Thyroid biopsy advice

[Armygirl73]

So, I'm a bit confused. I received the following US results, prompting a referral to endocrinology. When I should up for the appt the doc wanted to know why I was there. He said I should've already done a biopsy. Then, he said to save time we could just recheck in six months since the nodule was small. I am currently in remission from another cancer so I asked for a second opinion. The new doc said I should have a biopsy, but today I got a call from the clinic director berating me for seeking a second   Was I wrong? At the end of the call, I said if he really wanted me to wait I would but I was worried since my hubby was deploying for the year. He then said he'd do it. I don't want to be a pesky patient, but ...


RESULTS: right lobe of thyroid measures 4.7x1.5x1.7cm and demonstrates amarkedly heterogeneous echotexture w/ill defined regions of decreased echogenicity. There is a .7x.5x.6cm hypoechoic nodule w/in the inferior pole which demonstrates peripheral flow and no microcalcifications. Thyroid isthmus measures 3 mm. The left lobe is 4x1.4x1.4 cm and demonstrates a markedly heterogeneous echotexture with extensive regions of low echogenicity . Recommend endocrinology fu and biopsy.

[Armygirl73]

Thanks so much for your help. I really don't want to be a worry wart, but last time i didn't really assert myself when I needed a biopsy and ended up gong six months past that time and unfortunately the cancer spread. I'm trying not to let that experience influence me too much, but it's hard.

[898_1]

The volume of your right lobe per Brunn et al is 5.7 cu cm. It is larger than average 93 cu cm) but not normally visible on the average size neck. the swelling can be an abnormal cervical lymph node. the enlarged thyroid or nodule is normally visible when patients swallows with head tilted beck.(you may try this test yourself in front of the camera and post video or images somewhere.
The ultrasound description however sounds more like inflammatory process.
Based on your history the next step should be the PET scan; the nodules or lymph nodes in question will light up with suV of 4 and higher.
I am not very familiar though with possible common mets from uterine cancer, but most cancers are spreading via lymphatic system

[Armygirl73]

Thanks y'all. I have an extensive history of cancers in my mothers family as well as thyroid disease. Personally, I am currently in remission from stage three uterine cancer. No one checked my lymph nodes. I haven't been touched other than the US. I recently had a swing in my labs. After nine years of increased doses of synthroid, I had to decrease. I do have some swelling in my collar bone area on my right side and vague aching in my neck and throat which I've assumed were allergies.

[898_1]

What is the condition of neck lymph nodes?
Any past family history of cancers??
As per ultrasound it shows ONLY one small nodule without internal blood flow ( probably benign nodule) and it is smaller than 1 cm.
The heterogeneous echotexture with extensive regions of low echogenicity are commonly is a sign of inflammation.
based on the ultrasound description and if LYMPH nodes are normal, a possible cause of inflammtory process should be investigated. So far there are no firm indications for biopsy

[Red_Star]

"Benign sonographic features

large cystic component
hyperechoic solid
comet tail artefact
halo

Malignant sonographic features

hypoechoic solid
intranodular blood flow
large size: the cut off is often taken as 10mm to warrant a FNA
presence of microcalcifications - almost always warrants a FNA"

- Assessment of thyroid lesions - Dr Yuranga Weerakkody and Dr Jeremy Jones et al.