I'm glad you came over to this site. There are some very WONDERFUL people on this site who can really help you.
You're right about ultrasounds not being able to tell the difference between malignant and benign. Ultrasounds are a tool to diagnose - they can help narrow down the options but not completely rule out cancer on a nodule. As I mentioned, biopsies can't either. Some on here have had good results with biopsies, others haven't. I had two sisters who had biopsies - both were negative - both had cancer. Biopsies, even with the guidance of an ultrasound, can only collect so many cells and if the cancer is small or the sample just not taken from the right area it can be missed by a biopsy.
All I can tell you is my experience (and, by proxy, my family's). My nodule was small on the ultrasound but appeared to be complex. I read what I could find and realized that complex held the possibility of cancer (even though the possibility was remote). Personally, I decided against the biopsy (the nodule was small and mostly cystic) - I was afraid that if it was cancer it may be missed and I'd get a false sense of security. I decided to be aggressive and have the lobe out because deep down I had a feeling it was cancerous. They found a small (4mm) amount of papillary carcinoma. They didn't even find it right off, it took the pathologist a while to find it and I was in the recovery room by that time (I had the other half out a year later).
My youngest sister (24 at the time) had a chest x-ray a month or so later (from a minor traffic accident) which showed a shadow on her thyroid. She had an US and a biopsy (negative) but decided to get it out because mine was cancerous. She had stage II papillary carcinoma (lymph node involvement).
The other three of my sisters went in for ultrasounds (and 1 had a biopsy which was negative). They all opted for total thyroidectomies - two of them had papillary carcinoma (stage I) and one was precancerous. I had my son and daughter's thyroids ultra-sounded - daughter's full of nodules, son's clear. Daughter's thyroid was removed (she was 16) and hers was precancerous. Son's thyroid is still beautifully clear.
Okay, long story short. There is no foolproof way to rule out thyroid cancer. All the tests can only tip the scales for you as to whether or not you should have surgery. What it comes down to is a decision between you, your doctor, and your gut instinct.
Here are some sites that can help give you some questions to ask your doctor:
I'm sure you will get information and stories from others on this site. Please read down through some of their posts (many have just been through surgery and some are right where you are now).
thank you again for your reply. How small was your sisters nodules? I don't know if you saw my comments I added after my first post that pure cysts are rare and that most thyroid nodules are either solid are mixed with cystic elements and that mixed are 85% benign. If I can't trust a needle biopsy then I guess I have to have my thyroid out,and it's a very big step. Did you read the description of my ultrasound I described on Dr.Lupo's forum in my topic,I Need Advice About 3 Throid Nodules?
what gave you the instinct that you had thyroid cancer? You only had 1 very small thyroid nodule.
My nodule was described as a small, complex nodule. That was it.
I watched the ultrasound and asked questions then reviewed the pictures with my regular MD. I could see some areas of solid "clumps" around the fluid-filled cyst and the edges were irregular. After talking at length with my doctor (not an endo - he's my internal medicine specialist) I made the decision to forgo the biopsy and schedule the surgery. My doctor recommended a wonderful surgeon that I sat down and reviewed the ultrasound results with too.
I don't know why I suspected the cancer - I just did. Maybe it's just my luck and the way things go with my life. :-) I just knew that it would drive me crazy to leave it in there if there was any sort of chance of malignancy.
The largest cyst found in any of my family was right around 1cm. Meaning, *ALL* of our cancers were relatively small - probably because we caught it very, very early.
I really wish there was a blood test, DNA test, scan, *something* that could tell us for sure whether or not the nodule was malignant. And, as you know, even thyroid tests are usually normal for those with nodules and malignancies.
With your scan, the blood flow inside and the discontinuous hypoechoic ring are not positive signs. If I was going to put it on a scale (for me) that would tip it in favor of getting it removed.
