Solitary densely calcified nodule on US

[sam4305]

Hello Doctor,
I am a 37yo wf. In 11/08 a nodule was found during a MRI after my complaints of trouble swallowing. I was sent for an US. US stated thyroid was normal size, although a solitary shadowing nodule in the medial aspect of the right lobe was found. They requested an AP radiograph of the neck because they wanted to see pattern of calcification in the solitary calcified nodule. "If a thin peripheral rim of calc is present, this would favor a benign adenoma. Internal calc as opposed to periph calc could indicate malignancy."

I had the plain films done and this was the addendum to original US: "Outside plain films of the neck confirm the presence of 8mm calcified soft tissue lesion in right lower neck region that would correspond to the calcified lesion seen on prior US. Calcifications appear to extend throughout the small nodular lesion in question. A densely calcified lesion such as this would not be a good candidate for FNA and, in clinically indicated, surgical excision should be considered."

I spoke with my ENT at the time who recommended surgery, and after my last appt. with him (I also had to see a neuro and had 2 different barium swallow tests in the meantime, as they said this small size of nodule would not be causing my swallowing troubles), and after his palpitation, he said he didn't want to wait ONE more month to get it out. It is now a year later since my last appt, because I lost my insurance and just got insurance again...ugh!

I have had blood tests and all come back negative for thyroid issues such as hypo or hyper. No family thyca that I am aware of, although cancer claims every single person on my mother's side (all her aunts(7), uncles (5), parents and a brother), and she currently has bladder cancer now.

So my question is this...in your expert opinion, does this sound like a cancerous nodule, being that it is solitary, densely calcified, and I've also read that Medually typically forms as a this type of nodule and in the same area as mine---the medial aspect and upper right side. I see my ENT again on Mar 8, 2010 and we will be scheduling lobectomy. I feel fine, except that at times I can feel 'tingling' and/or a light 'pulling sensation' on the inside of my neck on the R side. I believe I also have a swollen submandibular gland, as it has been swollen under my jaw for the last year or so...no change in size.

Thank you for your time.
Stephanie

[sam4305]

Thanks for your reply!

I accidentally posted here instead of the Expert Forum, but I definately welcome patient replies/advice as well!!

I am very anxious to get the surgery done, and see what's going on...if anything at all. Hopefully not! :) The soonest I can get in is March 8, because my ENT is in the process of becoming a provider for my insurance. He said he can schedule the surgery within the following week. Yeah!!

As far as placement, Meduallary commonly grows in the medial aspect, as this is where the C-cells formulate. Medullary feeds off of C-cells. From what I read, it doesn't neccessarily form here everytime, but it is quite common.

I have spent wayyyyy too much time (lol) reading everything I can find so that IF it's a cancerous nodule, I can be well informed after surgery. If nothing else, I want to encourage others to get their thyroids checked and know that even though your labs can come back clean, you can still have major issues going on. (My GYN tested my thyroid hormones back in '06 because she noticed the right side of my neck bulged out a little more than the left side. Labs came back OK, so she said it was nothing. UGH! I didn't know any better......)

Anyway, thanks again for your comment. I appreciate it and I'm heading that direction:)

[utahmomma]

We are all just patients here but I can tell you that a solitary, densely calcified nodule needs further investigation.  My papillary carcinoma was also in the medial aspect of the upper right lobe.  Placement doesn't mean a certain type of cancer.  There have also been many calcified, solid nodules removed that were benign.

Sounds like you are on the right track meeting with your ENT and scheduling the lobectomy - just to be safe.

Be well,

Utahmomma
papillary carcinoma '03, second surgery '04, recurrence and RAI '06
three sisters with papillary carcinoma

[sam4305]

My ENT also found a cyst under my tongue that he will drain during surgery, he also stated it is not large enough to warrant dysphagia. My primary physician basically told me it's in my head...this was before the nodule was even discovered. I have been tested for myasthenia gravis and MS. I had some issues last year including IBS, acid reflux, urine retention, and pre-cancerous cells found on my cervix, fatigue, depression, anxiety, tinnitus, and a huge pressure feeling in my neck...like I was blowing up on the inside and being choked at the same time. I haven't had any troubles for quite some time, I believe it was stress. I have not been tested for lupus.