Thyroid Disorders Community
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253566 tn?1219683299

UltraSound Thyroid - "Consider Biopsy"!?!?

Hi all,
Been on MedHelp for a long time. First time poster to the thyroid community.
Had an UltraSound last week (as well as a few blood tests) and just got back the paperwork... hope someone can interpret the results (I have a referral with an endo July2nd and want to be really (overly) prepared).

Starting with the IMPRESSION:

Enlarged thyroid lobes bilaterally right greater than left increasing in size from the prior study.

Dominant nodule in the midpole of the left thyroid lobe. Consider follow-up ultrasound-guided thyroid biopsy of this nodule.


... and from the beginning...


HISTORY: multinodular goiter.

DISCUSSION: Comparison is made to prior examination dated 04/21/2005

Two-dimensional and color flow images were obtained.

The right thyroid lobe measures 6.3 x 1.7 x 1.9 cm previously measuring 5.1 x 1.5 x 1.8 cm.  There is a mildly heterogeneous appearance the right thyroid lobe.  There is no evidence of a focal nodule.  Color flow is unremarkable.

The thyroid isthmus measures 4 mm in width previously measuring 3mm in width.

The left thyroid lobe measures 5.5 cm in length by 1.8 x 2.0 cm previously measuring 5.0 x 1.2 x  1.6 cm.  There is a iso to slightly hyperechoic nodule in the midpole with mild peripheral vascularity measuring 1.6 x 1.5 x 1.3 cm which is new from the prior examination.

... and then onto the IMPRESSION...

*hope I copied that correctly*


On my blood work it looks like I only had
TSH HHS - 0.871 uIU/mL  -  0.36 - 3.74

other blood work done was: CBC & Auto Diff, METABOLIC, Lipid Profile - If any of those are important let me know and I can report them...


A little about my health issues. I treated for Hep C beginning in the end of 2013. The scan was done in the endos' office and maybe not extremely clear. My numbers showed nearing Hypothroidism and during treatment I was into the numbers of Hypo! Once treatment ended my numbers went back to Normal. I also cleared the Hep C but treatment left many scars and I was granted SSI disability due to chronic fatigue and a number of other debilitating issues.

My Hep C treatment was handled thru the University of Pittsburgh Liver Center and I saw a Endo there as well so very competent doctors.

I was left for years with symptoms that seemed to be endo but all my numbers were normal?!?! Crazy weight gain! Horrible chronic fatigue! Sleep issues so many more... Finally the Mayo Clinic came out with a diagnosis of Post-Interferon Syndrome. This fit me perfectly.


So, back to this issue with my scan. It seems that the one nodule might be cancerous. The little I have read seems the chances are more likely than it is with just one nodule than multiple.

Since it has been nearly a decade since the last scan is the growth of all my measurements pretty minimal?

I am guessing the Endo is going to do the biopsy. Lets say that it is cancerous. What are my options if it is? Is that nodule in the midpole pretty large? If it is removed will I be on medication for life? UGH! I hate meds!!!

My second liver biopsy was pure h@!! - will a thyroid biopsy be H*!! too?

Should I be asking other questions? Is there someone in the community with a similar case I can read up on? especially another male?

btw, I know that the TSH is not the only blood work to go by... SOOOOO... just to be sure this doc does a REALLY FULL workup - is there anything everybody agrees on is a FULL thyroid workup?

I really appreciate any answers on, what seems like a crazy complicated topic!!!
Thanks in advance,
22 Responses
649848 tn?1534637300
Hi Frank

I've been around MH, too for a while, mostly here on the thyroid forum... I'm confused as to what you might be seeing as a cancerous nodule.  Are you talking about the dominant one, mid pole, left lobe? Are you thinking it's cancerous because it's dominant and they recommended biopsy?  

