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2.2 cm solid hypoechoic thyroid nodule, how worried should I be?

An ultrasound just revealed that I have a 2.2 cm solid hypoechoic nodule on the left side of my thyroid. It is categorized as a TR4 (moderately suspicious) on the ACR TI-RADS scale. They are recommending a FNA (fine needle aspiration) biopsy as the next step. I am terrified that it’s cancer and unfortunately my biopsy isn’t for a few weeks.

All my bloodwork looks good and I have never had any thyroid issues. I would love to hear from anyone who has had something similar and what was the outcome. I am wondering what the likelihood it’s cancer.

Here are my specific results:

Nodule #: 1. Location: Mid inferior.
Size: 2.2 x 1.7 x 1.5 cm. Volume 2.7 cc. Change in size: Baseline.
Composition: solid/almost completely solid (2).
Echogenicity: hypoechoic (2).
Shape: not taller-than-wide (0)
Margins: smooth (0).
Echogenic foci: none (0).
ACR TI-RADS total points: 4.

Thank you, I really appreciate the support.
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Avatar universal
Hi BellaFrank81,

Most thyroid nodules are benign (90-95%).

The guidelines for doing a fine needle biopsy differ from place to place, but in general they usually wait until the nodule is over 2 cm (since the chance of cancer is slightly increased if it is over 2 cm, from about 10% if it is under 2 cm to 15% if it is over 2 cm).

Hypoechoic nodules also have an increased risk of cancer, but by no means does a hypoechoic nodule on an ultrasound mean you have cancer.  That's why they need to do the fine needle biopsy.

Other factors that could make it more suspicious are rough margins, taller than wide, calcifications, and vascularity.  Since your nodule has smooth margins, is not taller than wide, and there was no note of calcifications  or blood vessel infiltrations, the only thing that makes it "more suspicious" is the hypoechoic characteristic.

I'm not expert on this, but when I had my ultrasound, my hypoechoic nodule (similar to yours, mine was 1.3 cm, smooth margins, no vascularity or calcifications) had a chance of about 25% of being cancer based on my ultrasound report.

I know waiting for the biopsy can be terrifying, but please know that odds are still low that the nodule is cancer.  If it does end up being cancer, thyroid cancer is often very treatable, and most thyroid cancers are very slow growing.

My nodule did end up being cancerous, but my situation is different from yours.  I had a multinodular goiter due to chronic untreated Hashimoto's, which left my whole thyroid full of nodules and a few of many ended up being cancerous.  I had to have my thyroid removed, but luckily I didn't need any further treatment for the cancer because it had not spread past the thyroid.

In my case, my biopsy of the suspicious nodule came back as "Suspicious for neoplasm", and I had it sent off for genetic testing and it still came back "suspicious, 50% risk", so when I had my surgery there was still a chance that it was not cancerous (it ended up being cancer, but by then was out of my body and no further treatment was needed, so it is still weird for me to think of it as cancer).

Good luck with your biopsy - I hope all goes well for you.
Helpful - 0
Hello Sarahjogs,

Thank you so much for sharing your story with me and all the insights you provided. I am glad to hear that your nodule was successfully removed and the cancer hadn’t spread.

I stumbled across Medhelp during my frantic googling after I got the ultrasound results and am just blown away by the heartfelt and genuine support that you all provide each other. Reading all the responses instantly gave me a sense of relief and that everything is going to be ok.  Hearing from people who can relate to the situation I’m in, or just offer some kind words means more to me than I can ever express. Thank you all and I plan to pay it forward.
Avatar universal
Curious how old you might be. Only reason I ask is that I have read that there is some research that thyroid cancer may be better left untreated as the “cure” is worse than the disease.   Basically it is so slow that the vast majority of people leaving it alone is the better option.  The older a person is, the more odds are to leave it alone.

Every case case is unique and you have to discuss with dr the best options.

Get the Biopsy. And if negative then no more to worry about really. Unless the size of the nodule causes physical discomfort and trouble swallowing etc.

However. This is just my opinion.
Helpful - 0
Hello flyingfool,

Thank you so much for responding. I am 38 years old so I suspect I might be too young to leave it untreated if it’s indeed cancerous.  It’s an interesting approach though, I will definitely put it on the list to discuss with my doc if needed.

