I hope this helps. My mom had a sub-sternal goiter. The surgeon Dr. told her it was very large. I suggest you talk to a surgeon. I had nodes that were cancer. Both my mom and myself had a total thyroidectomy this year. My sister has a goiter also.
The surgeon said it's not if you will need surgery, it's when. Sounds like yours is already causing you problems. It only gets worse. My mom went hypothyroid and ended up in the ER.
We both had blood tests that showed our thyroids were working. I would save the trip to the Endocrinologist for after you find out about surgery. Get a name from your Dr. for a highly recommended surgeon, one he would go to. It's worth a consult.
Not everyone who has a prominent thyroid has to have it removed. My thyroid was very large and I had multiple nodules when I was first diagnosed with hypothyroidism. I have Hashimoto's, which is what was causing this to happen. The thyroid antibodies have now completely destroyed my thyroid, so it produces nothing. My endo can't even feel it anymore.
Have you had any thyroid blood work done? Not everything can be seen from the ultrasound and CT scans. They won't tell you how much hormones your thyroid is producing. You need to get the Free T3, Free T4 and TSH tests done. You should also ask for thyroid antibody tests to confirm/rule out Hashimoto's. Those tests are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobuliln Antibodies (TGab).
I'd suggest that you go on to the endo and make sure you get the proper testing done. In most cases, TT is not needed. The low density regions are most likely nodules, which many of us have and are usually no cause for concern. A 4 mm nodule is quite small.
Hypothyroidism can cause your thyroid to be swollen and inflamed. It can also cause hoarseness, as well as other symptoms. You may only need replacement medication to alleviate your symptoms.
I have had all the thyroid blood work done. It has all come back with in normal ranges. My primary care doctor says my thyroid is working fine. He also tested for thyroid antibodies and that result was normal aswell.
Was the uptake normal, as well, I take it? Do you have any symptoms of thyroid problems besides the voice and problems swallowing? Also, how long have you been having these problems? I don't think it's a bad idea going to an endocrinologist, and for what it's worth, my thyroid was twice the size it should of been when I had Graves', but I had no cancer-it was just swollen.
Could you post the actual results of the thyroid blood work; often results are in the "normal" range, but they aren't always "normal" for the individual. Be sure to include reference ranges, as well, since reference ranges vary lab to lab.
T4, Free .93 (.82-1.77)
TSH .951 (.450 - 4.50)
Thyro Perox 21 (0-34)