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393685 tn?1425816122

FNA unsuccessful/ thyroid nodule

Good Morning

A short background on my thyroid disorder. 2003 Dx/Graves - 2004 RAI - present Hypothyroid (subclinical 3.34) medically induced. Taking Armour meds since Oct 2007.  Feb 2008 I requested an ultra sound due to "feeling of something stuck in throat" this sensation has been going on since the RAI in 2004.  In the past have I expressed this with 2 endos- GI - ENT and many MD's.

Recently in Oct 2007 I made a switch to another MD and he ordered the US per my asking.

Results/ Findings : on Feb 2007 US -  The right lobe measures 2.2c1.0c0.9cm It has mildly heterogeneous echo texture and margins are indistinct. There is an increase cascularity associated with it . Left lobe measures 3.4x1.6x0.9 cm In lower left pole well circumscribed oval isoechoic nodule 11x10x8 . Mildly increased vascularity. Remainder of left lobe /mildly hetergeneous echo texture. Isthmus appears quite atrophic.  There does not apprear to be a mass effect by the thyroid or the left thyroid nodule upon adjacent strictures.

Impression : Decreased size of the thyroid due to RAI or thyroiditis. Solidary 1cc solid nodule in the lower pole. It's isoechoic echo texture suggests beign lesion, but amenable to US-guided FNA if desired.

Attempt an FNA - March 3- could not sample tissue

Findings: An attempt was made at location with US guided neddle biopsy but due to the deep location and size I was unsure if the needle tip was in the lesion itself. (this report just goes on on how he could not obtain a sample after 7 agonizing tries.)  He does note at the bottom that "Note is made that the lesion may represent a parathyroid adenoma."

We'll the hyperparathyroid situation is not an issue and I had all the appropriate tests VitD, serum and ionized calcium, phosphorus, PTH all coming back normal. Suggestions from radiologist report Three to six month follow up suggested ( for what? another US or anotheer FNA?)

During the FNA procedure they radiologist and the US tech urged me not to have the procedure due to the their thoughts of the parathyroid issue. it was the most tramatic biopsy anyone could have had and took over 30 mintues to finally stop trying. I was bruised from adam's apple to left collarbone and the pain during the attempt was unbelievable.  I almost fainted at the procedure. Literally sweated right through my garments.

From the US reports - what are your feelings about the nodule itself?
Should I be "overly concerned this is cancer by what the first US report says?
Due to the deep lesion and an attempt made with no sucess - should surgery be optional instead of a second FNA?
Do you feel my thyroid may still be working on it own along with the meds?

I am totally scared to go through this again with what happened during the first FNA. Due to the swelling I felt I couldn't breathe right for two days. and the panic of facing that again is unbearable for me. I suggested a seditive or "twighlight" IF another FNA was needed and was told this is not an option.

I am so unsure who to listen to- I have so many doctors and none of them are on the same page.

MD is not concerned on the findings of the original report.
ENT says I am a greater risk of it being cancer due to RAI - from the first report.
Radiologist states parathyroidism / do not advise another attempt-  (he even went as far to say - quote: "If you were my sister - this procedure would have never been done!" that freaked me out!!
Endo says nothing except repeat biopsy in 4 weeks and quit being anxious. ( not a very personable doctor)

What would you suggest?

5 Responses
291531 tn?1193614293
The nodule is not very big and the description does not give many characteristics usually associated with malignancies HOWEVER that does not specifically mean it is 100% surely benign. I doubt that this little nodule is the cause of your symptoms besides the feeling of something stuck in your throat, and assuming that your thyroid tests are in the optimal range. Based on the difficulties with sampling, most endocrinologists would suggest doing another US in 3-6 months to see if the size or characteristics of the nodule change. If they do, then a repeat biopsy or removal should be considered(in your case, you may want to see if an ENT can do this with minimally invasive endoscopic surgery, which is certainly gentler on you than full scale thyroid surgery). Then you will have the nodule gone, and have the pathology to tell you for sure if this was malignant or not.
The easiest way to find out if your own thyroid is still functioning is to slowly decrease your dose of replacement thyroid and see if your own gland kicks in on its own.

I think that while you decide which way to go regarding the nodule, you  should consider speaking with a rheumatologist or neurologist about your other symptoms to see if another cause can be found.

Take care.
393685 tn?1425816122
I have made a typo on the year the first ultra sound was done it was  February 2008 not 2007 - my apologies.
393685 tn?1425816122
Also the US from the FNA stated by the radiologist that:

the nodule was posterior to the lower left bed adjacent to the cortide artery.

Could this nodule be the cause of my constant mild achey headache (only left side), slight dizzyness, inflammation/stiffness of left back of neck and left chest/arm pit achey pain. I have had these symptoms for 2 yrs constantly and every physician I have seen have no explaination.
393685 tn?1425816122
Thank you for your suggestion - I was considering your thoughts on the wait and see approach very strongly - I have just had so many opinions - my head was absolutely spinning with which way to go. I have an MD appointment April 10. I will discuss this with him. Thank you also for giving me hope in the minimally invasive endo surgery, I didn't know that could be an option here. I have read about it and found it very interesting.

Do you know where I may obtain information on this type of treatment/surgery? I live in Wisconsin and have Froedert University Hospitol - I am very close to the Chicago University Hospitol also. Or an endo that may be able to follow this protocol?

Thank you
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