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What would you guys think
Ok I posted this to another endo but want your opinions. Seriously I am totally on the fence and don't know what to do - Of course this is long (don't expect anything else from me) but through.
Good Morning
A short background on my thyroid disorder. 2003 Dx/Graves - 2004 RAI - present Hypothyroid (subclinical 3.34) medically induced. Taking Armour meds since Oct 2007. Feb 2008 I requested an ultra sound due to "feeling of something stuck in throat" this sensation has been going on since the RAI in 2004. In the past have I expressed this with 2 endos- GI - ENT and many MD's.
Recently in Oct 2007 I made a switch to another MD and he ordered the US per my asking.
Results/ Findings : on Feb 2007 US - The right lobe measures 2.2c1.0c0.9cm It has mildly heterogeneous echo texture and margins are indistinct. There is an increase cascularity associated with it . Left lobe measures 3.4x1.6x0.9 cm In lower left pole well circumscribed oval isoechoic nodule 11x10x8 . Mildly increased vascularity. Remainder of left lobe /mildly hetergeneous echo texture. Isthmus appears quite atrophic. There does not apprear to be a mass effect by the thyroid or the left thyroid nodule upon adjacent strictures.
Impression : Decreased size of the thyroid due to RAI or thyroiditis. Solidary 1cc solid nodule in the lower pole. It's isoechoic echo texture suggests beign lesion, but amenable to US-guided FNA if desired.
Attempt an FNA - March 3- could not sample tissue
Findings: An attempt was made at location with US guided neddle biopsy but due to the deep location and size I was unsure if the needle tip was in the lesion itself. (this report just goes on on how he could not obtain a sample after 7 agonizing tries.) He does note at the bottom that "Note is made that the lesion may represent a parathyroid adenoma."
We'll the hyperparathyroid situation is not an issue and I had all the appropriate tests VitD, serum and ionized calcium, phosphorus, PTH all coming back normal. Suggestions from radiologist report Three to six month follow up suggested ( for what? another US or anotheer FNA?)
During the FNA procedure they radiologist and the US tech urged me not to have the procedure due to the their thoughts of the parathyroid issue. it was the most tramatic biopsy anyone could have had and took over 30 mintues to finally stop trying. I was bruised from adam's apple to left collarbone and the pain during the attempt was unbelievable. I almost fainted at the procedure. Literally sweated right through my garments.
From the US reports - what are your feelings about the nodule itself?
Should I be "overly concerned this is cancer by what the first US report says?
Due to the deep lesion and an attempt made with no sucess - should surgery be optional instead of a second FNA?
Do you feel my thyroid may still be working on it own along with the meds?
I am totally scared to go through this again with what happened during the first FNA. Due to the swelling I felt I couldn't breathe right for two days. and the panic of facing that again is unbearable for me. I suggested a seditive or "twighlight" IF another FNA was needed and was told this is not an option.
I am so unsure who to listen to- I have so many doctors and none of them are on the same page.
MD is not concerned on the findings of the original report.
ENT says I am a greater risk of it being cancer due to RAI - from the first report.
Radiologist states parathyroidism / do not advise another attempt- (he even went as far to say - quote: "If you were my sister - this procedure would have never been done!" that freaked me out!!
Endo says nothing except repeat biopsy in 4 weeks and quit being anxious. ( not a very personable doctor)
What would you suggest?
Good Morning
A short background on my thyroid disorder. 2003 Dx/Graves - 2004 RAI - present Hypothyroid (subclinical 3.34) medically induced. Taking Armour meds since Oct 2007. Feb 2008 I requested an ultra sound due to "feeling of something stuck in throat" this sensation has been going on since the RAI in 2004. In the past have I expressed this with 2 endos- GI - ENT and many MD's.
Recently in Oct 2007 I made a switch to another MD and he ordered the US per my asking.
Results/ Findings : on Feb 2007 US - The right lobe measures 2.2c1.0c0.9cm It has mildly heterogeneous echo texture and margins are indistinct. There is an increase cascularity associated with it . Left lobe measures 3.4x1.6x0.9 cm In lower left pole well circumscribed oval isoechoic nodule 11x10x8 . Mildly increased vascularity. Remainder of left lobe /mildly hetergeneous echo texture. Isthmus appears quite atrophic. There does not apprear to be a mass effect by the thyroid or the left thyroid nodule upon adjacent strictures.
