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Avatar universal

Dr. wants me to have thyroid removed

Just got home from my visit with my endo and got the results from my uptake/scan.  Findings:  Heterogeneous appearance of the thyroid is again identified.  Areas of decreased uptake are again noted within the right mid and superior thyroid corresponding to previously noted thyroid nodules.  Focal decreased uptake within the inferior left thyroid corresponding to known solid nodule is similar.  Six hour uptake value is 27.8% and 24 hour uptake value is 48.2%.  Impression: 1. Similar heterogeneous appearance of the thyroid with cold defects involving the right mid and superior thyroid and left inferior thyroid.  These nodules correspond to known thyroid nodules on ultrasound. 2. Moderately elevated 24 hours uptake value as seen previously.  (I don't know when all of this was seen previously as no one let me know!)  The endo says that I have 3 cold nodules.  He said there is no way of determining if they are cancerous unless I have surgery to have them removed and that is what he is suggesting and has referred me to a surgeon.  He said a biopsy sometimes misses the cancer if they don't biopsy just the right spot and with 3 that could happen.  He does not recommend Iodine because, again, he says this does not work if you have cancer. He says that trying to adjust my thyroid with medications could help but is not dealing with the possibility that there could be cancer.  He has put me on Methimazole to bring down the over production until I can have my thyroid removed. He says he will then follow up with hypothyroid medications to adjust the hypothyroidism after the removal. He does not think I have Graves Disease although his assistant did.  I asked for the TSI and he said he didn't feel I needed it because it would not change his recommendation for the removal of my total thyroid.  I requested it anyway and had it done today but no results yet.  My question is should I go ahead with the removal of my thyroid?  Is there anything else that I can do to find out for sure if my thyroid is cancerous? Is this the best avenue for me to take?
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Avatar universal
I need to know how big are those three cold nodules? :) Tamra
Avatar universal
The mid right has a solid nodule 1.0 x 1.0x.54 cm and a lower nodule 1.9 x 1.6 x 1.7 cm.  The previously noted largest right thyroid lobe nodule was 2.1 cm.  The lower left has a solid nodule 2.3 x 2.3 x.1.7 cm. The previously noted largest left nodule was 1.9 cm.  Three bilateral nodules noted on the u/s are Cold on the scan.  TSH is 0.0. and FT3 and FT4 are in normal range.  Dr. says "may be a benign nodular goiter (Plummers disease), but the cold nodules are larger on ultrasound and if there is a concern about cancer, the best way to address that would be surgery".  What do you think?
Avatar universal
If Graves comes back negative, then you should also get the TGab and TPOab for Hashimoto's. Hashi commonly causes these nodules and if the nodules leak enough hormone, you can go hyper for quite a while, making you look more like a  Graves patient.

Happened to me.

Most doctors recommend removing nodules over 2.0 cm. because once they get too big, it is hard to get an accurate biopsy. The cold nodule has a slightly higher chance of being cancer.

I have Hashimoto's and four nodules, each ranged from 1.0 cm to 8 mm. They all shrunk on thryoid hormone.However, if you are experiencing rapid heart rate, diarrhea, high bp, then you cannot take the hormone and those nodules may indeed get bigger.

If you decide to have surgery, then please do your research. Get a surgeon who does at least two thyroid surgeries weekly and who's been doing this for a few years.

My mom had a partial thyroid removal. She was back to her normal self within a week.
Best of luck to you and keep us posted.  

:) Tamra
Avatar universal
BTW - My mom's nodule was 7 cm. It was benign, but she didn't want to take a chance. Her doctor had told her that if it was thyroid cancer, it had a very high cure rate. He said, "If I were to get cancer, thyroid cancer would be the one to get."