I'm not saying you shouldn't get a biopsy. Some on this forum have had them with conclusive results. I'm just saying that if your biopsy comes back negative just consider it as one clue in the mystery of what's inside your thyroid. A positive biopsy result is conclusive but you can have "false negatives" with them.
Your post on the thyroid disorder's MD forum starts out that you are convinced that you do have cancer. You aren't alone - please read some of the other posts here. There are many in your shoes right now.
Thyroid surgery is frightening but I have had eight surgeries (two for thyroid) and my thyroid surgeries were much easier than any of the others. I recovered quicker, had fewer complications, and hurt less after my thyroid surgeries. There can (and are) complications including parathyroid problems, voice problems, hematomas, etc. You have to weigh all of it.
There is a good analogy on this forum. If you had a *mammogram* and they found a suspicious growth with a blood supply, a "discontinuous hypoechoic ring", and you thought it was probably cancer, what would you do?
I saw that you posted on another thread on this forum about having your thyroid out under local anesthetic. I haven't heard of this being done.
For both of my surgeries (and every other one I've heard about) I had to be intubated to keep the airway opened while the neck was being worked on. Also, there were a lot of muscles cut and my "sticky" thyroid had to be scraped from some nerves and other structures. I'm personally glad I was asleep for the entire thing.
Check with the surgeons because I'm surprised this surgery would be done without intubating the patient (and they usually don't like to intubate a conscious patient).
Yes, so interesting .. thanks for posting the post above ... mine are atypical follicular cells ... can you take the results to another Dr such as an endrocronologist or do you need this Dr's referral? I brought my test results to the 3 opinions I got .. this way they all read the same results and saw u/s photos, etc. as they gave me their opinion.
If possible, I'd get another opinion from an endrocronologist who deals with thyroid nodules .. this is a neutral party who doesn't do surgery and will most likely give a neutral opinion vs. an ENT who may be more prone to "slice and dice" ?
I'm online looking @ wallpaper for my laundry room .. doing some "house projects" lately to keep my mind off things :)
Hello ... my surgeon won't do it under local .. he said if I start to cough it could be disasterous results .. too close to nerves and arteries.
IMHO I would have the fine needle aspiration biopsy done but not rely on the results as final answers by any means. "IF" you get results indicating surgical intervention, then all the "if's" are out of the picture and you know what you need to do!
My growth is solid and hypoechic about 1.7cm's. I actually have 3 (2 on one and 1 on the other lobe) .. my FNA is "Atypical" ... so my surgery (after 4 opinions) is set for 1/9 .. I'm nervous about the actual surgery itself (being put out, etc.) but not what life has in store for me whatever the outcome is. I can accept the outcome and be glad this thing is gone. I had ups and downs getting to this comfort level but this board has helped me tremendously do so :)
Thank you both for your replies. My internist keeps insisting that I don't have any worrisome features on my nodules. I had asked her tgat from the beginning when I knew nothing about thyroid nodules,and then two months later when I read my ultrasound she still insists this and she is usually a very good doctor. I just don't think she knows enough about this and what to look for. I won't be put to sleep I just am too afraid of not waking up and I absolutely won't do it! There are surgeons who do this surgery with local anesthetic and more are doing it this way.
There is an article online called Radiology Rounds and I had read it a month ago and I just recently spoke with an oncology nurse at The American Cancer Society and she found this same article on her own not knowing I already read it,and it says that even though one or more of these ultrasound features increases the likelihood of cancer,in small nodules they are cancerous only 22% of the time. Another study using a lot of people,from Argentina found that even with worrisome features thyroid nodules were still more frequently benign. And as I said,many times benign nodules can have some of the same features on ultrasounds as cancerous ones. It is unreal though that only a very small % of thyroid nodules are cancerous and that 90-95% are benign and very comon,and I would have a few of the features that are commonly found with the cancer.
Did either of you have the discontinoud hypoechoic ring,some blood flow etc? Many benign nodules are also hypoechoic and can have some blood flow it might depend on how much.
