High TSH w/Hypoechoic Nodule

[percycute]

I'm a 30 y/o female w/no known family history of thyroid problems.  I went to have a routine physical done at my new PCP who also ordered  a blood panel.  It was found that my TSH levels were 5.58.  The doctor also said she felt a nodule.  The ultrasound was done earlier this week and just received the results today. My doctor ordered a Nuclear Scan to be done before she will discuss the findings with me.  I'm pretty concerned with the results, though. If you can help me understand them better, it would be greatly appreciated! What are the chances of Malignancy?  Btw, I don't have any symptoms & feel relatively healthy, for the most part!  Thanks!

ULTRASOUND FINDINGS:
The right thyroid lobe is 3.1 x 1.6 x 1.8 cm. There appears to be a subtle hypoechoic rounded nodule in the mid thyroid lobe with increased peripheral vascularity measuring 1 cm x 7.6 mm x 2.7 mm. The isthmus is 3.1 mm. The left lobe is 3 x 0.98 x 1.6 cm with a normal appearance.

INTERPRETATION:
1 cm hypoechoic rounded mid right thyroid nodule with increased peripheral vascularity. Nuclear medicine scan may provide helpful additional evaluation if clinically indicated. Consider biopsy.

[Mark Lupo, M.D.]

The nuclear scan will not likely add much to the situation.  With a TSH of 5.5, this nodule is not over functioning.  Also, a 1 cm nodule is not likely to be seen on nuclear imaging.  Most of these can be monitored over time, with this history, consider TPO antibody testing for Hashimoto's.  The chance of malignancy for a nodule like this is  5-10%.

[percycute]

So, I just received the Ultrasound CD today...and what do you know?  There was a typo error on the measurements in the Report printout...the nodule is actually 1cm x 7.6mm x 8.7mm.  

I have a biopsy scheduled for the 12th, same day results.  Though, the endocrinologist who will be performing it works at a Cancer Treatment Facility and specializes in thyroid disorders.  Do you think this is the best option regarding choosing my Endo or should I look for one at a private practice?  

[percycute]

Thank you very much for the response, Dr. Lupo.

Would you suggest that I request a FNA Biopsy rather than having the Nuclear Scan?  What may/may not be the benefit of such scan?  Are there adverse risks involved in this test?

Additionally, along with the Antibody test, would you recommend any other blood testing?  So far, I have only had my TSH levels checks.  I already have an order for another TSH w/Reflex T-4, free that my Doctor placed prior to my Ultrasound.  Would you consider that sufficient?

I am not currently taking any Thyroid medication, though with my last TSH level of 5.58, I'm trying to understand why I am not experiencing any symptoms.  Might there be a specific reason for this, such as early hypothyroidism?

I'd also like to point out some additional details.  My husband and daughter both ended up getting H1N1 in November, (there was an outbreak of it in our city, as well as my daughter's school, during this time).  Though, I didn't develop as severe symptoms as they had, mine were much more "mild," a sore throat, mild fever, diarrhea, as well as a couple days of vomiting/nausea.  

In December, my daughter and I developed a severe sore throat, our throats had red spots on it as well as the roof of the mouth.  Our tonsils also swelled up & had large white "spots."  I never found out what it was, though I suspect a Strep/Staph Infection (?)?  

Though, I did receive an antibiotic shot (Keflex) & a prescription for Flagyl.  The following day, I had severe burning sensations of my shoulders, neck, & head, it was hot to the touch as if I was sunburned, though my temperature was normal.  My hands and feet began to sweat profusely, my joints hurt, & I felt extremely cold.  Doctor told me it was just a adverse reaction and to discontinue the Flagyl.  A few days after, it felt as if there was a lump stuck in my throat and I had difficulty swallowing even water.  

I went back to the doctor regarding these symptoms who told me it was most likely dysphagia due to "Anxiety."  Didn't order a scan or blood test.  Didn't even check for any swelling of nodes.  Then, the front of my neck felt very sore & bruised, as if it had been punched, and pain when I moved it/trouble bending my neck.  It took nearly 2 months for all of these symptoms to subside.  I lost 10 lbs during this time, which I've since gained back approximately a pound a month (my normal weight is 110lbs at 5'5" & I'm currently 107lbs).  I'm wondering if there is any relation between these previous incidents and my current situation?  I can't help but wonder with the timing and all.

Thanks!

[percycute]

I agree, my PCP seems to be not so keen in regards to thyroid problems, she just happened to be the one to find it, fortunately...I asked her why the need for a Nuclear Scan & she said, "because the Ultrasound Interpretation recommended it."  When I've tried to ask her questions, she says I would benefit more from looking it up in the Internet.  :(

You're not the first one to suggest that a Nuclear Scan is not needed, is there specific reasons why it would or wouldn't be necessary?  

It also seems like the nodule, itself, is a strange shape...being 1cm in length & only 2mm in height.  I've been told that a biopsy may be difficult because of this.  Do you happen to know what this may suggest, along w/the blood surrounding it?  Could it possibly be in the process of shrinking?

I've also been told elsewhere that the blood surrounding a nodule is usually a sign of it being benign & that the "subtle hypoechoic" characteristic could be an error since it's such an odd shape.  Is this accurate?  & is it also a good sign that it has rounded rather than irregular bordered?

Though, I've read that "blood flow" is a characteristic of malignancy.  When they state this, are they referring to blood flow inside of the nodule rather than surrounding blood flow?  Or would blood flow of either type be a characteristic of malignancy?

Also, my father has a history of multiple skin limpomas.  He's 75, but has been getting them for the majority of his life.  They'll grow on his neck, torso, & arms.  He currently has a rather large one on the back of his neck that's been growing in size.  I have found them on myself, as well, and have a history of ovarian cysts.  Could this somehow be related, or is that completely off-topic?

I apologize for bombarding you with so many questions, just trying to better understand the complex nature of the thyroid & nodules in hopes that you, or another user, can help shed some light.  I'm pretty much in the dark about this until I can find a doctor who's more knowledgable. :(

Thanks!

[Karli143]

You should see an endocrinologist for further testing. Nuclear scans are not used much as they used to be.