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thyroid nodule/mass
Saw Gastroenterologist for gallstones. He informed me I had enlarged thyroid during exam. After cholecystectomy, I followed up with Fam. Dr.. He ordered labs and U/S. My TSH is 3.46. (0.27-4.20 ). My TSH was also considered in normal range about 10 months ago. I have had a nagging cough, often worse at night while trying to sleep. I have allergies, so I blamed my allergies for this. I also have numbness and tingling in one hand, but I broke my wrist >10 yrs ago and had nerve entrapment, so I blamed it on the old injury. I have gained a lot of weight over the past couple years, so I assumed my tired, lethargic self was due to overweight. Anyway, my ultrasound states: Both lobes are heterogeneous in echotexture and mildly enlarged. The right lobe measures 5.5 X 2.1 x 1.1 cm. The left lobe measures 5.7 x 2.2 x 2.1cm. There is a dominant 2.1cm mass within the mid right lobe.There is a dominant 3.4 x1.8 cm mass in left lobe. There are adjacent subcentimeter nodules. IMPRESSION: 1. Enlarged heterogeneous thyroid gland,2. Dominant 2.1 mass in mid right lobe 3,Dominant 3.4 X 1.8 cm mass in the left lobe. Further evaluation with thyroid scan recommended. Biopsy may be needed thereafter.
I am wondering about several things, Why is there no mention of these masses being fluid or solid? it seems like this is lacking in clarity and information. Is there a significant difference in the use of the word 'mass' vs ' nodule'? I am scheduled for a thyroid scan in one week, so I am quite apprehensive. Are these masses considered large and worrisome for cancer, or is this seen commonly with thyroid disease?,
I am wondering about several things, Why is there no mention of these masses being fluid or solid? it seems like this is lacking in clarity and information. Is there a significant difference in the use of the word 'mass' vs ' nodule'? I am scheduled for a thyroid scan in one week, so I am quite apprehensive. Are these masses considered large and worrisome for cancer, or is this seen commonly with thyroid disease?,
The uptake scan uses I-123 which is gamma particle emitter (unlike I-131 which is gamma and beta particle emitter); although it is "milder" than I-131 it can cause thyroid storm if given to the patient with longstanding multinodular goiter developed from iodine deficiency.
I-131 in "large doses" (which varies from article to article) causes thyroid inflammation, mutations in thyroid cells, changes in ovaries and breast tissues. (This is why RAIU scan is not recommended for women pregnant or planning pregnancy as well as for breastfeeding women).
Every test has its positive and negative sides, therefore its use should be justified.
In my opinion if doctor does not give clear explanation what are the benefits form the certain test could be either not clearly knowing what he is doing or trying to milk the insurance.
In addition, such doctor could screw up some more tests by messing up tissue sample from FNA (Another dental experience: "Your decay is too deep, I need to do the root canal".Which ended up in perforated root and 6 month of pain in previously symptom free tooth :()
I-131 in "large doses" (which varies from article to article) causes thyroid inflammation, mutations in thyroid cells, changes in ovaries and breast tissues. (This is why RAIU scan is not recommended for women pregnant or planning pregnancy as well as for breastfeeding women).
Every test has its positive and negative sides, therefore its use should be justified.
In my opinion if doctor does not give clear explanation what are the benefits form the certain test could be either not clearly knowing what he is doing or trying to milk the insurance.
In addition, such doctor could screw up some more tests by messing up tissue sample from FNA (Another dental experience: "Your decay is too deep, I need to do the root canal".Which ended up in perforated root and 6 month of pain in previously symptom free tooth :()
Bummer. Other than a waste of resources, does anyone know if there are additional risks? I have read if there is hyperthyroid, there is necessary delay if RAI131 is the treatment, and also if it is euthroid, there can be a slowing to hypothyroid.. Is this correct? Should I "just do it"??
Addendum: my RAi scan was scheduled for today and tomorrow but I rescheduled it for the end of April.
Dr. called and still wants scan. I called a Dr. I used to work for. He at first said the scan was appropriate, but then consulted his radiologist , who said the scan is basically useless info, and should go ahead with biopsy. I called Dr. office, spoke with nurse, and asked her to speak to the Dr. in my behalf, as I am still finding the biopsy to be best course of action, and let him know I spoke with a mutual Dr. acquaintance regarding it. He had her call me back and tell me 'no'- he still wants to scan first....what recourse now? I am feeling stuck here. I think I need a pep talk..
Thanks again. I also wondered about parathyroid and calcium relationship, and also my alk phos may still be fluctuating? after that large gallstone was removed in January! Dr. told my husband it was the size of an egg. I just want to know if it was hummingbird size or ostrich size! lol!
Well, 'Mary had a little Lamb' seemed an appropriate catchy tune for a 9 year old diagnostician.lol. More appropriate than 'Debbie had a Little Nodule'.lol. Sorry, no videos.