649848 tn?1534633700
No one can tell you the likelihood of your nodule being cancer because everyone is different.  As Sarah said, the fact that your nodule is not taller than wide, has  smooth margins, doesn't appear to have blood flow or calcifications is in your favor.

It's always hard waiting for something, like the FNA, but we're here to talk to while you wait.  Have you been tested for Hashimoto's yet, even though you don't have actual thyroid problems, such as hypothyroidism?
Helpful - 0
Hello Barb135,

Thank you for your insights and support. I have not been tested for Hashimoto's yet but since you mentioned it, I have done some research on it and definitely want to get tested. I have reached out to my doctor and requested the test.
1756321 tn?1547095325
4-6 points: moderately suspicious of malignancy.
Helpful - 0
Thank you Red_Star. Fingers crossed that it’s benign :)
Avatar universal

Hello everyone, I wanted to give you an update on my FNA results. They came back as “Follicular Lesion of Undetermined Significance” (see full report below). My doctor said that there is uncertainty about how to proceed, and wants to meet in person.

I would love to know if anyone has any insights into these results.  I am feeling really in the dark until I meet with the doc.

Thank you all so much!

Thyroid, Left #1, Nodule-Fine Needle Aspiration: Final Cytology Diagnosis:

Few follicular cells mostly in microfollicles and small fragments
Scant colloid.
The specimen is limited in part by obscuring blood.  

Specimen Adequacy:
Satisfactory but of limited diagnostic value due to excessive blood.

ThyroSeq genetic testing can be performed if desired. Please call Cytology at x36805 to request. Insurance preauthorization may be required.
Helpful - 0
Hmm, I was hoping someone else would comment because I'm not sure about the results, but I will try my best.

It sounds like they didn't get a good sample if it was contaminated with blood.  I do know that scant colloid and "microfollicles" are usually associated with a higher risk of cancer, but doesn't necessarily mean that it is cancer.  Undetermined could mean: we didn't get enough cells to make a determination, or, since is says "satisfactory", it might mean that even with enough cells, there are enough features of a neoplasm that make it suspicious.  Since it doesn't say neoplasm or suspicious outright, it is not clear to me.

My own biopsy came back as suspicious for neoplasm, I had a lot of Hurthle cells and scant colloid, and from the biopsy it was impossible to tell if it was cancer or not, because those can also be present in benign nodules as well as in malignant nodules.   I ended up sending a sample off for genetic testing (Afirma, which is a different company than what was suggested but probably does a similar test).  My own result came back as suspicious after the genetic test and I ended up doing a thyroid lobectomy, but the whole point of the genetic test is to determine if the nodule is benign or not and avoid surgery if the nodule is benign.  

A lot of people end up having thyroid surgery because it is difficult to tell whether a nodule is cancerous or not, and then find out later it is benign, and these genetic tests are trying to bring that number of surgeries on benign nodules down.

As to what the next step is going to be - they might suggest waiting 6 months and doing another biopsy and hopefully get a better sample (thyroid nodules usually grow slowly) or suggest doing another biopsy now and send it off for genetic testing (if they don't already still have some sample left to send - the doctor who did my biopsy was also a pathologist, so he could immediately tell me that mine was suspicious and we did another biopsy right away for genetic testing, I don't know what the normal protocol is for this because I don't think most biopsy doctors are also pathologists).

I'm sorry you have to go through this -- I can remember after the biopsy having an uncertain result was the most stressful part of my whole thyroid cancer diagnosis process because there is so much that is unknown and it could be cancer or could be fine.  (By the time I was diagnosed, I also knew that the cancer hadn't penetrated the nodule membrane or thyroid and hadn't spread and had already been surgically removed, so it was somehow not as stressful as the biopsy/genetic testing phase).

Good luck, and I hope if you do the genetic testing that all goes well.  Even if it comes back as suspicious from the genetic test, it still does not mean that it is cancer, just that it is impossible to tell without surgically removing the nodule, which unfortunately sometimes happens.  Hopefully it is not thyroid cancer, but if it is, you should know that most thyroid cancers in someone your age (especially if it is follicular/papillary thyroid cancer) has an excellent prognosis.  In my own case, my thyroid cancer was treated by removing the thyroid, and no further treatment was needed because it hadn't spread past the thyroid.  (I am 39 now, I was 37-38 when I was going through the whole diagnosis and thyroid surgeries last year).
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