large nodule on ultrasound

[mlrckm1]

My daugher had an ultrasound and the doctor upon seeing the report is sending her to Centennial Hospital in Nashville, TN   to see the best endocrinologist in Middle Tennessee.   He really didn't say anything except he will call us tomorrow with an appointment for our daughter.   This is making me really nervous.....I am going to type in her report and maybe someone out there can interpret for me as I can't get on the Ask a Doctor site...

Tiny hypechoic nodule in the medial lower pole.  *this may represent a small cyst).  It measures 1-2 mm.  There is a heterogeneous lower pole nodule that measures 3.2 x1.6x2.3 cm.  An adjacent 1.2 cm nodule is also present.  Impression:  Complex bilobed nodule in the lower pole left thryoid glad.  Pathology consult for biopsy is suggested.

Any help would be great!

[Nyxie63]

They'll probably want to do an FNA on the nodules.  What they will do next will most likely depend on the results of the FNA.  General guidelines suggest surgery for anything 4cm in size or over.

An FNA is a kind of biopsy done with a very small-gauge needle.  I've had 2 and, while they're uncomfortable, they're not unbearable.  They do numb the neck, so that really does help.  Make sure the FNA is ultrasound-guided.  That way they make sure to take samples from the nodules themselves, rather than the surrounding tissue.  

Has she had TPO and Tg antibodies run yet?  If not, then get these done before you even think of surgery.  Multinodular goiter is common in those with Hashi's, although I have one and my antibodies are negative.  

You might also want to ask the endo about running an iodine loading test.  This is a simple urine test that measures the amount of iodine the body is expelling.  Iodine deficiency is more common in this country than most people (including drs) will admit to.  Fluoride and chlorine in our drinking water and bromine in our food all block iodine receptors in the thyroid, inhibiting the ability to absorb and use iodine, in spite of the amount of iodized salt we use.

Please keep us posted. :)

[mlrckm1]

Well actually her gastro doctor found a large lump in her throat.....He is treating her for a gastric emptying problem....but wanted to do a general work up to make sure he is not missing anything....my daughter said the lump had been there for about a year...she really didn't think anything about it.....the gastro doctor ordered the ultrasound and as soon as the report came in he contacted us and set us up with our regular doctor, when the regular doctor saw the report, he wants her in with the best endocrinologist in Nashville, TN, one that treats young girls specifically.  We are now waiting for that appt.  The endocrinologist has asked us to bring the films, not just the report....she wants to see them personally.....Both the gastro and the GP have said it is unusual for young people to get nodules....so they want them checked out asap.  We were told to expect a biopsy and possible surgery because of the size of one of the nodules....but other than that...they said nothing....they didn't explain the report, said the endocrinologist would explain it in detail.

The report said her right lobe was 1.9 x6.8 x1.4 cm, left lobe measure 1.5 x 7.5 x 1.4  the isthmus measures 3 mm and appears unremarkable.  

I will keep monitering the boards to see if anyone else has had a similar experience....and if you have any futher advice please let me know.

[zaksmom]

I'm still in the learning stages of this as well, but from everything I've read, most endocrinologist's prefer to do a biopsy of any nodule that is greater than 1cm.  What was the reason for the ultrasound being done?  Did they feel that her thyroid was enlarged?  if so, that would probably represent a "multinodular goiter".  And, I've been told that radiologist reports often refer to further testing (you listed pathology consult for biopsy is suggested) -- to kind of cover their own rear for any sort of malpractice.  This way they've said they were not sure of the makeup of the nodule, and that it should be looked at further.

Let us know what you find out.  Best of luck,
betsy