Just to put your mind at ease... less than 5% of thyroid nodules are actually cancer and thyroid cancer is one of the easiest to cure, with removal of the thyroid, since thyroid cancer rarely metastasizes.  Of course thyroid removal leaves you with hypothyroidism, but then I'd have to say "welcome to the club"... I've been there for 7 years without thyroid removal... lol   (sorry, my little attempt at humor)

When you copied, you missed the impression, which is the most important part.  From what I'm seeing, I'm thinking maybe inflammation/Hashimoto's, but I'd really like to see that impression.

Is TSH the only Thyroid blood test that's ever been done? You should also have been having Free T3 and Free T4 tests, along with thyroid antibodies.  I have quite a few friends from the Hep C forum, but I'm not really familiar with what all you have to through to get a clean bill of health.  You'll have to help us with that part, because the drugs could affect thyroid function.
Avatar universal
Hyperechoic nodules without internal blood flow (it has peripheral blood flow only) is not tumor and likely benign.
It is hard to say about autoimmune thyroiditis due to the lack of blood test results (only TSH is given and it is normal)
some medication and medical conditions are causing thyroid enlargement by blocking the transfer of iodine form food to blood and from blood to thyroid.
If doctors will rule out side effects of drugs, peripheral thyroid hormone resistance, low T3 due to the liver problems and autoimmune thyroid disorders, the iodine transfer test may be administered.
253566 tn?1219683299
Hi Barb,
Sorry to be confusing!

I started with the IMPRESSION... lol... knowing that it was so important.


Enlarged thyroid lobes bilaterally right greater than left increasing in size from the prior study.

Dominant nodule in the midpole of the left thyroid lobe. Consider follow-up ultrasound-guided thyroid biopsy of this nodule."

And Yes, that was what I was thinking that it must be the C since they want to do a biopsy!!! I was also somewhat aware that it is probably pretty rare.

Good news to learn that it is easily taken care of! but! Fingers crossed NOT! lol.

My GP did the request and we were just doing test in general since it had been a while (years and years) so I knew that it was not a full thyroid workup. but In the past my numbers were all in the normal range for all those other thyroid test you mentioned *after Hep C treatment ended* - that was many years ago around 2005!

Currently my medical list is: Vyvanse (for chronic fatigue), Omeprazole, Topiramate, Baclofen (both pain meds), Lorazepam (Ativan - anti-anxiety), Ambien.

Interferon (a form of chemo) is the main med for Hep C that I treated with. New patients are lucky as they are trying to do away with it as it is so damaging! Back when I treated the usual was, at the longest, 42 weeks but due to a lab error I was on treatment for 72 weeks! Ribavirin is the other main med. It is a booster med to the interferon. Again, I ended treatment around 2005 and cleared the Hep C. but things never got better and at the Uni of Pittsburgh Liver Center one of the top nurses actually apologized for destroying my life! It was not said lightly and best describes my ongoing daily life struggles! I am not the only one, unfortunately.

This is why I have a bit of a fear of doctors and want to be overly prepared - UGH.

Again, thanks for the reply,f
253566 tn?1219683299
Thanks 898_1,
Very comforting to read your reply and all the mumbo jumbo defined!

I do wish I had more blood work but we were not thinking about thyroid when the doc ordered them... then I got the call that he wanted a scan.

During HepC treatment and more some time after I gained about 70 lbs while maintaining a very strict diet (I lived in Japan so understand portion control) and exercising daily! I never had a drivers license so I am a cyclist and runner and walker. BUT I was gaining weight as if I was living life like a couch potato! and at that time all my numbers were perfect! a real crazy medical mystery. For the first time, this year, in many years, I was actually losing weight without doing anything different. It is just a few pounds a month but everyone is really noticing and FINALLY! but again why?

I have read about blockage of iodine and was thinking it could be that. I only add/use sea salt to my food but am sure that I get enough iodine salt in my regular diet???

I will certainly bring your recommendations to my meeting with the endo.

