New thyroid nodule after no nodules one year ago

[kimmjmc]

I just finished a year of medication treatment (methimazole) for Graves disease diagnosed a year ago and now have TSH and free T4 levels within normal limits.

A year ago I also had a thyroid ultrasound that showed no nodules.  At that my time my RAUI showed a diffusely overactive and enlarged thyroid with no hot or cold spots.

My endocrinologist palpated my neck at my most recent office visit and said she could feel something new, after months of palpating my neck and expressing satisfaction that my goiter was shrinking.  She did another US in her office and said I have a nodule where none existed before, <1 cm.

I am now scheduled for a FNA in her office in a month.  I am a 56 year old female, six years postmenopausal.  From what I've read, only 5% at best of thyroid nodules are found to be malignant.  However, mine seems to have appeared and grown rather suddenly and swiftly with a history of hyperthyroidism and Graves disease.  I have no previous history of cancer and mostly have a benign medical history, other than hypertension that appeared a few years ago.

Should I be extremely worried now?  What are the most pertinent questions I should ask my endocrinologist?  I did have a large goiter before Graves disease treatment.  Could the nodule have been there all along and is just now apparent now that the goiter has decreased in size?

Thank you for an response.

[hemorrhagiccyst938]

Hi Dr. Lupo,

I'm very glad I found this forum.  I am a medical resident myself and was just diagnosed with a moderately large, now recurrent hemorrhagic thyroid cyst.  I had it aspirated twice already but it keeps recurrent.  It is moderately painful at this point as well.  I did some online research and found out that either ethanol or tetracycline hydrochloride are options for treatment in order to avoid surgery.  

2 questions for you: 1. Which would you suggest - the ethanol or tetracycline?
2. Do you know anyone in the Boston area who performs PEI? I have been calling major medical centers and no one seems to do this procedure. Please help!  
Thank you!

[kimmjmc]

Thanks for your reply, Dr. Lupo.

In addition to the 1-123 scan I did have a thyroid ultrasound in my endocrinologist's office last year 10/2012, and she said then the US showed no nodules.  I had the US in her office again this 10/2013, and suddenly there is a <1 cm nodule.

Oh, well, I guess I'll find out soon enough if I really have something worth worrying about.

[Mark Lupo, M.D.]

I-123 scans do not detect all nodules -- US is much better so cannot conclude that there were no nodules last year.  FNA of the nodule seems appropriate.