What Does Ultra Sound Results Mean?

[babs1953]

Dear Doctor, My GP found a lump on my thyroid and had an ultra sound done.

RESULTS:
FINDINGS:  Isthmus appears heterogeneously dense and measures 0.7 cm, slight enlarged. Right lobe is heterogeneous enlarged measureing 5.4 x 3.2 x 2.4 cm with multiple areas of irregular echotexture, one is slightly lobulated and measures 1.1 x 1.5 x 1.4 cm. Increased color flow in the right lobe is incidentally demonstrated.  Left lobe is smaller, difficult to visualize and measures 2.3 x 1.0 x 0.9 cm. No focus of abnormal color flow on the left is seen.

IMPRESSION : 1). Previous left thyroid resection questioned with asymmetry of the thyroid.
                        2). Nodular change right lobe with increased vascular flow. Correlation with a nuclear image might be some benefit.

My blood test for TSH has been anywheres from 46.84 to 31. and rising. GP did not test the Free T3 or Free T4. I have an appt. with a surgeon today and will be getting an appt. with an Endo, as well.  I have NEVER had surgery on my thyroid. Thirty years ago I did have a nodule (benign according to FNA) on the left thyroid lobe  and took synthroid for all those years.   What happened to the left side of my thyroid?  Also, with the "INCREASED VASCULAR FLOW", does that mean that the nodule may be cancerous?  Will I need surgery or should I if I am advised to have surgery?  Thank you for your expertise and advice...........

[Mark Lupo, M.D.]

This is Hashimoto's with Hypothryoidism.  The elevated TSH is stimulating the thyroid to try to make thyroid hormone, but the immune system has destroyed the normal thyroid -- so the enlargement is due to inflammation and growth due to high TSH.  This also commonly gives increased blood flow (due to TSH stimulation).  The right lobe is often larger than the left, so would not worry about that.

The "nodule" is likely an area of increased inflammation - we call this a pseudonodule.  However, there may be a slight increased risk of cancer in Hashimoto's, so close ultrasound follow-up is important to recheck this area and determine if FNA biopsy is needed.  Usually with levothyroxine treatment, the thyroid size (and often nodule size) will decrease.

[babs1953]

Hi! I went to the surgeon and during exam he could NOT feel a nodule. He said that he was going to order a FNA with Ultra Sound. Surgeon did not feel it was really any problem considering my past with the left nodule being benign.  He just wanted to be on the safe side. Well, I went to a different and larger city hospital for the biopsy and the Ultra Sound tech stated they saw NO nodule and NO increased blood flow on the right thyroid lobe.  The thyroid gland was lobulated and lumpy and the tech's words were, "ugly".  But, no nodule.  The Radiologist looked at the results and also stated there was no nodule to take any cells from so the biopsy was cancelled.  That was okay with me, but the question I have is why such a difference from the previous Ultra Sound (the one mentioned in the above message) and the one from today?  And, nothing has yet been determined what is causing the TSH numbers to be so high and out of whack and the Hypo symptoms.  Today's Ultra Sound also showed the left thyroid gland to be very small, hardly to be seen.  I have a call into an Endo and am waiting to set up an appointment.  I've been on medicine (Synthroid, Levothroid and Thyroxine) for many years. The last three years 3 different doctors have played around with trying to  adjust the meds and still the thyroid is not working right.  Getting pretty darn impatient with this whole thing and in the mean time I keep gaining more weight and feeling like ****.  Now what?  Thank you for your time.