Need help with thyroid nodules evaluation/symptoms

[wendy25]

I have had thyroid nodules for 10+ years, (I'm a 44yr. old female), and have had several ultrasounds to monitor any changes. I also had a FNB done in 2005 which reported I had a benign cyst. My last ultrasound done in 2011 concluded that I have scattered hypoechoic structures in both thyroid glands, some are mostly cystic while others are solid. On the right, the largest abnormality is a 1.3 cm cyst with a calcification seen centrally and was measured at 1.2cm last year. On the left, the largest mass is 1.5cm in diameter and is a solid mass in the central gland. I had a FNB done on the right side back in February, by the same general surgeon who did my previous left one back in 2005. He took one aspiration, and the path report came back as "findings could represent a colloid nodule, the lack of follicular epithelial cells preclude a more definitive assessment. Blood and colloid material only."
I was told by the surgeon that I was fine, and he felt that he didnt need to do another FNB on the left side because it hasnt grown in size over the last 2 years (although it is bigger since 2005), but I was concerned that it seemed to be more cyst like in the past but described as solid mass on the most recent ultrasound, but he did not think of it as a concern (I just read the 2009 ultrasound report on the left nodule that read "diffusely heterogeneous nodule in the left lobe of the thyroid at the upper pole measuring approx 1.7x1.06cm which has a slightly hypoechoic diffusely heterogeneous texture with some cystic change"). I recently saw an ENT who concluded that my path report was inconclusive. In addition to this, I have been very symptomatic over the past year with feeling unusually cold inside, and some tingling, and other symptoms which have been very distressing to deal with. I have been to many doctors with no explanation. My thyroid blood work comes back within range. The TSH seems to be on the lower range. I would like your professional opinion about my thyroid nodules and if I should pursue this further. I know this a lot of information .
Thank you for your consideration.
Thank you.
Wendy

[wendy25]

I just looked at the 2009 ultrasound report on my left nodule and it states"diffusely heterogeneous nodule in the left lobe of the thyroid at the upper pole

[wendy25]

I appreciate your input very much. I looked at report again and I failed to mention that the size was 5.4cm in length on right, and 5.6 cm on left, mildly enlarged.
Perhaps I should pursue getting left thyroid biopsied. The Endocrinologist I saw was going to send me to a Radiologist for an ultrasound guided biopsy. I wasnt sure if I was comfortable with a Radiologist doing it, although they probably do a lot of them. I live in Florida (East coast), any recommendations for a good Endocrinologist?
I do hope that I can find out what is causing my symptoms and be relieved of them.It's strange how the left side of my body is what is the most affected (for some tingling and muscle aches, but cold sensations are more scattered). So far, my blood work and MRI (along with nerve conduction studies done last year) has come back within range and no particular findings. I will keep researching before having to go to Mayo for a work up. Thanks again for your input.

[898_1]

I could also speculate that dye containing radioactive iodine isotopes caused thyroid disturbance (transient hyperthyroidsm or evemthyroid inflammation depending of the dose)

[898_1]

“Central gland” is unusual term; it could be either pyramidal lobe or isthmus. That 1.5 cm solid mass can be better candidate for biopsy, especially if it has internal blood flow and feels firm and fixed during palpation. Another opportunity is to take sample from the wall of the cyst but that is very challenging. It seems like report does not include the overall size of your thyroid (enlarged thyroid with nodules is sign of the thyroiditis in many cases)

[wendy25]

My symptoms started about a year ago, right after I had a nuclear stress test for heart palpitations, and I woke up that same night I had the test feeling very cold, and I initially dismissed it as the fan blowing on me. But it persisted, and followed by itching sensation without rash for about a month with no relief with Benadryl. I assumed I had some type of allergic reaction to the dye they used for the scan. But I noticed that the left side of my body would have increased muscle aches compared to my right, after mild exercise. Also, I started having tingling sensations on mostly the left side of my arm/fingers, and leg/feet. And then in July, I noticed feeling a little off balance at times. I have seen a Neurologist, Rheumatologist, and have had several tests done which so far have come back negative. My Internist mentioned MS, and I will be followed by Neurologist next month to see if he feels like it could be MS , but the tingling has gotten overall better but have had the persistent cold sensations in my body, and sometimes its very intense . And I have muscle/joint type pain . I'm trying to figure out on my own what it could be, and because I have these nodules in my thyroid, I'm wondering if that nuclear stress test I had last year, somehow triggered my thyroid to react. I don;t understand why I have these constant cold sensations. I also feel more tired than usual. Anyway sorry about going on about my symptoms. I hope I can figure out what is going on with my body.

[wendy25]

The full ultrasound report from September 2011, states" The largest abnormality in the right thyroid gland is a cystic structure with a central calcification which measures 1.3cm maximal diameter. The next largest nodule is about 6mm nodule which is a complex cyst but well circumcised nodule in the medial aspect of the mid right thyroid gland. There are several other smaller nodules. On the left, the largest mass is in the central gland and is a solid mass measuring 1.5cm in diameter. A few other small hypodensities are seen in the left thyroid lobe as well.
Impressions: There are scattered hypoechoic structures in both thyroid glands, some are mostly cystic while others are solid.
On right, 1.3cm cyst with a calcification seen centrally.
On left, largest mass is 1.5 cm in diameter and is a solid mass in the central gland.
Thanks for the information. I hope this helps determine your further input.

[wendy25]

Thank you for your input. I'm waiting to get back the results from my most recent blood work. I did have some antibodies checked last year and will check on which one. I know it came back negative, although an Endocrinologist casually mentioned that I probably have Hashimotos.  I will keep you posted.

[MANmom]

What other symptoms are you having?

[898_1]

The biopsy is rather non-diagnostic then non-conclusive because it contains only blood and colloid (typical matter that fills up the cysts). The sample from solid nodule containing follicular cells and tissue fragments as well as the white blood cells such as macrophages for example can give better diagnostic results. A full ultrasound report will be very helpfulto determine which nodules must be biopsied

[Barb135]

None of us on this forum are professionals; we're all patients just like you, though we do have some very knowledgeable members.

Ultra sound and FNB results are not really my best area, but we have members who are very good at interpreting results.  Hopefully, one, or more, of them will see this and give an opinion.

Aside from that, it would help greatly if you could post your most current thyroid blood test results.  You should be getting, at least, TSH, Free T3 and Free T4.  Please be sure to include the reference ranges, since these vary lab to lab and must come from your own report.

You should also be tested for thyroid antibodies, Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TGab).

Your symptoms indicate hypothyroidism, possibly caused by Hashimoto's Thyroiditis, but without supporting labs, we can't know.