Impression : Decreased size of the thyroid due to RAI or thyroiditis. Solidary 1cc solid nodule in the lower pole. It's isoechoic echo texture suggests beign lesion, but amenable to US-guided FNA if desired.
Attempt an FNA - March 3- could not sample tissue
Findings: An attempt was made at location with US guided neddle biopsy but due to the deep location and size I was unsure if the needle tip was in the lesion itself. (this report just goes on on how he could not obtain a sample after 7 agonizing tries.) He does note at the bottom that "Note is made that the lesion may represent a parathyroid adenoma."
We'll the hyperparathyroid situation is not an issue and I had all the appropriate tests VitD, serum and ionized calcium, phosphorus, PTH all coming back normal. Suggestions from radiologist report Three to six month follow up suggested ( for what? another US or anotheer FNA?)
During the FNA procedure they radiologist and the US tech urged me not to have the procedure due to the their thoughts of the parathyroid issue. it was the most tramatic biopsy anyone could have had and took over 30 mintues to finally stop trying. I was bruised from adam's apple to left collarbone and the pain during the attempt was unbelievable. I almost fainted at the procedure. Literally sweated right through my garments.
From the US reports - what are your feelings about the nodule itself?
Should I be "overly concerned this is cancer by what the first US report says?
Due to the deep lesion and an attempt made with no sucess - should surgery be optional instead of a second FNA?
Do you feel my thyroid may still be working on it own along with the meds?
I am totally scared to go through this again with what happened during the first FNA. Due to the swelling I felt I couldn't breathe right for two days. and the panic of facing that again is unbearable for me. I suggested a seditive or "twighlight" IF another FNA was needed and was told this is not an option.
I am so unsure who to listen to- I have so many doctors and none of them are on the same page.
MD is not concerned on the findings of the original report.
ENT says I am a greater risk of it being cancer due to RAI - from the first report.
Radiologist states parathyroidism / do not advise another attempt- (he even went as far to say - quote: "If you were my sister - this procedure would have never been done!" that freaked me out!!
Endo says nothing except repeat biopsy in 4 weeks and quit being anxious. ( not a very personable doctor)
What would you suggest?
I forgot .. how big is the nodule?
And, I totally agree the swelling was from the jabs so a sedative isn't going to help the situation at all bcz it sounds like you were compliant .. in other words you still may get swelling with a new FNA ... the sedative will only help you I think and not the radiologist.
My son had to have an injection in his eyelid of cortisone when he was only 6yrs old ... the Opthamologist said the same thing ... have his Ped script the Ativan and give it in his office waiting room 1/2 hr b4 the procedure to have peak effect and it worked wonders! The second injection my son didn't even need the needle ... he knew what to expect :)
I would explore teaching hospital too .. but don't let a resident come near you .. claws out .. teeth hissing ...... purrrrfect specimen for them to learn on LOL!
C~
And, I totally agree the swelling was from the jabs so a sedative isn't going to help the situation at all bcz it sounds like you were compliant .. in other words you still may get swelling with a new FNA ... the sedative will only help you I think and not the radiologist.
My son had to have an injection in his eyelid of cortisone when he was only 6yrs old ... the Opthamologist said the same thing ... have his Ped script the Ativan and give it in his office waiting room 1/2 hr b4 the procedure to have peak effect and it worked wonders! The second injection my son didn't even need the needle ... he knew what to expect :)
I would explore teaching hospital too .. but don't let a resident come near you .. claws out .. teeth hissing ...... purrrrfect specimen for them to learn on LOL!
C~
It was the "new endo's office that said they will not help me with a sedative. They told me I would need to see my MD for an Rx to get one if needed _ I don't see why they could not prescribe me one. Yet he also said he wouldn't treat me with meds either since I take Armour.
I really had done some soul searching this evening - thinking about this whole nodule thing - I may be crazy (hahaha) but since being on this board I have told you my weird symptoms. the "breakfast sausage" in the back of the left side of my neck. The dizzyness once in a while, (which is becoming more prominent and happening often through out the day now) the mild headache all the time on the left side and stiff arm pain under my left arm pit - not anxiety - just an ache always there. The feeling of a "truck" hitting me.... remember?
Always on the left side--- well maybe this nodule and where it is sitting is pressing on something (nerve, artery etc.) causing these symptoms. everything is on the left side including the nodule and towards the back of the neck. Another odd thing is my blood pressure from my last endo appt was 146/88 which my mom said was high while we at the appt. . I didn't know that - Could it be this nodule is causing these things?...... now who am I going to talk to on this theory?? WHo will listen to this crazy thought?
