multinodular goiter with calcification

[doggiedoc]

Help. I have been experienceing problems with an enlargement of my left thyroid. I have started a work-up with a family practice, but have questions. I am a veterinarian, so i have done alot of research on my own and am trying to make this process quick and efficient.  I have had extreme fatigue, swelling hands and feet, dry skin and brittle hair for approx 3-4 months. I have gained 28 lbs in 3 months also.  I am experiencing difficulty swallowing and gagging/choking on food. I wake up at night feeling like I cannot breathe and my voice has changed. I battle a sore throat...it comes and goes.  My tsh and t4 levels last week were normal (0.95 and 3.12 respectively). My doctor says my fatigue, etc must be caused by something else. My thyroid ultrasound showed a tiny cyst and a few tiny nodule (under 5mm) in the right thyroid, which is not palpably enlarged. My left thyroid shows 2 large nodule (approx 3cm each), one of which also has calcification. There are also several smaller nodules varying from a few mm to 1cm.  He wants me to have an uptake scan to rule out malignancey, and if the nodules appear "hot", that means it is bening and since my hormone levels are normal, there would be no treatment. He is not the one with the big lump in his neck which is quite uncomfortable!  I just want to have the left side removed whether it is malignant or not because it hurts and is causing all the afore-mentioned problems.  Why can't I just have the surgery, then they can biopsy it after it is out for a definitve diagnosis. I have read in multiple medical sites that an uptake scan cannot determine malignance for sure and that hot, cold, and warm nodules can be malignant although the percentage of malignancy is quite low. Some sources say that calcification and poorly-defined nodules (which is the case with all of mine) is more suggestive of malignancy.  Should I have it surgically treated? If not, how can it be "shrunk" if hormone repacement is not warranted? Please help!!

[Mark Lupo, M.D.]

Scan/uptake is not indicated in this work up.  The TSH and T4 are normal -- so thyroid hormone imbalance is not the issue (or cause of symptoms).  The nodules need biopsy -- usually FNA biopsy then consideration for surgery.  But if benign and not causing compressive symptoms (which it seems like you do have some compressive symptoms), would usually watch.  With the symptoms, though, surgery may be indicated.  However, we usually like to FNA biopsy first as if it is cancer, then the extent of surgery changes...

Thyroid hormone suppression treatment is no longer recommended to try to shrink nodules.  It usually does not work and is often associate with hyperthyroidism which increases the risk of heart rhythm problems and bone loss.

Now, if you meant the TSH is 3.12 and the FT4 0.95, then this may be a very early (mild) hypothyroidism, and if the antibodies are positive (ie, hashimoto's) a trial of levothyroxine may be of benefit.

[TracyBeth]

Oh my goodness-I just posted my question and you said it much better as to how I feel!  I too have normal TSH and the pain and discomfort is even more tiring than the fatigue!  After the thyroid specialist told me it was not cancer than it is no longer his problem to go back to my general doc, I was at a loss!

I had thyroid cancer in 2000 and they removed the right lobe and it has grown back!!!  But there is no sign of cancer, just the pain, discomfort, and SWOLLEN NECK!