topics covered include goiter, graves disease, Hashimoto's thyroiditis, hyperthyroid, hypothyroid, thyroid cancers, thyroiditis, and thyroid stimulating hormone (TSH).
Are these tests problamatic?
by clgraham, May 07, 2008 02:08PM
I orginally went to see my Dr. for extreme rib smasms and a cronic cough as well as muscle aches. A CT scan and bloodwork was ordered which resulted in enlarged lymph nodes in the abdomen noted and thyroid nodules, three of them. Also my bloodwork showed elevated liver enzymes. I was referred for an thyroid ultra sound and another abdomen and pelvic CT scan which I have recently completed.
Ultra Sound results:
The right lobe of the thyroid measures 1.8 x 2 x 5.1 cm (AP,TR,CC) The left lobe of the thyroid measures 1.8 x 1.6 x 4.7cm (APxTr x CC) . Both lobes are mildly heterogeneous in its echotexture and mildly enlarged. Several bilateral solid appearing nodules are seen in each thyroid lobe.
On the right these include a 5x4x5 mm hypoechoic nodule in the upper right lobe z 1.4 x 1.1 x 1.5 cm, mildly echogfenic solid nodule in the posterior mid right lobe, a 5 x 6 x 7 mm hypoechoic nodule in the mid right lobe. Small submandibular lymph nodes on the right measures 1.2 cm. On the left there is a o.8 x 1 x1 cm milldly heterogeneous appearing , hypoechoic solid nodule in the posterior upper to mid left lobe and there is an additional 1.5 x 1.6 x 1.7 cm iso- to mildly hyperechoic solid nodule in th inferior left lobe. Vascularity of the thyroid is within normal limits. The isthmus is unremarkable.
No recommendations.
Impression from the newest CT scan
1. Borderline periportal lymph nodes. This lymph node is not pathologic by CT size criteria.
2. No liver or pancreatic abnomalities are noted
No recommendations
I also feel like I have a lump in my throat all the time, nagging cough, and soft tissue inflamation. Some of my blood work showed elevated monocytes and ensophils.
What next? Should I be worried
Ultra Sound results:
The right lobe of the thyroid measures 1.8 x 2 x 5.1 cm (AP,TR,CC) The left lobe of the thyroid measures 1.8 x 1.6 x 4.7cm (APxTr x CC) . Both lobes are mildly heterogeneous in its echotexture and mildly enlarged. Several bilateral solid appearing nodules are seen in each thyroid lobe.
On the right these include a 5x4x5 mm hypoechoic nodule in the upper right lobe z 1.4 x 1.1 x 1.5 cm, mildly echogfenic solid nodule in the posterior mid right lobe, a 5 x 6 x 7 mm hypoechoic nodule in the mid right lobe. Small submandibular lymph nodes on the right measures 1.2 cm. On the left there is a o.8 x 1 x1 cm milldly heterogeneous appearing , hypoechoic solid nodule in the posterior upper to mid left lobe and there is an additional 1.5 x 1.6 x 1.7 cm iso- to mildly hyperechoic solid nodule in th inferior left lobe. Vascularity of the thyroid is within normal limits. The isthmus is unremarkable.
No recommendations.
Impression from the newest CT scan
1. Borderline periportal lymph nodes. This lymph node is not pathologic by CT size criteria.
2. No liver or pancreatic abnomalities are noted
No recommendations
I also feel like I have a lump in my throat all the time, nagging cough, and soft tissue inflamation. Some of my blood work showed elevated monocytes and ensophils.
What next? Should I be worried
Doctor's Answer
by Mark Lupo, M.D., May 08, 2008 06:18AM
, May 08, 2008 06:18AM
Would biopsy the 1.5cm R and the 1.7cm L thyroid nodules.
Check thyroid levels - TSH and T4,T3.
Check thyroid antibodies - TPO and Tg -- the heterogeneity may mean Hashimotos.
Would defer to general surgery or GI for the periportal lymph node enlargement -- the CT report does not seem that concerning, but these need follow-up.
Once that is done, go to an ENT for evaluation of the cough/lump -- may be gastro-esophogeal reflux or other cause -- ENT is usually the best to sort this out.
Check thyroid levels - TSH and T4,T3.
Check thyroid antibodies - TPO and Tg -- the heterogeneity may mean Hashimotos.
Would defer to general surgery or GI for the periportal lymph node enlargement -- the CT report does not seem that concerning, but these need follow-up.
Once that is done, go to an ENT for evaluation of the cough/lump -- may be gastro-esophogeal reflux or other cause -- ENT is usually the best to sort this out.