I really had done some soul searching this evening - thinking about this whole nodule thing - I may be crazy (hahaha) but since being on this board I have told you my weird symptoms. the "breakfast sausage" in the back of the left side of my neck. The dizzyness once in a while, (which is becoming more prominent and happening often through out the day now) the mild headache all the time on the left side and stiff arm pain under my left arm pit - not anxiety - just an ache always there. The feeling of a "truck" hitting me.... remember?
Always on the left side--- well maybe this nodule and where it is sitting is pressing on something (nerve, artery etc.) causing these symptoms. everything is on the left side including the nodule and towards the back of the neck. Another odd thing is my blood pressure from my last endo appt was 146/88 which my mom said was high while we at the appt. . I didn't know that - Could it be this nodule is causing these things?...... now who am I going to talk to on this theory?? WHo will listen to this crazy thought?
It sounds like it's behind the thyroid next to (not connected to) the carotid artery. Just out of curiosity, who told you that having sedation if you get another FNA is out of the question? I've certainly heard of people having mild sedation for that before. Shoot, if they can give people valium before MRI's, they certainly can at least do the same when they stick a big needle in your neck!!!!! I know if I had to have another FNA I'd definitely request some sort of sedation and mine wasn't nearly as bad as yours.
I think it may be time to explore other options. Is there another ENT surgeon you could go to even if it's within the same practice? If not, the University of Chicago or University of Illinois Chicago might be the way to go. Northwestern University has a really good thyroid specialist as well, though his name is escaping me at the moment.
I've had to claw and fight my way with the medical community many times and I know how emotionally draining it is. No matter how much they are "trained" to deal with the patient and not the numbers, they can't help but lump us all together. I just found out today that something happened to me that my doctor had two days before stated was not medically possible. That goes to show that we are all different. No two patients are alike and the medical community needs to learn to treat their patients with dignity and respect and remember that we know our bodies better than anyone else.
Sorry for the soapbox. Please keep us posted!
I think it may be time to explore other options. Is there another ENT surgeon you could go to even if it's within the same practice? If not, the University of Chicago or University of Illinois Chicago might be the way to go. Northwestern University has a really good thyroid specialist as well, though his name is escaping me at the moment.
I've had to claw and fight my way with the medical community many times and I know how emotionally draining it is. No matter how much they are "trained" to deal with the patient and not the numbers, they can't help but lump us all together. I just found out today that something happened to me that my doctor had two days before stated was not medically possible. That goes to show that we are all different. No two patients are alike and the medical community needs to learn to treat their patients with dignity and respect and remember that we know our bodies better than anyone else.
Sorry for the soapbox. Please keep us posted!
Oh my gosh Stella, I'm sorry for all you're going through. In my opinion, your Endo has to go. It's enough going through this ordeal, you don't need to have to deal with his being incompassionate and unprofessional. No matter how good he is, you can always find someone better.
I personally would be scared also to go through the FNA again. Although if you have a gentle, compassionate doctor your experience could be completely different than the first. And as for a sedative, when I had my FNA they gave me a little valium to take the edge off. So it is an option.
I might be wrong but I think adjacent means "close to" the carotid artery. I agree that you should try and get into a teaching hospital. Can you ask your MD for a referral?
I personally would be scared also to go through the FNA again. Although if you have a gentle, compassionate doctor your experience could be completely different than the first. And as for a sedative, when I had my FNA they gave me a little valium to take the edge off. So it is an option.
I might be wrong but I think adjacent means "close to" the carotid artery. I agree that you should try and get into a teaching hospital. Can you ask your MD for a referral?
Adjascent means next to, not joined to.
Posterior means behind, so it sounds like it is on the back side of the thyroid, and most likely attached to the thyroid.
Posterior means behind, so it sounds like it is on the back side of the thyroid, and most likely attached to the thyroid.
I think the swelling was from the jabs - not anxiety. He was really digging deep to get that sample. I posted above his impression, so you can imagine how low and far back it is.
As I read more on the US report the radiologist wrote after his attempt to do the FNA he states:
Impression:
Attempted biopsy of the nodule just posterior to the thyroid bed adjencent to the common carotid artery.
So am I reading it right that "posterior: means not connected to the thyroid bed but is "adjencent" (connected) to the carotid artery?
{{{{{{{{{{{{{[[ am i confused? }}}}}}}}}}}}}}}}}}}}
Impression:
Attempted biopsy of the nodule just posterior to the thyroid bed adjencent to the common carotid artery.
