Thyroid Problem and Breast Problem

[mommy2two2008]

Hi Dr. Lupo.  I have posted here before with goiter/heterogeneous thyroid.  I have a 4 month onset of thyroid swelling and normal blood work.  I take the smallest dose of thyroid medication now to see if that could make the thyroid stop swelling and it has not.  I had a US and CT and the US shows heterogeneous thyroid upper limit of normal in size, larger on the right.  The CT revealed the same thing.  Neither test revealed any nodules or suspicious areas.  That was in April. My swelling is every day now - pics in my profile.

7/16- I had a Diagnostic Mammo due to pain in both breasts that is only better with the arrival of my cycle.  Below are the findings and I am concerned.  I am 30 and my dad died of lung cancer when he was 45.  My question is really, do you know if the problems (breast and thyroid) can be related or aggrivated by the other?  I am really freaked out.

Bilateral Diagnostic Mammogram and Right Breast US Dated 7/16/08:

Clinical Histroy of Episodic Bilateral Breast Tenderness with the Patient's Menstrual Cycle.  The patient report breast paind has decreased since her initial physician visit.

Findings:

Bilaterial mammogram deminstrates extremely dense breast tissue.  There is asymmetrically dense breast tissue in the 12:00 o'clock position of the breast.  No spiculated masses, architectural distortion or clustered pleomorphic microcalcifications are identified.

Sonography of the 12:00 o'clock position of the right breast demonstrates and 8 x 7 x 3 MM cyst and a well circumscribed lobular 12 x 5 x 11 MM solid nodule.  

Final Assessment:

Probably Benign, BI RADS 3.

Recommendation:

Follow-up right sided mammogram and ultrasound in six months.  Asymmetric breast tissue is noted in the 12:00 o'clock position of the right breast.  Sonographically there is a solid nodule which is thought likely to represent a fibroadenoma and a small breast cyst.

I would appreciate any thoughts you may have on this.  Thanks!

[Mark Lupo, M.D.]

The thyroid enlargement is likely due to Hashimoto's thyroiditis (causes heterogeneous appearance on US) - it may not decrease in size w/ meds but the med may help prevent further increase. Would ask that TPO antibodies be tested to confirm.  The breast issue is most likely independent from the thyroid problem and followup of the R breast nodules is important - as recommended by your doctor.

[mommy2two2008]

Thanks Dr. Lupo you provide a great service.  In April my TPO antibodies were <10 with a range of <35.  I guess my question on that would be is it likely that I would have hashi without antibodies?  Alternatively, is it possible that I was developing Hashi and have the antibodies now?  My docs have not re-run the antibodies tests.  Also, they did not run the Tgab, can you have a neg TPO and a positive Tgab and have Hashi?  My ENT diagnosed carotidynia in June, with a separate thyroid thing happening, he was just unsure of the thyroid problem at that point.  I have a followup with him on 7/30 and would like to know your suggestion on which labs I should request.

Again, thank you for your insight.  I have a surgeon appointment tomorrow to discuss the mammo films and options.  I think I will just request that it be taken out and biopsied for safety.  I have a very strong cancer rate in my family.

So appreciative!  ~Kim

[Jules77733]

From what I've heard (I think AR-10 said this in one of his posts), it is possible, but highly unlikely, to have positive TgAb and neg TPOAb. Mine are borderline positive, so I've been wondering myself if they should be checked again anytime soon to see if they've increased.

My thyroid's doing the same thing as yours, though...so it seems. I'm having an MRI done in a few hours and getting bloodwork back from the pituitary panel I had done on Thursday or Friday--I'll keep you posted!

Does breast cancer run in your family at all? This might be a dumb question to ask since you probably would've pointed it out already...but I figured I'd ask anyway. What about other cancers besides lung cancer?

[mommy2two2008]

Breast cancer is in my family, again on my father's side, but it has only taken a tole on my father's aunts, which would be "great aunts" for me.  Breast cancer has touched 2 of his 3 aunts.  One is a surviver, the other, not so lucky.  She died when I was 13.

[Mark Lupo, M.D.]

It is possible to have neg Tg and TPO and still have hashi and I have many patients with pos Tg and neg TPO.

[mommy2two2008]

Thanks again Dr. Lupo!  BTW - I am having a lumpectomy on Thursday for the other issues listed above.  Surgeon said he doesn't chance it when larger than a CM (I actually think he said sonometer??  But mine is just over the cusp.) with a history of familial cancer.  I am thankful, at least they are moving quickly on one ailment.  I haven't had much success with doctors of late, but I so far like my ENT.  Hopefully he can help me with my thyroid.

[mommy2two2008]

Dr. Lupo - I saw my ent today and he said he thinks he feels a nodule now, along with increasing thyroid size.  How worried should I be about this given all of the above?  I have a tingling lip thing going on and so he ordered a calcium panel along with TSH, FT3 & FT4, TPOab and TGab.

Thanks so much!  ~KIM