Thiroid Nodule

[julisudman]

Hi. I just had a radiation thiroid test done and my specialist told me that one of the growth is "cold". Can you tell me what percentage of cold nodules are cancer? Thank you

[Mark Lupo, M.D.]

10% - more or less.....this needs FNA biopsy if ultrasound (a much better test for nodules) confirms there is a nodule that corresponds to this cold spot.

[callymissy]

my understanding is that, yes, if you have a hyperactive thyroid (ie, no hyperactive nodules), then the RAI treatment will have a much higher chance (about 80%) of ending in a hypothyroid condition (could be 6mths to 20 years after the treatment).  however, if the thyroid is fine (as is my case) but the nodule is hyperactive, your chances of your actual thyroid becoming hypoactive are much, much slimmer (less than 25% chance).  the reasoning given to me is that RAI treatment goes to the areas of the thyroid and/or nodules that are the most hyperactive first.  

regardless of this, i know that having a hypoactive (low) thyroid and taking a pill for the rest of your life is quite manageable with very little, if any, side effects (family history tells me so).  Dr. told me that there is too high a risk of nasty side effects and future diseases/cancers/bone loss if taking those meds that are designed to decrease the hyperactivity.  safest, least chance of future side-effects, and most curable for hyperactive nodules is RAI therapy.  Surgery is only recommended if the nodule is so large it pushes on the trachea causing problems with swallowing, choking, etc.  Since neck anatomy is sooo complex, my personal opinion is to decide on that as a last resort only.  

by the way, had RAI 5 days ago and no major side effects from the pill at all.  had to isolate myself from family for 48hrs and it was wonderful.  felt like a mini-vacation.  have to get weekly blood work for 6mths but no biggie.  

[unsure613]

My Dr. actually told me the RAI treatment will most likely end in a hypothyroid condition after about 6 months, which then you will need to take medication the rest of your life; however, this medication is a natural replacement vs. the medicine for hyperthyroid which is a synthetic drug and can damage the liver.

"The scan tells whether the nodule is hyperfunctioning (a “hot” nodule), or taking up more radioactivity than normal thyroid tissue does, taking up the same amount as normal tissue (a “warm” nodule), or taking up less (a “cold” nodule). Because cancer is rarely found in hot nodules, a scan showing a hot nodule eliminates the need for fine needle biopsy. If a hot nodule causes hyperthyroidism, it can be treated with radioiodine or surgery."

[callymissy]

my nodule is hot....meaning that it is (hyper)active.  i just had RAI treatment on it to stop the activity in it and, hopefully, normalize my thyroid bloodwork and eliminate (I hope) my symptons.  my understanding (please correct me, Dr., if I am wrong) is that cold nodules are inactive.    i was told that my hot nodule only has less than 5% chance of being cancer (had two ultrasounds and two biopsies and can back benign).  I was also told that since nodule creating the problem, the RAI treatment (only about 1/10th the dose of what they'd give if it was cancer), would go mostly to that nodule, shutting it down and i have a very low risk of causing the thyroid to turn underactive and thus needing pills the rest of my life.  hope I am correct on that.

[stace601]

Hi, I have 9 cold nodules but am waiting for a follow up appointment. Does this mean cold nodules are worse than hot ones???

I thought it was the other way around.