Thyroidectomy?

[Myhope360]

In October 2009 I was diagnosed with hyperthyroidism and multinodular goiter.  I am 43 and female.  My TSH was .098.  The thyroid ultrasound in 2009 revealed a multinodular goiter.  The right lobe of the thyroid gland measures 5.3 x1.8 x 2.6 cm and the left lobe measures 5.2 x 1.9 x 2.1 cm.  There is a heterogeneous acoustical architecture involving the thyroid gland diffusely. Scattered tiny hypoechoic thyroid nodules are seen throughout both right and left lobes.  The largest nodule within the right lobe of is 4 mm in diametre.  The largest nodule within the left lobe is 6 mm.  Within the isthmus there is also a 1.4 x 0.8 x 1.3 cm complex hypoechoic thyroid nodule with both mixed cystic and solid components.  This nodule is predominantly cystic.  A biopsy of the isthmus nodule was normal.  Thyroid scan and uptake finding: Six hour uptake 20.8.  Twenty four hour uptake 37.2.  I have been on Methimazole since oct 2009.  My TSH level have been normal since.  My symptoms are lightheadedness, chest pain, feeling sluggish and the feeling of a ball stuck in my throat. (I don't have acid reflux).  My endocrinologist now recommends a thyroidectomy because of the size of my thyroid and the nodules and maybe a new nodule he hadn't seen before, he also think that my thyroid might be pressing on a vein causing the lightheadedness.  My questions are 1) Is my thyroid really that big that I should have it removed?  2) Could a thyroid of that size be compressing a vein in my neck causing lightheadedness and chest pain?  3) Once a thyroid is removed, how long does it take to get back to normal with synthroid?  4) Is surgery a good recommendation or should I get a second opinion?  5) Is a consultation with a ENT surgeon a good idea at this time? 6) What would be the best scan to see if my thyroid is pressing on a vein or wind pipe?  Thank you for your help

[Mark Lupo, M.D.]

The thyroid and the nodule are not very large, it would be unusual for this to compress a blood vessel in a way that would cause light-headedness or chest pain.  Would consider cardiac evaluation for these symptoms.

It's unclear to me why you have hyperthyroidism - is this thought to be due to nodule(s) or to Graves' (ie, what is the TSI blood test result and is there a hot nodule on scan?).

CT scan can sometimes help with evaluation of possible compressive symptoms - if with contrast, continue the methimazole as contrast can aggravate hyperthyroidism.

[Myhope360]

Thank you for your reply.  At first my endocrinologist was certain I had Graves' but the blood test came back negative.  After that he told me I had two issues unrelated.  A multinodular goiter and hyperthyroidism. (The scan doesn't mention anything about having a hot nodule).  Does this make sense?  Is it possible to have hyperthyroidism and not knowing what is causing it or is there something else to consider?  Would you still recommend surgery?  I don't think I should have it anymore.
Thank you