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Solid hypoechoic nodule on isthmus

Can I please get help interpreting? My insurance switched with a new system and my FNA was cancelled. Not sure how long until new one.

RIGHT THYROID: Measures 5.9 x 2.1 x 1.9 cm. There is heterogeneous echogenicity and normal
color Doppler flow. No significant discrete nodules.
LEFT THYROID: Measures 5.3 x 2.2 x 1.4 cm. There is heterogeneous echogenicity and normal
color Doppler flow. Mixed cystic and solid hypoechoic 1.3 x 1.3 x 0.7 cm nodule with punctate
echogenic foci mid left thyroid TR 4.
THYROID ISTHMUS: Measures 0.52 cm. Solid hypoechoic 1.4 x 0.6 x 0.4 cm nodule in the right
thyroid isthmus TR 4.
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649848 tn?1534633700
I had a TR 4 (moderately suspicious) nodule last year that they couldn't find on this year's ultrasound.

I'm wondering if you're taking thyroid hormone medication and what your actual thyroid levels might be.  When my nodule was classified as TR4, my thyroid hormone levels were very low and TSH was the highest it's been in 15 yrs.  This year, when I had the ultrasound, my TSH was suppressed and FT4/FT3 levels were well within the normal ranges.
Helpful - 0
I’m not on medication and my last thyroid labs were 6/23/22. TSH was 1.11, T4 1.4, Thyr Peroxidase Ab <3 IU/mL My thyroid levels has not been discussed.
Avatar universal
Thank you for the information. I do have Hashimoto's. It runs in my family and my great-grandmother had thyroid cancer. Not sure which kind. I have been monitored off and on. It depends on the doctor. I will be following up this next week. I’m hoping to find a really good team of doctors with the insurance switch.
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Avatar universal
The main concern from the ultrasound are the nodules.  Before I get to that, the heterogeneous echogenicity is often found in people with Hashimoto's or Graves diseases - do you have one of these thyroid autoimmune conditions?  (Heterogeneous echogenicity can also be caused by thyroiditis not caused by autoimmune condition.)

Most thyroid nodules are not cancerous.  90-95% of thyroid nodules are not cancerous.  FNAs are usually recommended when the size of the nodule is above 1.5-2 cm, which makes them more likely to be cancer, or sometimes when it is above 1 cm and has certain characteristics that make it more likely to not be benign, such as calcifications, mixed solid and cystic components, or hypoechoic texture.  This does not mean the nodule is cancerous, just that it is more likely than nodules without those characteristics, and further investigation needs to be done.  

I had a hypoechoic nodule that was around 1.3 cm, which was biopsied.  They gave me a 25% likelihood that is was cancerous after the ultrasound, and 33% chance after the biopsy (mine ended up being cancer, but that certainly does not mean yours will be cancerous, just that they need to look at it and decide what the best follow up is -- for example continue to watch by ultrasounds every 6 months to a year, or possibly thyroid surgery based on the FNA results).  I think they would probably want to do an FNA  on both the nodule on the isthmus and the one on the left lobe, since both are hypoechoic and one is partially cystic.

As for not knowing how long it will take to get an FNA - most thyroid cancers are slow growing, and doctors will often wait until a thyroid nodule gets to a certain size to even do a biopsy, even with more suspicious characteristics.  My thyroid surgery was scheduled for over two months after we got the biopsy results back, and the follow-up second thyroid surgery was scheduled for two months after the first, after I was diagnosed with papillary thyroid cancer.  So I don't think it is something you need to rush to do quickly, but it is also not something I would put off for a few months either (mostly because not knowing what the next step was with my thyroid treatment was much worse than actually being diagnosed with thyroid cancer, for me I get anxious about the unknown).

I hope this helps - at this point we can't really tell whether the nodules are benign or not until they do a biopsy, and only then can you start making decisions about what the next course of action is for the nodule.  Most solid nodules are benign, and even with more suspicious characteristics, there is still a good chance your nodules are benign, they just need further examination.

Good luck and take care,
Helpful - 0
Thank you Sara. Hope all is well.
My updated results from this November.

THYROID SIZE: Right lobe: 2.2cm TX x 1.7cm AP x 5.6cm CC. 11.2cm3 Left lobe: 1.7cm TX x 1.4cm AP x 4.7cm CC. 6.0cm3 Isthmus: 0.5cm AP THYROID NODULES: -------------------- -------------------- NODULE #: 1 Previously designated as Nodule L1, assuming same nodule. Location: Left mid Size: 1.1 x 0.6 x 1.1 cm (TR x AP x CC). Volume: 0.4 cm3. Previously: 1.3 x 1.3 x 0.7 cm (TR x AP x CC). Volume: 0.6 cm3. Composition: solid/almost completely solid (2); Echogenicity: hypoechoic (2); Shape: not taller-than-wide (0); Margins: smooth (0); Echogenic foci: Punctate: None; Peripheral/Rim: None; Microcalcification: None ACR TIRADS total points: 4; ACR TIRADS category: TR4 (4-6 points) COMMENT: Diffusely heterogeneous thyroid gland. No other thyroid nodules that meet size threshold criteria for formal TIRADS reporting. No other supra-centimeter thyroid nodules or no 0.5-1.0 cm TIRADS 5 nodules. Previously described right thyroid isthmus 1.4 cm nodule is not definitively delineated on today's exam. Mild diffuse hyperemia. LYMPH NODES: No abnormal cervical lymph nodes identified. A few shotty lymph nodes adjacent to the thyroid isthmus less than 5 mm in short axis.

Being referred to an Endocrinologist.

This ultrasound looks good - it sounds like the nodule on the left lobe hasn't grown larger, which is good.  I'm glad you are being referred to an endocrinologist - if the nodule hasn't changed in size and is small, they might just want to monitor it by ultrasound, or they may want to do a fine needle biopsy.  (Hypoechoic increases the risk that it could be malignant, but the size is right on the border of doing a biopsy or not, depending on what guidelines they are following.)

I haven't been on MedHelp in a long time (I just happened to stumble across this post today as I was cleaning out my email inbox and decided to check out MedHelp).  I returned to work in December 2021, after 7 years of not working (due to health issues) , and things are going really well (except I am much busier and I spend most of my time either at work or running, or recovering from those two things).  I have a friend at work who is now going through their own thyroid cancer journey and I remembered how helpful this site was when I was going through mine.
Welcome back Sarah.  We need your knowledge and experience, especially on ultrasound results.  I hope your friend will use this site for help with her thyca journey.   Best to you.
I’m glad to hear your doing well Sara. Sending healing thoughts to your friend.
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