Three Thyroid Nodules, one with rim calcification

[tamrakat]

Hi All,

I'm new here and very scared. Three weeks ago I found a small lump on my thyroid. Here is the ultrasound report from last week:

"Impression: The right lobe of the thyroid measures 4.5 x  1.3 x 1.3 cm.  The left lobe measures 4.5 x 1.5 x 1.5 cm.  The thyroid is diffusely heterogeneous. There are multiple ill-defined bilateral subcentimeter hypoechoic nodules.  The largest on the right measures approximately 9 mm, and the largest on the left demonstrates rim calcification and measures 6 mm.  A 4-mm hypoechoic nodule is seen in the isthmus.    
    
IMPRESSION: Diffusely heterogeneous thyroid with multiple small nodules.  Differential diagnosis includes adenomatous nodules.  As usual, thyroid malignancy cannot be excluded sonographically."
  
I'm a 47 year-old female. My mom had thyroid cancer when she was 31, had her thyroid removed, took thyroid medication the rest of her life. I can't see an endocrinologist for 5 weeks because I'm a new patient. I've called around but no luck. I'm hoping they are benign but trying to prepare myself. I know most thyroid cancers are very survivable, and if it were the other kind it would be growing rapidly, and mine are not.

The last 10 months I've had symptoms of depression, anxiety, body aches, sensitivity to cold, poor appetitie & weight loss, fatigue & insomnia. 2 weeks ago I was diagnosed by a phys med doc with fibromyalgia, but now wondering if these symptoms could be related to my thyroid. My primary doc says no. Thyroid panel was mostly normal but T3 (85) and intact PTH (11) were slightly low. Primary says blood tests are reassuring because they're pretty normal.

I'm happily married and have a 4-year old daughter. I'm trying to stay positive but would appreciate hearing from anyone else who has gone through a similar experience. The anxiety and depression I'm feeling since the ultrasound report are much worse.

Any help would be appreciated, or just words of encouragement!!!

Thanks, Tamra

[Mark Lupo, M.D.]

The nodules are small, but with the family history, at least the 9mm one on the R needs FNA biopsy.  The US description may represent hashimoto's - would also consider thyroid antibody testing (good pathologists often like to know antibody status when interpreting the FNA).  The PTH of 11 is hard to interpret without knowing the calcium level -- if calcium was normal, then this PTH is not significant.  Thyroid cancer is very treatable if indeed this is the case, though most likely this is benign.  Make sure the endo has thyroid expertise -- some endos may not suggest FNA at this point.  Check out thyroidologists.com or thyroid.org or aace.com to see if there is a thyroid specialist in your area.

[tamrakat]

Dr. Lupo, Thanks for your quickresponse! Here are some more of my blood test numbers:

TSH - 0.96, Sodium - 141, Potassium - 3.8, Chloride - 101, Glucose - 81, BUN - 10, Creatinine - 0.8, Calcium - 9.0, Albumin - 4.3, CO2 - 29, Phosphorus - 3.1, GFR - Other >60, Intact PTH - 11, Free T4 - 1.06, T3 - 85.

My primary emailed the endo and told her about my mom's thyroid cancer and they moved my appointment up to this Monday, June 9. The endo's going to do an FNR. My doctors are at Palo Alto Medical Foundation in Los Altos, CA. My primary is Dr. Amy Muzaffar and my endo will be Dr. Seneviratne. She called yesterday and said she had reviewed the u/s and is not terribly worried, but wants to see me on Monday because of the family history. I will ask her about a thyroid antibody test for Hashimoto's.

Too many questions, I know..... but: Do the other blood test numbers indicate anything to you? Also wanted to ask you, how accurate is the FNR result? If it comes out benign, can I trust that result and stop worrying? Should I have the nodules out anyway? Will there be continued follow up even if the results are benign?

Still nervous, but at least I don't have to wait a month to get an FNR.

Thanks for your help!

Tamra