High TSH w/Hypoechoic Nodule

[percycute]

I'm a 30 y/o female w/no known family history of thyroid problems.  I went to have a routine physical done at my new PCP who also ordered  a blood panel.  It was found that my TSH levels were 5.58.  The doctor also said she felt a nodule.  The ultrasound was done earlier this week and just received the results today. My doctor ordered a Nuclear Scan to be done before she will discuss the findings with me.  I'm pretty concerned with the results, though. If you can help me understand them better, it would be greatly appreciated! What are the chances of Malignancy?  Btw, I don't have any symptoms & feel relatively healthy, for the most part!  Thanks!

ULTRASOUND FINDINGS:
The right thyroid lobe is 3.1 x 1.6 x 1.8 cm. There appears to be a subtle hypoechoic rounded nodule in the mid thyroid lobe with increased peripheral vascularity measuring 1 cm x 7.6 mm x 2.7 mm. The isthmus is 3.1 mm. The left lobe is 3 x 0.98 x 1.6 cm with a normal appearance.

INTERPRETATION:
1 cm hypoechoic rounded mid right thyroid nodule with increased peripheral vascularity. Nuclear medicine scan may provide helpful additional evaluation if clinically indicated. Consider biopsy.

[898_1]

If image is on cd you should be able to save it to your desctop and then upload it to Medhelp. Before uploading, you may need to crop out the personal iformation etc. using MS image editor

[percycute]

I viewed the scan...definitely no typo!  Wish there was some way I could put up the images.  My PCP is baffled, as well.  My TSH levels has dropped significantly since stopping the one med & I haven't been taking any thyroid medication, either, so it could very well be that.  She's referred me to an endocrinologist.  Hopefully he'll be able to figure out what's going on w/me.  Not really sure what to think at this point... :\ Should I be relieved ?

[898_1]

I never heard or read about hot nodules coexisting with HIGH TSH, so the next step is to retest the TSH and see if it was elevated due to the medicine (I know that Metformin suppresses TSH if TPO antibodies are present in blood). I hope there is no typo in scan report(!)
Hot nodules rarely cancerous (2%) but they are composed of atypical cells capable of producing hormones without TSH stimulation.

[percycute]

The significant change that I've made since I took my original TSH test (March 27) is that I stopped taking Gabapentin.  I've read clinical studies that have shown that Gabapentin has caused hypothyroidism & abnormal TSH tests in some individuals.  Can't say if that's the case for me or not, though, just wanted to put that out there..    

[percycute]

Just got my report for the Thyroid Scan & Uptake.  It's a hyperfunctioning nodule & I had a normal thyroid uptake.  So very confused by all of this.  I haven't gotten my new blood work back yet to compare ranges, will post those results as soon as I get them, though.

Clinical History
Abnormal thyroid ultrasound, 1 cm hypoechoic right thyroid nodule.

Thyroid Uptake
Thyroid uptake is calculated to be 20.9% at 24 hours, this value is normal

Thyroid Scan Findings
Nuclear scan images were correlated with ultrasonography demonstrating the area in question in the right lobe to represent a hyperfunctioning nodule as there is an area of increased activity seen within the central midportion of the right thyroid lobe.  There is no discrete cold nodule seen in the right lobe, isthmus, or left lobe.
The right lobe is mildly larger in size than is the left lobe.

Impression
Normal thyroid uptake.
The area of nodularity is seen in the right lobe on ultrasound corresponds to a hot nodule.

[percycute]

So, I just received the Ultrasound CD today...and what do you know?  There was a typo error on the measurements in the Report printout...the nodule is actually 1cm x 7.6mm x 8.7mm.  

Don't think I'm going to go ahead w/the Nuclear Medicine Scan, Dr. Lupo backed up your opinion & said it wasn't necessary, either.  

I have a biopsy scheduled for the 12th, same day results.  Though, the endocrinologist who will be performing it works at a Cancer Treatment Facility and specializes in .  Do you think this is the best option regarding choosing my Endo or should I look for one at a private practice?  

[percycute]

Thank you so much for all the info...you've helped me out a great deal & the findings definitely make much more sense to me now!  

[898_1]

For the small nodules (less than 2cm) the blood flow around it favors benign nodule.
I can speculate that on the side view a nodule demonstrated hypoechoic characteristics because it is very thin (this will make biopsy more difficult)
Based on the description it is not possible to say if nodule is solid or cystic.
It can be composed from fibrous tisssue.

[percycute]

One more question!  Would the findings indicate whether/not the nodule was solid?

[percycute]

Thanks for pointing that out!  I read that a spherical shape is also a characteristic of a nodule being malignant.  Since mine seems more of an "oval" shape, does that also lessen the chances of malignancy?

[percycute]

Thank you for your quick response, I greatly appreciate it!

So, when they list the specific abnormalities in nodules that have a higher risk of malignancy, I've noticed hypoechoic & increased blood flow are two of these characteristics.  In regards to the characteristic of "increased blood flow," are they really saying increased blood flow INSIDE of the nodule, as you said, rather than outside?  I've found that the characteristics of Increased Intranodular vs Peripheral Blood Flow regarding nodules is hard to find, unfortunately.  Also, do you happen to know what "'subtle' hypoechoic" would signify, exactly?  Is it treated as a "regular hypoechoic" or does the term "subtle" also reduce the chances of malignancy?

Again, thank you so very much! :)

[898_1]

Additional info:
The nodule appears to be of very odd shape so the second ultrasound needed to evaluate it. It is only 2 MM thick!! The nuclear scan is NOT the right method for this nodule

[898_1]

Your thyroid is small in size; the nodule has increased blood flow around it which in most cases is a sign of benign nodule.
The nuclear scn is NOT necessary because your TSH is HIGH.
The best metod is to rule out malignancy is to perform FNA biosy of that nodule. In addition, repeated ultrasound needed to evaluate lymph nodes..