Swollen thyroid found in routine gyn. Exam.
History: TSH 9.65, 54 yr. woman, weight gain and extreme fatigue. Daughter has Hashimoto's , sister had papillary thyroid cancer.
US Findings: Scan of the thyroid gland show the right lobe to measure 4.7 x 1.6 x 1.9 and the left lobe 4.3 x 1.8 x 1.8 cm. The gland is diffusely heterogeneous in echotexture. There are at least three more distinct nodules, in the lower pole of the right lobe measuring 6 x4 x 4 mm and 9 x 8 x 9 mm and in the upper portion of the left lobe measuring 12 x 7 x 8 mm the latter being hyperechoic. There is no adjacent adenopathy or other abnormalities identified.
IMPRESSION: Mildly enlarged thyroid gland with multiple bilateral nodules. The sonographic features are most consistent with a multinodular goiter. I would however, recommend a follow up ultrasound to confirm stability. These nodules would also be amenable to fine needle aspiration as clinically warranted.
Please help me understand what is being said here.
1. Should I be concerned that the gland is diffusely heterogeneous in echotexture?
2. Or that one of the nodules is hyperechoic?
3. When follow ups are recommended does any change that might be detected indicate something bad?
4. Ideally should there be absolutely no change?
5. Does any of this sound alarming to you?
Thank you.