Hi, Bruce. Lymphoma seems unlikely at this point. Do you have successive scans that show the size has not increased over months? That would be a very optimistic sign.
While the presence of the hilum in a node almost always means not-cancer, the opposite isn't necessarily true: absence doesn't necessarily mean there is a cancer and the cause might be from inflammation instead. Besides, as you know, it's not sure that these even are nodes.
Is the pain possibly from repeated irritation from the pullups? Have you tried laying off from the pullups for a week or so to see if the pain subsides?
If they are nodes, the pain can be from inside as the swelling pushes against the enclosing 'capsule'. Painful nodes usually are not-cancer, btw.
Or a nodule or node can cause pain by pressing against a nearby nerve. The cause of the pain influences whether to remove the nodules for pain relief (besides the main purpose of seeing what they are made of). I'd probably lean towards only doing the FNA, except if the pain is bad enough to want removal of the nodules.
The shapes themselves seem like reactive nodes, being not round. Did you have a color doppler ultrasound that showed no suspicious blood flow? That'd also be a good sign of not-cancer.
Nodes can stay enlarged if there is scarring (fibrosis) inside from inflammation.
You didn't have thyroid cancer, right? That would change everything.
I'd mainly wonder if whatever caused your original thyroid problem is now causing these nodules. Do you have a family history of immune system dysfunctions?
Have you been reading studies like this one about how Dupuytren's is associated with thyroid dysfunction?
https://www.ncbi.nlm.nih.gov/pubmed/12864792
"Musculoskeletal manifestations in patients with thyroid disease."
Also, with the nodules being in the thyroid bed, I'd think that pretty much eliminates any thought of Virchow's node and chest involvement, etc.
Did you have radiation in that area for ablation?
the nodules are right outside the thyroid bed. The only thing i have had are 3 sonograms and a ct. The first two scans did not show anything. The final one did. The only other thing i have noticed is that my lower back and my testicles ache in concert .
Yes i knew that about the DD, my mom and brother both have DD as well. I am the lucky one to have it really bad.
DO you think its weird that these nodules are not getting any better , but in fact the pain seems to be getting worse and more painful? I don't know if the nodules themselves are causing pain, but the fact they are in there pushing against something that is causing the pain.
also weird that they are abnormal in morphology and do not have a fatty hila.
and the pull up thing , it started when i did pull ups ( i could feel it by stressing the muscle) but now, the pain is there constant. I don't have to do any pull ups to feel them. In fact last night i could barely sleep because they hurt so bad ( or the area hurt) .
Thank you for helping me
i am noticing a slight increase in my tesicle pain ( in that area) and my back pain ( lower back) . has me worried too
It's not the usual thing, but also it's not all that rare for people to have enlarged nodes that don't go down - while still being not-cancer. Cat scratch fever is an example.
Your nodules are hypoechoic, which could be from fibrosis. That would mean that anti-inflammatories wouldn't reduce the size.
Normal immune cells such as neutrophils and macrophages can efface the normal node architecture, including the hilum.
Your problem might be from some granuloma.
It might be from inflammatory pseudotumor. That has in the DDx nodular fasciitis - which might possibly have the same underlying cause as your DD.
Maybe your DD is worse than others because general immune activation is periodically stirring it up?
Regardless, I wouldn't go into the biopsy surgery worried that you might have lymphoma. In fact, you can even ask the surgeon immediately afterward about how the nodules looked to the naked eye. Cancer like a lymphoma would look ugly. When he says it didn't look like cancer, your mind would be set at ease immediately, rather than waiting for a followup office visit after microscopic evaluation by the pathologist.
The full resectional biopsy certainly does give a much better chance at diagnosis than just an FNA. As you know, the FNA can miss important cells just by chance; but also the pathologist can see the pattern of cells in the slices from the resection.
thank you . i have an appointment today with the surgeon and tomorrow with an oncologist. I will report back to let you know if your suspicions were correct :)
hey ken-
went to the Surgeon today. She wants me to go see the oncologist to get him to work me up. I have the insurance so I'm going to do it. Now the nodules are painful on both sides. She thinks its weird that i have painful non-fatty Hela nodes but really no other symptoms. Honestly if it wasn't for the pain, i wouldn't be having this conversation. But its probably good because it brought it to my attention.
She doesnt want to remove the nodules yet because she wants to see what what the oncologist wants to do first. She said the FNA is worthless because if it comes back unremarkable, she will want to do the removal anyway so might as well wait.