. I will ask the Dr. to test TPO and TG antibodies.
As you suggested, I have been reading up. Yes, I will work on being positive and staying busy. once again, thanks for the support, and I will keep you posted.
Well, 'Mary had a little Lamb' seemed an appropriate catchy tune for a 9 year old diagnostician.lol. More appropriate than 'Debbie had a Little Nodule'.lol. Sorry, no videos.
. I will ask the Dr. to test TPO and TG antibodies.
As you suggested, I have been reading up. Yes, I will work on being positive and staying busy. once again, thanks for the support, and I will keep you posted.
Alkaline phosphatase (ALP) is a protein found in all body tissues. Tissues with higher amounts of ALP include the liver, bile ducts, and bone. So this may be related to your liver problems and/or hyperparthyroidism (high calcium levels). Now, (it is a very wild guess!!) it is possible that one of the nodules can be benign parathyroid tumor. Parathyroids are embedded into thyroid gland on some people and may look like thyroid nodules.
Thanks for the voice test! i wish I could see a video of it!
i need to read more about it but from the top of my head it looks like nodule or mass has NOT attached itself to the voice nerve, which is not adding extra risk if surgery will be needed.
There is good idea to for a next blood test to measure TPO and TG antibodies.
Lets stay positive and hope that nodules will be benign!!
Best!!
Thanks for the voice test! i wish I could see a video of it!
i need to read more about it but from the top of my head it looks like nodule or mass has NOT attached itself to the voice nerve, which is not adding extra risk if surgery will be needed.
There is good idea to for a next blood test to measure TPO and TG antibodies.
Lets stay positive and hope that nodules will be benign!!
Best!!
Dr, not in today, but spoke with office staff and asked to be called on Monday. I explained I am uncomfortable about proceeding with scan.
I am wondering if I should go ahead and try to schedule with an endocrinologist also.
I gave my daughter a little audition with Mary had a little lamb, singing neck straight and forward,, then with head tilted back. She said it was clearer with head back ,She said straight forward sounded like there was static,and crackling,(like on the radio) then repeated singing straight forward again, then with light pressure on masses. She said, with pressure on my neck, it sounds like there is a vibration. I feel the vibration, and also notice with my breathing lately. Any idea if the Alk Phos is related? curious. I was surprised that my calcium is 10.1 (8.8-10.2) not out of range but on the high end of the spectrum.. Thanks, I am going to read more of the literature you are referring to and try to keep busy until Monday! Thank You Very Much.
I am wondering if I should go ahead and try to schedule with an endocrinologist also.
I gave my daughter a little audition with Mary had a little lamb, singing neck straight and forward,, then with head tilted back. She said it was clearer with head back ,She said straight forward sounded like there was static,and crackling,(like on the radio) then repeated singing straight forward again, then with light pressure on masses. She said, with pressure on my neck, it sounds like there is a vibration. I feel the vibration, and also notice with my breathing lately. Any idea if the Alk Phos is related? curious. I was surprised that my calcium is 10.1 (8.8-10.2) not out of range but on the high end of the spectrum.. Thanks, I am going to read more of the literature you are referring to and try to keep busy until Monday! Thank You Very Much.
Also does your voice sound better if you tilt your head back while singing?
Does it get worse if you applying light finger pressure to your mass?
The next diagnostic step after getting as many info as possible from the ultrasound could be biopsy.
Does it get worse if you applying light finger pressure to your mass?
The next diagnostic step after getting as many info as possible from the ultrasound could be biopsy.
This is one of the article that describe use of shear wave ultrasound
http://www.thyroid.org/patient-thyroid-information/ct-for-patients/vol-7-issue-7/vol-7-issue-7-p-6-7/
Even the standard ultrasound must use Power Doppler to analyze blood flow in the mass or entire gland.
The radioactive isotope (I-123) scan is used to determine if nodule takes iodine or is not taking iodine.
It was based on the outdated believe that nodules which are not taking iodine are having higher chance to be cancerous.
The recent study shows that:
little less than 90% of cold nodules ( that do not collect iodine) are benign
90% to 95% of warm nodules (that are collecting same amount of iodine as surrounding tissues) are benign
and more than 95% of hot "nodules" that are collecting iodine are benign.
Also nodules smaller than 1 cm will not show up on most RAI scans.
5% chance is not very significant test; if small hot nodule is present the TSH is low (less or equal to 0.1) with normal or high normal T4
Therefore RAI test makes not much sense.
Firm nodules are usually calcified however if they are calcified like an egg ("calcified rim"), they are usually benign.
If youare calling to the doctor ask him about your lymph nodes.
http://www.thyroid.org/patient-thyroid-information/ct-for-patients/vol-7-issue-7/vol-7-issue-7-p-6-7/
Even the standard ultrasound must use Power Doppler to analyze blood flow in the mass or entire gland.
