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Thyroid Cancer / Nodules & Hyperthyroidism Forum
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Complex cystic and solid nodle - cancer?

27 year old female with enlarged thyroid gland. Discovered in March, 2012. As soon as I found the lump, I scheduled an appointment with my dr, had blood tests ordered and an ultrasound. My blood test came back showing I am hypERthyroid with TSH being 0.17.

ultrasound found:
Bilateral thyroid nodules. The largest nodule by far is seen on the left side occupying most of the inferior lobe. This is a complex cystic and solid nodule which is more than 50% cystic, but contains several sizable solid components within it. Dimensions of lesion are 4.4 x 2.2 x 3.0 cm.
The right lobe, small solid nodules are identified, including one in the inferior aspect which measures 1.0 x 0.7 x 0.7 cm, and a smaller solid nodule in the mid right lobe measuring 0.7 x 0.5 cm.

I was then sent to an ENT and had a fine needle biopsy, but it wasn't ultrasound guided. The results were non-diagnostic.

I then went to the endocrinologist (where I should've gone in the 1st place) recommended surgery because of its size. But since the endo wasn't concerned that it was cancer, I didn't want to jump into having surgery, and wait it out and monitor it for a little while. The endo put me on 5mg of methimazole, 5 times a week. I just had my follow up visit with the endo a couple weeks ago. Had another ultrasound, and another round of blood tests.

This round of blood tests showed my hyperthyroid levels are stable and under control. I can even reduce my medication to 4 times a week now. The ultrasound showed my thyroid as stable. However, they ordered another biopsy, this time an ultrasound guided biopsy, of the >4cm complex cystic and solid nodule of left lobe. I go next week to have this done.

I guess what it all comes down to is, should I be worried? Because I'm FREAKING out.
1 Responses
97953 tn?1440865392
MEDICAL PROFESSIONAL
This is a large nodule and needs evaluation.  However, you did not mention an I-123 scan which is usually part of the work-up for nodules in the setting of low TSH to see if this large nodule is "hot" and causing the mild hyperthyroidism (TSH was only slightly low). Hot nodules are seldom malignant and we often do not do FNA unless there is something suspicious about the history or ultrasound appearance.  Cannot do a scan on methimazole - would stop this for at least a week in this case if your doctor decides to order a scan.
For large nodules that are not "hot" there is some concern about false negative FNA rates -- if the US is very benign appearing, one satisfactory benign FNA would suffice, but if there are any suspicious features, I usually like to document 2 benign FNAs if we are not planning surgery (ie, patient has no symptoms and prefers to observe w/o surgery).
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