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Nuclear Thyroid Scan Problems

A few months ago I had a throat infection and my doctor noticed my thyroid was swollen. I had an ultrasound performed that confirmed the presence of two hypoechoic lesions on my thyroid. It was recommended that I have a nuclear scan performed to see if the lesions are malignant or not. The largest is 1 cm, I believe.

My blood tests are otherwise normal, though in the past (age 15-17) I was diagnosed with hypothyroidism and put on Synthroid for about a year. I also had PCOS when I was a teenager, but I'm doing fine now that I'm on low-hormone birth control (I'm 30, been taking the pill since I was about 23).

Here's my problem: my health insurance is refusing to cover the nuclear scans, and I hear they are expensive out-of-pocket. I understand that 90% of thyroid nodules are benign, but with my history of thyroid and metabolic issues (that and the presence of not one but two lesions), should I argue my case with my health insurance? Or would the nuclear scan be superfluous since my blood tests (taken about a month before the ultrasound) show everything normal?

Any advice is much appreciated!
4 Responses
Avatar universal
If your TSH is not low or your TSH is low, but you are taking Metformin, the nuclear scan is not necessary.
The cold nodules have 10 to 15% chance of cancer
the warm anodules have 10 to 5 % chance
5% difference may not worth this extra step.
The hypoechoic nodules without borders can be also inflammatory lesions
Avatar universal
Thanks so much for the speedy response; I really appreciate your input!
Avatar universal
Okay, I talked to my health care providers and they said that they recommend a fine needle aspiration test to be performed in lieu of the nuclear scan. Do you think the FNA will be sufficient enough a procedure to rule out the possibility of cancer?

Thanks again for all your help!
Avatar universal
the FNA is the best tool to evalute for cancer but there are some things to consider to get the best outcome:
It must be done under high resolution ultrasound guidance
If sample is contaminated by blood the result may not be accurate
The specimen must be aplied to the slass using smears not "thin prep"method.
All the best!
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