So am I reading it right that "posterior: means not connected to the thyroid bed but is "adjencent" (connected) to the carotid artery?
{{{{{{{{{{{{{[[ am i confused? }}}}}}}}}}}}}}}}}}}}
I am still concerned about injury (risk/benefit) if it is this deep ......a sedative will help you relax but the swelling was not from you being tense I don't think (or was it?) .. KWIM?
When I was so confused after my surgery I did speak quite at length and with frankness to my Prim. Doc. He was good for me helping me decide. But I know you are in a pickle bcz Endo #2 and ENT #1 are a piece of work ...
C~
When I was so confused after my surgery I did speak quite at length and with frankness to my Prim. Doc. He was good for me helping me decide. But I know you are in a pickle bcz Endo #2 and ENT #1 are a piece of work ...
C~
That ENT is a real piece of work - not even the common courtesy of a returned phone call! I'd march down to his office and go to the front desk and ask if he (he?) has been getting his messages, as you have not had a single reply to the ones you've been leaving for weeks. Then I'd ask for a copy of all of your paperwork so you can take it elsewhere, as he is obviously so busy he has no time for new patients. Unreal. I am annoyed for you.
Your MD should be more on your side here -especially since he had to give you a shot after the FNA. He obviously could clearly see how traumatized you were - emotionally and physically. When you see him, you should definitley ask for a sedative for the next FNA, in case you do decide to do it. That way you are covered.
I'd also let your MD know about the ENT - did your MD refer you to him? If so, ask for a referral to another ENT. Tell him you need to see someone else as this one cannot even call you back after the trauma of the test HE ordered! That is not an unreasonable request, and you are entitled to a 2nd opinion, anyway. Will your MD refer you to an endo? I know you had a bad experience w/the last one you saw, but I didn't know if there were others around.
You not in an easy position, and I am sorry about that. I hope it turns around soon!
Your MD should be more on your side here -especially since he had to give you a shot after the FNA. He obviously could clearly see how traumatized you were - emotionally and physically. When you see him, you should definitley ask for a sedative for the next FNA, in case you do decide to do it. That way you are covered.
I'd also let your MD know about the ENT - did your MD refer you to him? If so, ask for a referral to another ENT. Tell him you need to see someone else as this one cannot even call you back after the trauma of the test HE ordered! That is not an unreasonable request, and you are entitled to a 2nd opinion, anyway. Will your MD refer you to an endo? I know you had a bad experience w/the last one you saw, but I didn't know if there were others around.
You not in an easy position, and I am sorry about that. I hope it turns around soon!
AR - the ENT i refer about all the time is a surgeon. He was the one who ordered the first FNA - but has not contacted me back regarding his thoughts. I have called almost a dozen times and not once has he called me back.
No thoughts of shrinking it - but good thought.. good thing to bring up at my MD appt April 10th - thanks.
I have not gotten any answer on any master plan - basically I think these doctors either don't have one for me - or they think I am too crazy to touch. (hopefully not)
I do not think it is bothering me physically. it is kinda in that pocket between the left collarbone and cortaided artery. (that sure was a trip when I was getting that FNA and the radiologist was knicking that artery) eeeeeekk.
What I am leaning towards is since the FNA is difficult to do - I think surgery should be done - I can't win over any thought on this with the ENT and now an endo.
Yes I have Froedert Hospitol in Milwaukee. This is a university school also I have the university of Chicago Hospitol near too ( I live in the middle of these two cities. Froedert seems to only take referrals and I am not getting anyone to refer me. I am still working on Chicago.
I just can't seem to get the pieces connected to move me to a place to get some answers.
Should I just talk over this with my MD april 10? I am sure that visit will be a treat after my last visit with him right after the FNA. I was in sheer panic and swollen so bad he gave me a shot to shrink the swelling from the FNA. He really thinks I am nuts now.
No thoughts of shrinking it - but good thought.. good thing to bring up at my MD appt April 10th - thanks.
I have not gotten any answer on any master plan - basically I think these doctors either don't have one for me - or they think I am too crazy to touch. (hopefully not)
I do not think it is bothering me physically. it is kinda in that pocket between the left collarbone and cortaided artery. (that sure was a trip when I was getting that FNA and the radiologist was knicking that artery) eeeeeekk.
What I am leaning towards is since the FNA is difficult to do - I think surgery should be done - I can't win over any thought on this with the ENT and now an endo.
