Endo or ENT based on initial findings?

[6kidsandcounting]

I've never posted on a board before but would love to have a professional opinion on whether I should be scheduling a visit with an endo doc or an ENT?  I had an ultrasound at the request of my GYN and the report has the following findings:

The left thyroid lobe measures 6.0 x 2.8 x 2.1 cm.  In the inferior pole there is a heterogeneous complex hypervascular nodule measuring 4.8 x 3.5 x 2.0 cm.  The isthmus measures 4 mm without focal lesions.

The right thyroid lobe measures 3.7 x 1.6 x 1.3 cm.  In the superior pole there is a 9 x 8 x 6 mm heterogeneously hypochoic nodule with associated vascularity.  In the mid pole there is a 1.1 x 1.0 x .7 cm additional heterogeneous hypoechoic complex nodule with associated vascularity.

I'm not worrying unnecessarily because we don't have any more info than this and obviously trying to diagnose with just this would be silly.  I have labs scheduled tomorrow so should know more on that end in a few days.  My question at this point is if an ENT or an Endo is the best place to start.  The little research I've done makes me think this nodule in the left is rather large and I suspect will warrant a biopsy no matter how the blood tests come back.  My GYN suggested an ENT but their office says I could see an endo first or come to them first.  Wondering if, based on these results, I'd be wasting my time starting with an ENT since I've heard they don't usually do a biopsy.  Any thoughts would be appreciated!  Thank you.

[Mark Lupo, M.D.]

Important thing is to start with a specialist who can do his/her on ultrasound and ultrasound-guided biopsy in the office and has a lot of experience in dealing with nodular thyroid.  This is either an ENT, endocrinologist or endocrine surgeon.  In this case the individual person is probably more important than the specialty.

[6kidsandcounting]

Hi Dr. Lupo,

I'm still waiting for an FNA on my almost 5 cm. nodule on one lobe and then I have the two smaller nodules on the other.  The FNA is scheduled for the 8th.  I just discovered yesterday that I'm pregnant.  Only a few weeks pregnant so obviously it doesn't relate to the ultrasound diagnosis from a few weeks ago, but I'm wondering how this could affect the outcome of my situation.  Given the size of the nodule, is it likely they would consider just "watching" it (assuming it's not suspicious) or will it require removal due to it's size?  The other question is how confident can I be in knowing they'll get an adequate sample since it's so large?  Prior to the pregnancy factor, I assumed if they couldn't get an adequate sample, they would recommend removal and the decision would be easy.  I'm hoping the pregnancy doesn't complicate things - if that's possible!  :)  Thanks for your thoughts.

[6kidsandcounting]

Thank you for the advice.  I spoke with both the ENT and the Endo offices today and they both agreed that the Endo would be the best place to start because these biopsies are his specialty.  I'm scheduled for a consultation and (potential) biopsy just after the new year.  This doctor came highly referred by the ENT as well as a couple of people in our community.  I may end up back in the ENT's office in the end but getting the proper diagnosis is important.  Thank you so much for taking the time to respond. It means a lot to hear from a doctor.  I'm trying to stick to facts and not internet hype!  My labs came back and everything was within normal range.  TSH was on the high end of the spectrum at 3.890 but the normal range was .450-4.50.  Makes me wonder how the heck a nodule can grow to almost 5 cm. when the thyroid functions appear "normal!"???