I forgot to add that I asked my internist if she ever had patients with thyroid cancer,and she said no but she's had pateints with thyroid nodules before. And she's booked for months and does everything,she gives rectal exams to men,vaginal exams to women etc. If she has had patients with thyroid nodules before she certainly read their ultrasounds so you would think she would have known that I *do* have a few worisome features.
I can certainly understand all of your dilemmas. I had a partial TT and then total TT (a month apart) even though my nodule was 2.8 cm. My fight with my surgeon was the opposite of all of yours. I remember reading website after website that indicated that the bigger the nodule the higher chance of cancer and I wanted my doctor to just remove it and get it over with. At almost triple the 1 cm mark, I was 99% sure that I had cancer. I let the doctor talk me into the sub TT and I wish I stood my ground. I mean the nodule was big and the biopsy came back suspicious. My doctor still insisted that my quality of life would be much better if I could keep half of the thyroid in tact. Anyway, I think that all of these decisions catch the patient between a rock and a hard place. Good luck to all!
Did you have cancer? Also there is a lot of online medical sites that explain size doesn't really determine if it's cancerous or not,and there has been a recent increase in finding microcancerous thyroid nodules.
Did you find you had thyroid cancer? Also many online medical sites explain that the size of the thyroid nodules doesn't really matter and that there has been an increase of finding microcancerous thyroid nodules.
I really wish there was an edit button on here,my first recent response to bizwiz,didn't show up on here so I posted it again and now there is a double post!
I forgot to add to the list of atypical findings to the post above this one .. I also had a small atypical colon polyp removed 4/05. I guess I am an "atypical" person << wink >>.
I'm really sorry you are going through all of this too. If you look up on google.com thyroidectomy with local anesthesia you will find masny article about more doctors doing this. I won't be put to sleep and thats it!
We need to "trust our instincts" .... that is Rule #1 in my book ... by doing so we have all posted on this board ... isn't it a wonderful resource! We are all going to get through all of our thyroid issues and be able to do it together .. it is wonderfully comforting isn't it :)
My u/s didn't indicate the blood flow on the report so I'm not sure, but it stated "hypoechic" .. the report didn't use the word 'ring'. I had many ?'s as you do, but I had the luxury of getting my answers (after being awesomely confused online with reading all sorts of reports, etc.) directly from my pathologist whose e-mail was on the business card they gave me after my biopsy. I wanted to know exactly what 'my' odds are for my node being cancer and was told 30% chance a tumor and an extremely low chance for cancer which was under 1% ... that still confuses me, though, as I have read and all the ENT's told me 95% chance benign which leaves a 5% odd for cancer.
I am a firm believer in stats in that somebody will be affected so there is a chance no matter what the odds are with anybody I guess.
As far as being put out I asked my ENT (surgeon) and he said he only knew of one surgeon in NY City who did it (I think he is on the Thyroid Center's wepage or somebody else is on it who does it awake) and that particular Dr. is retired he told me.
I, too, am terrified of not waking up .. I have to be honest. And that is the reasoning I have not had my gallbladder removed until push comes to shove and I have a relentless attack. Yes, I have gallstones (and kidney stones) too.
The risks of hitting the main artery in your neck probably far surpass of something happening by being put out .. that is what I keep telling myself.
Will your Dr. let you get a fine needle aspiration? I would push for that and then readdress your concerns after you get the results. It may take some of the guesswork out as to whether surgery is necessary without making a decision about it or it may complicate it moreso and make you really not know what to do if it is benign.
I have a 2mm node on the left lobe that I ?'d thoroughly and they keep telling me that unless either of the other 2 are cancer they will keep it intact. I want it snipped off but they refuse to do so bcz of the risk/benefit factor (vocal cords and nerves I've been told by all 4 of my opinions). The other node is .5 cm but as you say size doesn't mean anything esp. with others on this board and their relatives.