Yes I have Froedert Hospitol in Milwaukee. This is a university school also I have the university of Chicago Hospitol near too ( I live in the middle of these two cities. Froedert seems to only take referrals and I am not getting anyone to refer me. I am still working on Chicago.
I just can't seem to get the pieces connected to move me to a place to get some answers.
Should I just talk over this with my MD april 10? I am sure that visit will be a treat after my last visit with him right after the FNA. I was in sheer panic and swollen so bad he gave me a shot to shrink the swelling from the FNA. He really thinks I am nuts now.
Let us know when you hear back. I think you stated everything clearly, and I hope s/he'll be able to offer you some answers and advice. You're doing a GREAT job staying on top of things.
Just another thought - have you tried submitting your history to a medical school or teaching hospital to see if they'd take on your case? I don't know if you live close to any (I don't), but I saw where someone else had done that.
Best of luck, Stella!
Just another thought - have you tried submitting your history to a medical school or teaching hospital to see if they'd take on your case? I don't know if you live close to any (I don't), but I saw where someone else had done that.
Best of luck, Stella!
I think you have to go with your gut. Myself, I'd rather have it out if its bothering me in the least or has any chance of being cancerous.
What are you leaning towards?
You have to be your biggest advocate. Take charge of your health and be proactive. You have to take of you. Be the "squeaky wheel". Get whatever tests done that will help you make the decision.
The ultrasound (a year ago?) says "not likely cancer" to me, but they suggest a FNA to be sure. Obviously the FNA is a problem for you so you have to decide whether you just want it out (is it bothersome or causing other issues - breathing, swallowing, etc.) or can live with it. If you can live with it in, then I think you need to know what it is and must try another FNA. Are you near a thyroid centre that does FNAs every hour of every day? I think the least you should do is get a second opinion.
IF the FNA fails again (or if it really is too dangerous according to the second opinion) then maybe TT is the answer. That way, at least, you'll be rid of it and can get on with healing.
Good luck!
What are you leaning towards?
You have to be your biggest advocate. Take charge of your health and be proactive. You have to take of you. Be the "squeaky wheel". Get whatever tests done that will help you make the decision.
The ultrasound (a year ago?) says "not likely cancer" to me, but they suggest a FNA to be sure. Obviously the FNA is a problem for you so you have to decide whether you just want it out (is it bothersome or causing other issues - breathing, swallowing, etc.) or can live with it. If you can live with it in, then I think you need to know what it is and must try another FNA. Are you near a thyroid centre that does FNAs every hour of every day? I think the least you should do is get a second opinion.
IF the FNA fails again (or if it really is too dangerous according to the second opinion) then maybe TT is the answer. That way, at least, you'll be rid of it and can get on with healing.
Good luck!
This may not go over well, but maybe the person who attempted the FNA wasn't "professional enough".
I was in the ER one time and four people spent a half hour taking turns trying to get an IV feed into me. They finally called in someone who was off duty, and she did it on the first try.
This is a quality of life issue, Stella. Assume for a minute that it is not cancerous. Put that issue aside for a minute.
Has anybody hinted they could shrink it?
Can you live with it in there, even if it gets bigger?
If the answer is yes, then you need to find out if it is potentially cancerous. If the answer is no, then you need to get it taken out.
If a surgeon won't touch you without an FNA, is it because the operation would be difficult? Why haven't you been referred to a surgeon for a consult?
What is the master plan if you have another FNA and the results are inconclusive? Then you go see a surgeon.
I don't understand why a surgeon hasn't been involved yet, at least to give an opinion and explain what surgery would involve.
Or maybe you've been there already. My memory is so poor, I can't remember.
I was in the ER one time and four people spent a half hour taking turns trying to get an IV feed into me. They finally called in someone who was off duty, and she did it on the first try.
This is a quality of life issue, Stella. Assume for a minute that it is not cancerous. Put that issue aside for a minute.
Has anybody hinted they could shrink it?
Can you live with it in there, even if it gets bigger?
If the answer is yes, then you need to find out if it is potentially cancerous. If the answer is no, then you need to get it taken out.
If a surgeon won't touch you without an FNA, is it because the operation would be difficult? Why haven't you been referred to a surgeon for a consult?
What is the master plan if you have another FNA and the results are inconclusive? Then you go see a surgeon.
I don't understand why a surgeon hasn't been involved yet, at least to give an opinion and explain what surgery would involve.
Or maybe you've been there already. My memory is so poor, I can't remember.
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