The radioactive isotope (I-123) scan is used to determine if nodule takes iodine or is not taking iodine.
It was based on the outdated believe that nodules which are not taking iodine are having higher chance to be cancerous.
The recent study shows that:
little less than 90% of cold nodules ( that do not collect iodine) are benign
90% to 95% of warm nodules (that are collecting same amount of iodine as surrounding tissues) are benign
and more than 95% of hot "nodules" that are collecting iodine are benign.
Also nodules smaller than 1 cm will not show up on most RAI scans.
5% chance is not very significant test; if small hot nodule is present the TSH is low (less or equal to 0.1) with normal or high normal T4
Therefore RAI test makes not much sense.
Firm nodules are usually calcified however if they are calcified like an egg ("calcified rim"), they are usually benign.
If youare calling to the doctor ask him about your lymph nodes.
Well 898_1, I got nowhere with a call to radiology dept at the hospital. They said they had never heard of a High frequency shear wave u/s, and couldn't assist with getting the u/s reread or reviewed... if the Dr. wanted something specific, then he would have to call. So, I will put in a call to the Dr..
Oh, yes, my neck does have bulging on the left and right, visible and palpable, feels full down to my clavicle,somewhat tender areas traveling up to my ears, and my voice isn't clear like it used to be. I love to sing, but can't get a clear sound or range like I used to. Unfortunately, when I started gaining weight, I thought-wow fat all the way up to my neck now! My hands have been puffy, and I have noticed my eyelid on the right looks a bit droopy.
Thank you for your advice. I am going to call the radiology dept and speak with someone there.
When I visited the Dr., March 11, 2015. I asked for a complete annual physical. The labwork, did not include a CBC, which I think should have been included.
March lab work: My fasting glucose was high:121(70-99), Alk Phos was high: 120(35-105), Cholesterol was high:236(0-200)
.[ In December, my fasting glucose was 88, Alk phos was 108. ]
May 2014, plasma glucose 94, and glucose 99. Alk Phos was 87.(wnl)
My TSH w/reflex to FT4 was 1.38(ref.range 0.40-4.50mIU/L) I don't know if this is significant . I don't understand this test., Can you explain the significance of the two tests and the ultrasound?.; my most recent being March 12, 2015-- TSH:3.46(0.27-4.20) and Free T4: 1.2 (0.7-1.9).
I am not very organized in my thinking right now. sorry. Just a bit frazzled about these reports and no input from the Dr except just do the scan. I have it scheduled in one week, but if there is no need, I would rather move on to your suggestion.
When I visited the Dr., March 11, 2015. I asked for a complete annual physical. The labwork, did not include a CBC, which I think should have been included.
March lab work: My fasting glucose was high:121(70-99), Alk Phos was high: 120(35-105), Cholesterol was high:236(0-200)
.[ In December, my fasting glucose was 88, Alk phos was 108. ]
May 2014, plasma glucose 94, and glucose 99. Alk Phos was 87.(wnl)
My TSH w/reflex to FT4 was 1.38(ref.range 0.40-4.50mIU/L) I don't know if this is significant . I don't understand this test., Can you explain the significance of the two tests and the ultrasound?.; my most recent being March 12, 2015-- TSH:3.46(0.27-4.20) and Free T4: 1.2 (0.7-1.9).
I am not very organized in my thinking right now. sorry. Just a bit frazzled about these reports and no input from the Dr except just do the scan. I have it scheduled in one week, but if there is no need, I would rather move on to your suggestion.
I agree the report must specify type of masses, however:
"out of tune "machine or poorly trained tech may perceive areas with inflammation or with scarring tissue as nodules (tumors);
The cancer is usually accompanied with abnormal lymph nodes (your report says nothing about their condition)
Your TSH is close to upper limit (hypo) considering new proposed range of .3 to 3.3
RAI scan will not add anything because your TSH is NOT low.
Recommendation:
Ask to clarify your report by providing info about type of blood flow in nodules, condition of lymph nodes, types of nodules.
Nodules of these sizes should be visible during swallowing: https://youtu.be/yFa2mReaR2M
Consider high frequency shear wave ultrasound before doing anything else!
"out of tune "machine or poorly trained tech may perceive areas with inflammation or with scarring tissue as nodules (tumors);
The cancer is usually accompanied with abnormal lymph nodes (your report says nothing about their condition)
Your TSH is close to upper limit (hypo) considering new proposed range of .3 to 3.3
RAI scan will not add anything because your TSH is NOT low.
Recommendation:
Ask to clarify your report by providing info about type of blood flow in nodules, condition of lymph nodes, types of nodules.
Nodules of these sizes should be visible during swallowing: https://youtu.be/yFa2mReaR2M
Consider high frequency shear wave ultrasound before doing anything else!
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