In the very begining I had very negative thoughts on my node to the degree I didn't tell my children anything until AFTER the biopsy. Secretly I think this node is malignent. I have no reasons why except since it is solid and been there a very very long time (I've been told years) I cannot help but wonder if the deep insides are cancerous with the outer areas "atypical". Yes, I was able to write this out .. it is emotional for me to do so. But this is my "fear" inside. Fearful I am right in my thoughts this time. I have had many atypical moles removed with 12 stitches but NOT Melanoma and atypical renal cells but NOT renal Cancer and I wonder how many times I'll luck out w/o it being Cancer. I hope I'm wrong but something still ticks away inside of me saying I think this is cancer and I will have a TT on the table ..... if it isn't then I'll be VERY HAPPY and very WRONG in my instincts which will be good news.
Thanks for letting me ramble a bit of me in your post .. I hope you don't mind :)
Just rememeber we can only Fear one thing and that Fear Itself.
I just read an excellent long article from Ultrasound Quartly about what ultrasound features require an FNA and ultrasound follow up and they describe common ultrasound features of benign and cancerous thyroid nodules and one of the things they explained is that in 15-30% cases of papillary cancer there is often an incomplete halo and I have read this elsewhere too,I have a discontinous hypoechoic ring around my biggest nodule the 8mm which also has some blood flow inside.It really makes me mad that my internist didn't regognize these as worrisome signs! It also says that 87% of cancerous thyroid nodules are hypoechoic but that 55% of benign thyroid nodules can be hypoechoic too,it's more likely to be cancer when it has other features especially califications.
Yes I did have cancer, unfortunately. And I did find in my research that the bigger the tumor the more likely it is cancer. That's why the large nodules are more likely operated on than the small nodules which are normally monitored. "Prognosis directly related to tumor size [less than 1.5 cm (1/2 inch) good prognosis]" http://www.endocrineweb.com/capap.html. That's not to mean that small nodules are never cancerous but there is a lesser chance. Good luck.
If you look up thyroid incidentalomas or thyroid microcancers on google.com search engine you will find tons of good medical papers explaining that they have found that the size or the number of nodules is not less likely to be cancerous and that thyroid microcancers are quite common but clinical larger thyroid cancer is more uncommon.
I'm going to an endocriniologist on January 17th at University of Penn Hospital and he was recommended by a top doctor there who specializes in thyroid cancer Dr.Susan Mandel. I spoke with her for a minute over a month ago and I said I need to know if I should see you. So she said it depends what your ultrasound shows and she asked me to fax it to her and I had my internists office fax it to her. Her secretary and the woman who runs the nursing office called me and said Dr.Mandel read my ultrasound and said that I don't fit her criteria and recommended I see a reugualr endo doctor at the same place. I asked the woman who runs the nursing department why would Dr.Mandel say I don't fit her criteria when my ultrasound describes some of the features including blood flow in one of the nodules,that Dr.Mandel wrote in several online articles is a definitive cancer marker! I don't understand this at all and she also wrote that in 79% of cases thyroid cancer was hypoechoic on ultrasounds!
No sense arguing about the point now since I do have cancer and I underwent a TT with a 2.8cm (very large tumor). I can only go by experience and my research. I didn't google, I went to the actual cancer sites which are more reliable. Good luck.
That is where I found this great reliable information google.com takes you to great medical sites articles written for the journal Of Endocrinology and Metabolism by endocrinologists and ENT surgeons.
they have found that the common worrisome features such as calification,irregular borders,blood flow inside,hypoechoic,incomplete halo are factors more predictable then the sizes. In the past it used to believed that the bigger the nodules and that if you had more than 1 thyroid nodule it was less likely to be cancer,but now they have found it's not true. If you look up on google.com American Association Of Clinical Endocrinologists Task Force On Thyroid Nodules it is an extensive paper presentation from this year and has oncologists and endocrinologists as commitee members and chairpersons.