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.
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.
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,