Thanks again,f
649848 tn?1534637300
You'll need to have the Free T3 and Free T4 tested, along with the TSH. FT3 and FT4 are the actual thyroid hormones and are much more telling than TSH alone, which is a pituitary hormone.  

To be honest, I haven't researched all the drugs you've been on (interferon, etc,), but I know from family/friend who have had various forms of chemo that they can have an effect on healthy tissue, as well as invading cells.  

The meds you are currently on, should not have an effect on your thyroid; in fact, I've been on the Omeprazole myself and am currently on Topiramate.  We've had quite a few members on the others.

The good news is that often Chronic Fatigue, GERD (acid reflux), anxiety, and sleep disorders often go away when one has adequate thyroid hormones and some of the drugs can be dropped, or at least, reduced.  

Do you take the Topiramate for seizures or for neuropathy or for some other condition?  I'm not prying, just trying to figure out a full plan of attack.  I take it for neuropathy caused from years of untreated Pernicious Anemia (vitamin B-12 deficiency).  Topiramate has been studied, and shown to work, as a weight loss drug, so could be considered as a possible cause for your weight loss - just thought I'd throw that out there.

So -- you need to go ahead with the biopsy, as recommended.  Even though thyroid cancer is rare, one must never take chances or ignore a possibility.  The result will come back either negative, inconclusive or positive.  Positive would result in recommendation for thyroid removal, which would then leave you hypothyroid, which is where some of us are - not necessarily from removal, but from destruction from Hashimoto's.  Inconclusive could result in the same recommendation or it could result in a "wait and see" - if given the option, I'd go for removal just for peace of mind.

You need the Free T3 and Free T4 tests and thyroid antibody tests.  Those are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).  Make sure you get them both, because they are both markers for Hashimoto's; some of us have only one or the other, some have both.

There are some vitamins/minerals that some hypothyroid people are often deficient in.  I don't, typically, recommend them, across the board, but because of your history, symptoms and the meds you're on, I'm going to suggest that you get them

Those are: Vitamin B-12, which can cause the most horrendous fatigue you've ever imagined, plus if the deficiency is left untreated, it can cause tingling, numbness, burning in hands, feet and legs, ultimately causing permanent nerve damage, which is what I have and I wouldn't wish on my worst enemy.

Vitamin D is necessary for the proper synthesis of thyroid hormones.

Ferritin is an iron storage hormone and is also necessary for the synthesis of thyroid hormones.  Low ferritin levels indicate low iron stores. High ferritin levels indicate high iron levels or high inflammation levels.

In a nuts shell:  Ultrasound, FT3, FT4, TPOab, TgAb, Vitamin B-12, Vitamin D, Ferritin.

1756321 tn?1547098925
"An ultrasound guided thyroid biopsy is a painless, minimally invasive method that uses a much smaller incision and does not require general anesthesia."

That may be so for a lot of people. My mother tells me her thyroid biopsy was "grit you teeth is it over yet" pain. She was pale and had to lay down as she didn't feel well after the first 10 attempts.  Her nodule was solid so they did 20 attempts! to obtain enough cells.

My mother was also on Nexium, which is stronger than Prilosec (Omeprazole), but this was the wrong treatment as her GERD and LPR as both conditions were due to low stomach acid. She was told she had too much stomach acid and a simple home baking soda test showed how wrong that diagnosis was!  Hypothyroidism is one of the many causes of low stomach acid just to add.  

Today she takes betaine HCL with pepsin supplements to increase stomach acid and digestive enzyme supplements to help with digestion (low stomach acid means you are most likely to also have low digestive enzymes).

A normal thyroid gland is homogeneous (smooth and uniform texture). A heterogeneous thyroid gland is not uniform in structure or composition. Recommended to test for thyroid antibodies.

"Hepatitis C infection is a well-recognized precipitator of autoimmune thyroid disease when treated with interferon therapy." - Hindawi - Autoimmune Thyroid Disorders.''

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649848 tn?1534637300
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1756321 tn?1547098925
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