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Hyperthyroid with cold nodules?
I have finally seen the endocrinologist. My ultrasound revealed lots of (10 I think) large solid masses.
the report says:
"The right lobe measures 4.8 x 1.8 x 4.3 cm. The left lobe measures 4.6 x 1.6 x 2.5 cm.
Multiple masses are present throughout the right and left lobe, quite large. In the upper pole, there is a solid exophytic mass measuring 13 x 6 mm. Central located mass near 41 x 16 x 36 mm which is solid is present. In the lower pole there is a 14mm and a 10 x 11 mm solid mass present. On the left, there is a solid mass 7 x 8 mm. In the upper pole and in the mid pole, a large solid 42 x 14 x 22 mm mass present as well as a 7 mm mass in the lower pole. 9 x 5 mm solid mass and an 8 mm solid mass.
IMPRESSION: very large thyroid gland with bilateral extremity (I think they meant extreemly) large solid mass densities. With solid mass of this size, biopsy may be necessary to exclued any possibility of malignancy. Correlation with 2 and 24 hour radioactive iodine 123 uptake and nuclear medicine scanning recomended as well as correlation with TSH."
The nuclear medicine scan says most if not all are cold nodules. I didn't have the presence of mind to copy down that results sheet.
I am aware that the cold ones are more likely malignant than hot nodules. All this in a reeeeeeally big thyroid which is secreting way too much hormone.
So.. the endo put me on tapazole for a few weeks prior to doing the FNAs.. first 5 days were 3 pills/day. Now one pill a day. The 3/day made me feel much better pretty quickly.. one a day - not so much.
I guess my questions are
(1) is waiting over a month for the FNAs standard with the higher risk for malignancy? and
(2) with a huge goiter and this many good sized cold nodules, the chances for keeping my thyorid look pretty slim. Why wouldn't they just take it out, do the pathology and put me on synthroid right away?
the report says:
"The right lobe measures 4.8 x 1.8 x 4.3 cm. The left lobe measures 4.6 x 1.6 x 2.5 cm.
Multiple masses are present throughout the right and left lobe, quite large. In the upper pole, there is a solid exophytic mass measuring 13 x 6 mm. Central located mass near 41 x 16 x 36 mm which is solid is present. In the lower pole there is a 14mm and a 10 x 11 mm solid mass present. On the left, there is a solid mass 7 x 8 mm. In the upper pole and in the mid pole, a large solid 42 x 14 x 22 mm mass present as well as a 7 mm mass in the lower pole. 9 x 5 mm solid mass and an 8 mm solid mass.
IMPRESSION: very large thyroid gland with bilateral extremity (I think they meant extreemly) large solid mass densities. With solid mass of this size, biopsy may be necessary to exclued any possibility of malignancy. Correlation with 2 and 24 hour radioactive iodine 123 uptake and nuclear medicine scanning recomended as well as correlation with TSH."
The nuclear medicine scan says most if not all are cold nodules. I didn't have the presence of mind to copy down that results sheet.
I am aware that the cold ones are more likely malignant than hot nodules. All this in a reeeeeeally big thyroid which is secreting way too much hormone.
So.. the endo put me on tapazole for a few weeks prior to doing the FNAs.. first 5 days were 3 pills/day. Now one pill a day. The 3/day made me feel much better pretty quickly.. one a day - not so much.
I guess my questions are
(1) is waiting over a month for the FNAs standard with the higher risk for malignancy? and
(2) with a huge goiter and this many good sized cold nodules, the chances for keeping my thyorid look pretty slim. Why wouldn't they just take it out, do the pathology and put me on synthroid right away?
thanks for the replies.
I broke down and called the office and asked why I was waiting and the reason he gave was because he wanted to see if the meds would shrink any of the nodules, and that would take 6 - 8 weeks.
I am feeling a bit better on the medication.
My other option was to go to the original suggestion by my primary care guy.. the ENT vet (I tend to refer to all doctors as vets) on the air force base for the biopsies.. somehow I prefer the specialist to stick me multiple times.
Apparently, this endo is the only one for miles around here .. and he's almost 60 miles away. The FNAs are July first.. results on the 10th.
Until then.. I pace a lot.
I am just guessing here, but with cold nodules, the radiation of choice wouldn't be the iodine and I'll probably end up with the spot rays.
I broke down and called the office and asked why I was waiting and the reason he gave was because he wanted to see if the meds would shrink any of the nodules, and that would take 6 - 8 weeks.
I am feeling a bit better on the medication.
My other option was to go to the original suggestion by my primary care guy.. the ENT vet (I tend to refer to all doctors as vets) on the air force base for the biopsies.. somehow I prefer the specialist to stick me multiple times.
Apparently, this endo is the only one for miles around here .. and he's almost 60 miles away. The FNAs are July first.. results on the 10th.
Until then.. I pace a lot.
I am just guessing here, but with cold nodules, the radiation of choice wouldn't be the iodine and I'll probably end up with the spot rays.
I agree the ghent but I think waiting for the FNA is wrong. With the results of your scan it shows a greater possibility of ThyCa so an FNA should be done now. There is no reason to have to wait and I would push for the biopsy sooner.
Sometimes a patients just needs to push to be able to move forward for answers.
Sometimes a patients just needs to push to be able to move forward for answers.
By default I think most endos try to keep the thyroid, and now prefer radiation therapies to kill off a thyroid rather than surgery. Only in cases of nodal hyperthyroidism or nodal malignant thyroid cancer. Thyroidectomy with even the most skilled head & neck surgeons is very risky and can leave you with a paralyzed tongue and face, salivary disorders, no parathyroid glands & calcium/bone problems for the rest of your life.
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