:) Tamra
Avatar universal
I would at least try the biopsy first, but it looks like eventually you will have to remove it.  I was in much the same position, four nodules from 2.1 cm to .8, I had a biopsy that revealed "benign follicular clusters", but they could not rule out cancer.  I had 1/2 removed, then they found small papillary tumors.  One doc said leave the other side, that it is not really necessary to take out the other side, but the surgeons said take it out.  I figured that eventually I would use all thyroid function, so I had the rest removed.  That's when they found the big tumor.  If your hashi's is eventually going to destroy your thyroid, why not take it out now?  At least you would have your answer.
Avatar universal
You can always get a second opinion if you are unsure of what the first doctor told you. Ultimately it will be up to you.

I had a TT 16yrs ago. It has not alter my life any as far as quality.
Avatar universal
Thank-you for your responses.  Your responses helped me to make my decision.  I will visit with the surgeon in two weeks.  As both sides of the thyroid have cold nodules, it will be necessary to have TT. The ENT physican I have been referred to for surgery only has approx. 200 surgeries p/yr as this is not a large area.  Not sure what to do about that. I am still waiting for the results of the antibodies test so not sure about the Graves yet.  I do believe I have a better chance at feeling better after the TT if I can regulate the hypothyroidism.  I will keep you posted and thanks again for your responses.  I find this site very informative.  
Avatar universal
As long as the ENT does two thyroid surgeries per week, then you should be fine.

After surgery, you may need some advice about medication, etc.

Please come back and post how your are doing and ask any questions.

:) Tamra
929504 tn?1332585934
200 surgeries per year is a great amount. When you meet with him you will be able to sense a form of comfortability with him and determine your decision as far as he goes.

I had a TT due to multi nodules on both sides and one of them was solid and cold @ 3.7cm but shrunk to 3.3cm after trying a natural supplement. Due to the issue in hand (solid and cold nodule) surgery was recommended because it's just not gonna change the fact of the findings and having biopsies every six months and praying that one doesn't come up maglinant was nerve racking enough.

I feel relieved that i don't have that issue anymore...
Avatar universal
How have you done since the TT and how have you handled the issue of changing to hypothyroidism?  Does it ever really end?  I am now trying to deal with chronic Interstital Cystitis, chronic degenerative  back and leg pain as well.  A few days ago I woke up with no hearing from my left ear with pain and swelling of the left side of my face. I have a pea sized lump behind my ear and a large cyst-like bump on my left cheek.  A visit to the PA at the ENT clinic said it was not an ear infection but could not tell me what it is. I'm discouraged.  My endo just started me on Methimazole 5 mg. to cool the thyroid a little in anticipation of surgery.  Could this be a reaction to the Methimazole?  I called the endo's office and he has gone to a symposium and hasn't returned my call from last week.  I have gone off my Vit. D supplement as I wonder if that could be causing my IC to flare, but would love to get back on it as I am so tired.  Just not sure what to do anymore with the meds.
929504 tn?1332585934
Im sure that it is very draining and inconvenient to have more than one issue going on.
Everyone's reaction is different but as far as i go, i'm relieved to have had the TT, however, i wish the doc's were honest about what can and will happen when you are left with "hypothyvoidsm" due to the TT. My levels are not yet normal due to the surgery in Dec, but i am extemely tired past 6pm daily but have lots of energy in the morning and mid day, I have developed higher blood pressure and heart issues (heart palps, flutters, and extra beats)...and now seeing a cardiologist...my blood sugar is higher than usual and found out that my last blood work showed low vitamin D (11) so i have much to discuss with Endo at my next appt. These are things that i will be sure to keep tabs on and hound my doc's when necessary. These are things that all patients should be aware of before they occur just in the event.  

Avatar universal
Thanks, blsdnsvd!  I agree!  My endo says we will address the hypo issue after the surgery but I want to know what problems can come after the surgery, especially where I have other health issues.  I already have all the issues that you mentioned (heart, blood pressure, fatigue and Vit D) so I am concerned.  After reading many of the posts, I am truly wondering about the connection with Thyroidism and Vit D.  I think I will do some research on this.  Thinks for your response!
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