How often to have an FNA? TSH lvel checked?

[HighMinus]

I am a 61 year old female disganosed with hypotherthroidism 3 years ago. Overall health is good - need to lose weight of at least 30 lbs. My Endocrinilogist has prescribed that I take Levothyroxin 75mcg daily and have been doing that since 6/2008. I have stayed with the same medical group and Dr. I also have a 4.5cm complex thyroid nodule on my right thryoid that had been checked out with 3 different ultrasounds and FNAs. There has been too much blood and not enough cells when last FNA was done for a clear diagnosis on the nodule. My last TSH blood test in 5/2011 was in the normal reange at 2.6.  
I do not have symptoms from the nodule. It is not that noticable when looking at my neck and surrounding area.
Do I continue to have annual FNA testing? Do I continue to have annual bllod work or more oftern?
Is it time for another Dr's opinions?  Will I enventually need surgery to remove the nodule?
Thanks for your time.
HighMinus

[HighMinus]

Doctor,
Thanks for your reply.
I plan to make a follow up appointment with my Endocrinologist in the next month. At the beginning of finding I had a thyroid disorder, I had blood tests more often. Now, it's been done annually. The latest FNA was done on 7/7/11. Other FNAs and ultrasounds were in 2008 and 2009 There was too much blood in the FNA on his nodule in two out of the three FNAs. The nodule has always been this size since the 2008 diagnosis.
Since I am not having pain or neck discomfort, no problems swallowing, no hoarseness,etc., I have felt surgery has not been needed. Think there is more risk with surgery. Worry that a benign nodule can become cancer. From reading many hospital sites on thyroid disease like Mayo Clinic, Cedars Sinai,etc.it sounds like surgery is not always needed to remove nodules.
I guess I may need more info. on long term thyroid treatment. Medication appears to be working as first TSH was almost 5. It's been in the normal range staying on the daily meds. Right now, I have good HMO insurance and it covers blood tests and the FNA as part of the office visit $15 co-pay. I worry about losing this coverage if something happens to my employment in the future and then not sure I could afford out of pocket expense for all the testing and surgery.
Oh well, another examply of our own Drs. not giving us all the answers - that is why patients are her on these forums.
Again, thanks for your interest and time.
HighMinus

[Mark Lupo, M.D.]

This is a large nodule that requires adequate FNA or surgery.  Some would argue that all nodules >4cm should be removed, but it really depends on individual patient circumstances.  Would not wait for annual ultrasound/FNA.  Repeat FNA in 2-3 months or at least consult with a surgeon to discuss surgical option.