if it's not hashis, then what is it? and lymph nodes

[mtkst13]

history:  35 female, diagnosed with thyroiditis when i was 29.  presented as hyper.  slightly positive antithyroglobulin, negative antitpo.  went extremely hypo and was on meds for about 3 years.  i've had normal thyroid function since.  i get ultrasounds done yearly because i've had "nodules" or "psuedonodules"...not really sure which.  

i had ultrasound a few weeks ago.  tech wouldn't measure any discrete nodules.  she said there's too many and that the gland is just heterogeneous.  looked like little holes to me.  i asked her if she thought it was hashis, and she said no because hashis usually has more blood flow, and my thyroid didn't have a lot of blood flow.  so, if it's not hashis, what could cause the heterogeneous gland?  another process?  diet?  i haven't had antibody profile done since i was 29.  should i have it done again, or is it insignificant?

also, i have a left supraclavicular lymph node that's 2 x .5 x .7 cm and another level 4 node that's 1.1 x .6 x .7 cm.  endo referred me to ent.  i'm very concerned because i've google left supra node, and malignancy rate is very very high in that area...especially with that size.  statistics don't look good for me... :(  could that be thyroid-related?

thanks,

[Mark Lupo, M.D.]

while the US overall is c/w hashi, that does not exlcude the possibility of a suspicious nodule blended in with the inflammatory changes. If there is an ENT or endocrinologist in the area who is experienced doing his/her own US, that may be best choice for thyroid and LN assessment.

[Mark Lupo, M.D.]

The thyroid changes are classic hashimoto's - increased or decreased or normal blood flow can be seen in Hashi.

The lymph nodes (LN) are tough to comment on w/o seeing the US images - it is not uncommon to have normal, prominent reactive lymph nodes adjacent to an inflamed hashi thyroid.  

Stability compared to prior CT is good.  US is better than CT for LN characteristics.

ENT will likely suggest monitoring vs antibiotics vs biopsy (some argue surgical removal over FNA, but we usually do FNA first of a LN that is worrisome).

[mtkst13]

well, i have an ent appointment soon.  guess i'll find out soon enough.  any suggestions?

[mtkst13]

also, the lymph nodes have been there for awhile...i had a ct in august that showed the same nodes at about the same size.  they haven't gotten smaller.