Another biopsy

[caraway]

Hello, and I thank you so much for your help and advice.
Current symptoms:  Pain starting in throat (region of the thyroid) that shoots up into right ear, noisy swallowing, changing voice.

I am awaiting a third biopsy this year in the right lobe.  Here are the ultrasound findings:

Right lobe  L:  6.2cm  W:  2.3cm  AP Diameter 2.9cm

The left lobe has been surgically removed (4 years ago benign follicular adenoma)

Impression:

1.  There is again noted to be a solid nodule in the mid pole of the right lobe that remains stable 1.5cm

2.  The nodule in the inferior pole of the right lobe has increased in size measuring 1.9 cm and therefore I would recommend a biopsy of the inferior pole nodule.  

Blood work.  TSH .990  
T4  1.2
ThyroperoxidaseAb <20
PTH 63
Vit D2  <4.0
Vitamin D3 14
Vit D total  14
Calcium 9.6

Pathology and Observation of the right lobe when left lobe taken out 4 years ago was "essentially normal"

I am now taking 1,000 i/u of Vitamin D.  
My maternal great grandmother had thyroid cancer

With one nodule 1.9cm and another 1.5cm-I am wondering if I am a candidate or if I should be contemplating having this right lobe removed.  The first biopsy I had on this thyroid was 9 months ago, and that came back with mostly colloid tissue, follicular, and hurthle cells.  The new endocrinologist wasn't happy with the sampling, and a new biopsy was ordered.  The second biopsy was done on the 1.5cm nodule only (again, it was benign).  This third biopsy is going to be done on the inferior 1.9 cm nodule that is growing.

Is another biopsy my best choice?  

[Mark Lupo, M.D.]

Probably a good idea to biopsy the growing nodule to be certain. The labs are normal except the low vitamin D -- replacement of this is important.

If there are not compressive symptoms (choking, hoarseness, trouble swallowing) and the nodule biopsies are clearly benign, then surgery is not usually necessary.

[caraway]

Nuclear scan shows large cold nodule