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Ultrasound results - feedback greatly appreciated
Dear Dr. Lupo,
I am a 41 YO female, dx'd with Hashimoto's a few weeks ago. Mother and sister have thyroid disease, maternal aunt with thyroid cancer. I have elevated TPO and TG Ab antibodies. Last TSH (early April) was 3.551. Among my symptoms are a throat lump feeling and hoarseness. Endo felt nothing and was inclined to wait a few months for an ultrasound, but I insisted on one as the throat lump feeling is bothersome, although not painful.
Today I received the results of the ultrasound, as follows:
Right lobe measures 4.6 x 1.7 x 2 cm and demonstrates heterogeneous echotexture without focal lesions. Left lobe measures 4.5 x 1.3 x 1.4 cm with heterogeneous echotexture. There is a 1 x 0.7 x 1 cm hypoechoic solid nodule in the lower pole demonstrating mild central flow.
Isthmus measures 2 mm.
No significant adenopathy noted near the carotid vessels, or the thyroid gland.
Thyroid gland is within normal limits in size with diffusely slightly heterogeneous echotexture and a 1-cm nodule in the lower pole left lobe.
I'm not going to jump to conclusions but the hoarseness and the characteristics of the lesion seem to be potential cancer warning signs from various readings I have done. I'd appreciate your opinion on this so I can better understand what I may or may not need to be doing. The endo has scheduled an FNA for late May.
I am a 41 YO female, dx'd with Hashimoto's a few weeks ago. Mother and sister have thyroid disease, maternal aunt with thyroid cancer. I have elevated TPO and TG Ab antibodies. Last TSH (early April) was 3.551. Among my symptoms are a throat lump feeling and hoarseness. Endo felt nothing and was inclined to wait a few months for an ultrasound, but I insisted on one as the throat lump feeling is bothersome, although not painful.
Today I received the results of the ultrasound, as follows:
Right lobe measures 4.6 x 1.7 x 2 cm and demonstrates heterogeneous echotexture without focal lesions. Left lobe measures 4.5 x 1.3 x 1.4 cm with heterogeneous echotexture. There is a 1 x 0.7 x 1 cm hypoechoic solid nodule in the lower pole demonstrating mild central flow.
Isthmus measures 2 mm.
No significant adenopathy noted near the carotid vessels, or the thyroid gland.
Thyroid gland is within normal limits in size with diffusely slightly heterogeneous echotexture and a 1-cm nodule in the lower pole left lobe.
I'm not going to jump to conclusions but the hoarseness and the characteristics of the lesion seem to be potential cancer warning signs from various readings I have done. I'd appreciate your opinion on this so I can better understand what I may or may not need to be doing. The endo has scheduled an FNA for late May.
Just a patient, just an anecdotal evidence based opinion.
In addition: Can't hurt to get a GI eval ( though to be honest I found the tests, and their after effects, unpleasant) but I would not write off your thyroid.
I also initially went into the regular doc with a feeling of something stuck in my throat and, without even palpating my throat, the PCP sent me straight off for a slew of GI testing. All perfectly normal results came back, including a biopsy the looked for eosinophils which would have been indicative of allergy/sinus problem. My ENT had just examined me and pronounced my sinuses clear but he chekced, I assume it was a rotuine part of the endoscopy.
Started taking PPI's (Prilosec) anyway and they made no difference, still felt something physically in there.
It was almost 9 months later when my cardiologist ran a routine TSH test that came up abnormal. I was sent back to that the self-same PCP who finally felt my throat and said, and I quote:"Yes, I do feel something in there, but you are so skinny maybe things just stick out on you."
My TSH has switched from hypo to hyper in the course of the last year and is currently normal where I hope, against hope, it will stay. My new endo is reluctant to give me any thyroid replacment hormone for fear of making the instability worse. Last TPO antibodies were around 1300.
The lump is still ever-present with periodic hard pain in the throat that radiates to my jaw , especially with exertion, and during two FNAs the exact same pain was reproduced when the thyroid nodule was pierced.
The first one was done by the doc who did it in his office, 9 passes with no useable sample. The second was done by a pathologist in a hospital and was done adequately with just a few passes, so be sure someone is on site who can verify that your sample is adequate for evaluation.
Oh and the undetectable reflux went away when the hyperthyroidism, which prompted increased appetite and excessive salivation, did.
Hope you feel better soon. FNA follow-up at 6 months is common practice.
In addition: Can't hurt to get a GI eval ( though to be honest I found the tests, and their after effects, unpleasant) but I would not write off your thyroid.
I also initially went into the regular doc with a feeling of something stuck in my throat and, without even palpating my throat, the PCP sent me straight off for a slew of GI testing. All perfectly normal results came back, including a biopsy the looked for eosinophils which would have been indicative of allergy/sinus problem. My ENT had just examined me and pronounced my sinuses clear but he chekced, I assume it was a rotuine part of the endoscopy.
Started taking PPI's (Prilosec) anyway and they made no difference, still felt something physically in there.
It was almost 9 months later when my cardiologist ran a routine TSH test that came up abnormal. I was sent back to that the self-same PCP who finally felt my throat and said, and I quote:"Yes, I do feel something in there, but you are so skinny maybe things just stick out on you."
My TSH has switched from hypo to hyper in the course of the last year and is currently normal where I hope, against hope, it will stay. My new endo is reluctant to give me any thyroid replacment hormone for fear of making the instability worse. Last TPO antibodies were around 1300.
The lump is still ever-present with periodic hard pain in the throat that radiates to my jaw , especially with exertion, and during two FNAs the exact same pain was reproduced when the thyroid nodule was pierced.
The first one was done by the doc who did it in his office, 9 passes with no useable sample. The second was done by a pathologist in a hospital and was done adequately with just a few passes, so be sure someone is on site who can verify that your sample is adequate for evaluation.
Oh and the undetectable reflux went away when the hyperthyroidism, which prompted increased appetite and excessive salivation, did.
Hope you feel better soon. FNA follow-up at 6 months is common practice.
Get the 1 cm nodule biopsied. The likelihood of cancer is low, but, it will put your mind at ease. I have similar symptoms and my Endo says it's the inflammation from the Hashis. Everybody gets heartburn periodically, but if you notice an ever-present difference in your throat I'd bet on the inflammation from Hashis.
Hope you feel better soon.
Hope you feel better soon.
"(heartburn, this can sometimes be silent)"
If you want to google this, look into: Laryngopharyngeal Reflux
I've personally have dealt with this, as well as post nasal drip due to deviated septum and nasal "spur."
~Kate
If you want to google this, look into: Laryngopharyngeal Reflux
I've personally have dealt with this, as well as post nasal drip due to deviated septum and nasal "spur."
~Kate
MEDICAL PROFESSIONAL
It is not a large nodule and there were no suspicious nodes. The 1cm nodule may or may not be the cause of the symptoms -- other common causes would be sinus congestion w/ post-nasal drip OR gastro-esophogeal reflux (heartburn, this can sometimes be silent). An FNA is the next logical step -- if benign and you still have symptoms, then an ENT evaluation to see if the nodule/thyroid might be the cause. The overall size of the thyroid is normal, the heterogeneity consistent w/ hashi.
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