Answer to question

[Mucka]

I did have a biopsy.  It came back benign with folllicular cells. My doctor is still suspicious and states he just doesn't like the appearance.  Psammoma-like calcification came from an u/s and with the radiologist remarking that on ultrasonic grounds, it is high suspicion for malignancy.  The photopenic area came from the uptake scan which did show uptake in the nodule with absolutely no uptake with the rest of the thyroid. The small photopenic area was just below this nodule.   I did have a CT with contrast also not two weeks before this.  Sx is in three weeks.

[Mucka]

The endo surgeon I am seeing is experienced and is cheif of surgery of this particular major hospital.  He is my second opinion.  I had to travel off Island to see him.  My first was an ENT surgeon, who said I had acute thryoiditis which I obviously don't.  My endo surg is going to only do a partial thyroidectomy in hopes that my right side starts producing again.  The nodule is quite large 5.2x4x3.7 and it is quite visible.  My TSH is suppressed. The scan suggested this :  distribution of the radiopharmaceutical demonstrates a large amount of increased uptaek of the radiopharmaceutical in the region of the left lboe of the thyroid gland generally, with a rather poor/no trapping of the radiopharmaceutical in the right hemithyroid.  Distribution of hte radiopharmaceutical in the left hemithyroid does demonstrate inhomogeneous distribution with a tiny photopenic area long its inferior lateral aspect of the left hemithyroid.  This is an abnormal appearance.  This corresponds to the large nodule as previously noted on utlrasound examination.  24 hr uptake just above upper limits of normal at 28%.  The ultrasound, other than what I have already stated says ....multiple small foci of psammamatous calcification noted throughout the nodule.that there is defined margins c with adjacent adenopathy. Multiple small foci of psammamatous calcification noted throughout the nodule.

Anything else you can add would be greatful!  Sx is coming soon!!

Thanks, again!

ps: I think we need to nominate you for a show on Oprah!!!!

[Mucka]

The endo surgeon I am seeing is experienced and is cheif of surgery of this particular major hospital.  He is my second opinion.  I had to travel off Island to see him.  My first was an ENT surgeon, who said I had acute thryoiditis which I obviously don't.  My endo surg is going to only do a partial thyroidectomy in hopes that my right side starts producing again.  The nodule is quite large 5.2x4x3.7 and it is quite visible.  My TSH is suppressed. The scan suggested this :  distribution of the radiopharmaceutical demonstrates a large amount of increased uptaek of the radiopharmaceutical in the region of the left lboe of the thyroid gland generally, with a rather poor/no trapping of the radiopharmaceutical in the right hemithyroid.  Distribution of hte radiopharmaceutical in the left hemithyroid does demonstrate inhomogeneous distribution with a tiny photopenic area long its inferior lateral aspect of the left hemithyroid.  This is an abnormal appearance.  This corresponds to the large nodule as previously noted on utlrasound examination.  24 hr uptake just above upper limits of normal at 28%.  The ultrasound, other than what I have already stated says ....multiple small foci of psammamatous calcification noted throughout the nodule.that there is defined margins c with adjacent adenopathy. Multiple small foci of psammamatous calcification noted throughout the nodule.

Anything else you can add would be greatful!  Sx is coming soon!!

Thanks, again!

ps: I think we need to nominate you for a show on Oprah!!!!

[Mark Lupo, M.D.]

Sounds like this could be a hot nodule suppressing the uptake by the remaining thyroid.  Even with the recent contrast exposure, the nodule showed uptake -- underscoring that it is over-functioning.  Would look at the TSH -- if low, then this is all consistent with a functioning nodule that has a very low risk of cancer.  Also confirm that the scan does indeed correlate to the nodule on ultrasound.  If so, then the chance of cancer is low and would consider a second opinion before going on to surgery.  It is important to have an experienced endocrinologist do the ultrasound him/herself.  Also consider a repeat FNA or at least send the slides off for a second opinion.  While surgery is the only way to be 100% certain about the nature of the nodule, there is a chance that this is a low risk situation that can be safely observed.