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Pregnant and "Suspicous" Thyroid Nodule

Hello -
I'm 23 weeks pregnant with our third child, 38 years old, with a history of pituitary issues but not thyroid issues.

At an endocrinologist visit for monitoring my pituitary issues in pregnancy my endo felt my neck and said there had been significant change in the past month or two.  She sent me to get an ultrasound, and based on the ultrasound I have to get a biopsy next week on two nodules.   As of a month ago, anyway, all thyroid readings were normal.

The only symptoms I've had, that I was attributed to pregnancy, are difficultly catching my breath.  Now I'm wondering if this thyroid growth has something to do with it.

I know I have to wait for my biopsy results to really know what is happening, but I would really appreciate it if someone could help me understand my ultrasound results.   Are they really concerning, or is the biopsy just SOP? My biggest worry, obviously, is the pregnancy and if this is something (like cancer) that would need to be treated while pregnant.  

Could anyone offer me some insights? THANK YOU in advance!!!  Here are my ultrasound notes:

FINDINGS: The right lobe measures 5.5 x 1.8 x 2 cm. The left lobe
measures 5.1 x 1.4 x 1.9 cm.

The thyroid gland is smooth in contour and homogeneous in echotexture
with the exception of a few lesions as described below.

Right lobe: Nodule 1, image 19, 2.8 x 1.9 x 2.6 cm, solid, homogeneous,
isoechoic, oval in shape, smoothly marginated, well-circumscribed, not
calcified, peripherally vascular. Indeterminate.

Left lobe: Nodule 1, image 47, 1 x 0.8 x 0.8 cm, coarse central
calcification, otherwise homogeneous and isoechoic, not
well-circumscribed, not vascular. Indeterminant with suspicious
features.

Few other cystic lesions are identified some containing comet tail
artifact typical of colloid lesions.

IMPRESSION: Biopsy is recommended of a 2.8 cm indeterminate lesion on
the right and a 1 cm solid lesion with calcification on the left.
4 Responses
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Avatar universal
Thank you so  much for your responses!

All doctors (Endocrinologist, Surgeon, OB/GYN, MFM) seem to be in agreement that I need to do the surgery ASAP... so it looks that that is the plan.  Apparently, this is growing pretty fast so they want to get it out.  This week, I am doing lymph node mapping to have a better idea of how extensive the lymph node involvement is.

I am scheduled for surgery when I am 28 weeks as that is the earliest they can get me in.  I'm a little nervous since that is technically in the third trimester, but hopeful that being early in the third won't make much difference as far as safety to the baby is concerned.  I'll be doing a total thyroid removal plus a central neck dissection.  Radioactive iodine treatment will wait until after delivery.   It sounds like pain isn't too bad after this surgery, usually, so I'm thankful for that since all I can have is tylenol anyway.

I'm happy to have a treatment plan in place, and feeling optimistic that the baby will come through it all just fine.  It's just hard to not worry when you are pregnant, but I feel I am (we are) in good hands.
Helpful - 0
97953 tn?1440865392
MEDICAL PROFESSIONAL
Please review my initial response (before the results returned) -- while 2nd TM surgery is acceptable, most situations can defer until after delivery with no change in outcome unless there is aggressive behavior/growth noted.  Using levothyroxine to keep TSH slightly low is also a consideration during pregnancy until surgery done after delivery.  Careful ultrasound to evaluate for lymph nodes and invasive features may help this decision.
Helpful - 0
97953 tn?1440865392
MEDICAL PROFESSIONAL
Nodules are fairly common - even during pregnancy.  The right nodule has an indeterminate ultrasound appearance and the left is small but of potential concern due to the calcifications.  Most of these are still benign.  We usually do recommend FNA biopsy during pregnancy for such nodules but can delay surgery until after pregnancy even if FNA is suspicious/cancer without changing the prognosis -- unless there is rapid growth or other changes, in which case, surgery can be done during the second trimester.   Sometimes nodules can cause breathing, etc problems so that may be related.
Helpful - 0
Avatar universal
Thanks for your response, Gibbon!

I just had the biopsy today - and it wasn't too bad.  Unfortunately I just got a call from my doctor (still amazed at the fast turnaround) and it is cancer.   She said it was Papillary Cancer, which from my understanding is very treatable.

She wants me to proceed with treatment right away, which makes me nervous because I'd rather wait until after delivery.   But I will be talking to her about it in person tomorrow and she said we can discuss it.

Does anyone know a reason to treat this during pregnancy?  I thought it was slow moving and could wait.  I'm 24 weeks pregnant now, and my doctor said that the second trimester is the time to treat it.  

Thanks for any insights, I appreciate it very much.
Helpful - 0

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