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Thyroid Nodule-Hyper-Are these my only options?

Dear Dr Lupo,

I am a 42 yr old female diagnosed in May 2010 with hyperthyroidism and a dominant nodule on the rt side.  the physicians notes mention that my abnormal thyroid funtion studies give reason to consider toxic adenoma versus toxic multinodular goiter.  

my ultrasound results were:

Isthmus 0.35 cm
Rt lobe replaced by dominant nodule
Lt lobe 4.33 cm by 1.73 cm by 1.60 cm
Rt nodule 3.34 cm by 2.47 cm by 4.35 cm
Mixed echogeneity, cystic components, negative color doppler flow, negative calcification

My lab results were:

TSH 0.10
T3 Free 3.3
T4 Free 1.0

I have very mild symptoms of edema, very recent loss of my mentral cycle and some very recent pain in my neck.
The doctor I saw quickly scheduled me for RAI which I later declined and also mentioned surgery to remove the rt lobe if RAI was unsuccessful.

My questions are:

Are RAI or surgery my only options?  The word "radioactive" really sends up a redflag for me and I have read where other people have wished they had not done this and advised against it.  Is RAI really safe long term?

On the Cleveland clinic website they mention Alcohol Ablation and you mentioned a few years ago that trials did not go well so it wasn't being done in the US.  Has that changed if it is listed on the Cleveland Clinic website?

Any insight or suggestions would be greatly appreciated.
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97953 tn?1440868992
Alcohol (ethanol) ablation is not a proven treatment for an overactive nodule.  The studies in Italy have not been compelling as many patients have needed repeated ethanol injections.

First, need to prove this is a "hot" nodule -- would do an I-123 scan.  If this confirms a hot nodule, then treatment options are surgery or I-131 and most would recommend I-131 to avoid the surgical risk.  

At age 42, a TSH of 0.1 does not absolutely mandate treatment, but if this is a hot nodule, it will become increasingly hyperthyroid with time and require treatment.
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180749 tn?1443598832
September 27, 2010
This is an alternative for your thyroid issues. All this works gradually, so do not give up before 6 months, and report here when you start to feel the benefit.
Thyroid pressure point – press (50 times) the fleshy bit on palm between  the base of thumb and wrist on both hands. You will feel pain when you press.

Build up your timing gradually. If you feel tired or dizzy, stop and resume after 1 minute.
Kapalbhati pranayam-(Do it before eating) Push air forcefully out through the nose about once per second. Stomach will itself go in(contract in). The breathing in(through the nose) will happen automatically. Establish a rhythm and do for 15 to 30 minutes twice a day. Not for pregnant women. Seriously ill people do it gently.
Children under 15 years – do for 5 to 10 minutes.  

Ujjayi Pranayam : While breathing in, tighten throat(contract glotis) and there will be sound from back of throat, then drop chin(rest chin on chest), hold breath for abour 4 seconds.Then  chin up, close right nostril and slowly breath out through left nostril.
Duration: 5 – 21 times

Ujjayi pranayam detailed:
First exhale fully through the nose.
During inhalation your glottis should remain partially closed. Glottis is the opening between the vocal chords.While inhaling, produce a sound as if you are sobbing, by partially closing the glottis.(This is reverse of clearing your throat, where your are exhaling).
The face muscles should not be contracted during inhalation. Abdominal muscles should be well controlled. Inhale smoothly and uniformly.
After deep inhalation, retain your breath as long as possible. While retaining breath do Jalandhara bandh (lock your chin, touch your chin with your chest).Initially, try to retain breath for 2 to  5 seconds. Gradually increase the time of retention of breath.
After retaining breath, first open the Jalandhar bandh(chin up) and then, close right nostril and exhale slowly through left nostril. The glottis should all along remain partially closed.This is one set of ujjayi.
Do this for 5 to 21 times everyday.

Thyroid exercises
1 Neck exercise for thyroid.
Breathe in slowly while turning your head to the left, pause and hold breath for 3 seconds,
Breathe out slowly while  bringing the head back to middle position,pause for 3 seconds,
Breathe in slowly while turning your head to the right, pause and hold breath for 3 seconds,
Breathe out slowly while bringing the head back to middle position.
Do this exercise 5 times.
Repeat this 5 times, with the head going up and back, and then head going down.

2 Neck exercise for thyroid
Stand on your knees with hands folded across your chest,
Lean backwards with the head falling back while breathing in, hold breath for 3 seconds,
come back to straight position, while breathing out.
Repeat this 5 times.

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