In other news, the steroids the internal med guy put me on made me feel so bad today ( day 4) that it actually made me feel HYPERTHYROID and made the pain everywhere hurt worse.
She re-did my sonogram today and the nodules did not get bigger. thats a good sign. But its just weird that i have these things in there, but no other symptoms. but extremely painful to touch. Like i have the flu. I wanted to update you, if anything maybe my story will help if others come along after i am gone.
Hi everyone... I hope you don't mind if I jump into this conversation...
Bruce originally had Hashimoto's Thyroiditis, with nodules, which is what prompted his TT in the first place. As we all know, Hashimoto's is autoimmune. I'm not real familiar with DD, but considering all the other issues Bruce has had, if this is an immune reaction, wouldn't it make sense to think an issue would only crop up somewhere else?
I'd rather find the cause and try to stop it, if possible.
no ankle swelling BUT so weird, some soreness in my calf / ankle area. weird.
I think its weird i just have some non fatty Hela nodules in the neck area with zero explanation I guess thats the part I'm worried about :(
Update - went to the oncologist today. First of all i got yelled at because in 2010 i had a PEDA SCAN and it wasn't covered. LOL
Then she told me I'm having an inflammatory response to something. She started groping all my lymph nodes. One on my neck is swollen and one next to my groin. Then the one in the neck areas.
She said that she doesnt think i have cancer. I told her my back hurt so she agreed to a CT scan on my chest. She also did blood work but it didn't seem like a lot of blood. Maybe one tube ( probably CBC and some sort of marker)
Then she told me NOT to get the unusual nodules out and biopsied because chances are they wont be anything. they aren't "big enough" and i told her " 3 CM tumours start off as 1 CM and I'm not sitting on my butt and waiting".
so i think next step is to have the lung X-ray, and then if the pain doesnt leave i am going to have the 3 non fatty Helas removed to biopsy.
by the way, I'm also off the regimen of prednisone and now both sides of my neck hurt
and now my back hurts when i breathe. tomorrow chest X-ray and FNA> both a waste of money.
Bruce, when was the last time you had thyroid antibodies tested? Do you have any idea what they might be, at this point?
my antibodies are like 5 now. So i went in to have the biopsy and they told me these suckers went from 1.05 CM to .38 in my neck. But I'm still in pain in my neck and back. I don't feel like they got any smaller. I can hardly function with this pain.
In addition, i went to the ER last night, ( I'm a cheap skate so for me to drop 2k on a visit there must really be something wrong)
they did a ct with and without, and an Xray of my back and lungs. Both were clear.
blood work came back perfect
Cancer markers from the oncologist came back fine too.
These nodules almost seem like they have their own life, they are getting smaller and bigger like a blow fish!
I am starting to wonder now if its in my esophagus causing the problems and the nodules is a way of responding to it. Or my stomach etc I feel like i have increased random pain in random areas like my back, under my ribs etc. but maybe this is from being on too much hormone. I don't know if its related as well but i have increased dirareah that shows my body is pushing it out too fast ( TMI). anyway i think i need to have this nodule removed just for pain reasons alone. But now i need to find someone to do it because my surgeon wants to do FNA first, thats a waste of time. And the ENT only has an opening on the 24th, by then i may hang myself LOL
ken, now it shows this:
Changes of the total thyroidectomy there are some areas of hyper density present on post contrast images within the thyroidectomy bed which represent residua of the thyroid tissue.
have you ever heard of them going in and just looking around like a Knee?
i have an update! still have swollen lymph nodes on the right side of my neck and no one has any idea why! thought i would say hi!
and we are back. strep throat 2 weeks ago. Lymph node under neck back again. Hurts like heck. The strep is gone, lymph node still very painful and present. has anyone every heard of this?
just in case anyone decides to search this up on here, it is 2 years later and the neck thing Is back. I have no idea what this is but I do know I just searched the problem up on here and MY post came up. I am thinking that something auto immune or a virus gets the lymph nodes upset or something. It is weird that almost exactly 2 years later my same issue is back. Maybe this is my body's reaction to a virus. But it is very scary how painful the lymph nodes can get when they are upset.
It was good of you to post the update, Bruce.
"It is weird that almost exactly 2 years later my same issue is back."
Maybe the timing is a coincidence, or maybe there is some trigger in your environment. Ultra humidity. Pollen. Mold. Parasite. Did you travel?