slightly larger thyroid nodule

[tiredpoet]

I have a very, very small isolated nodule described as isoechoic in the lower right pole of my thyroid that is not even palpable.  It was found during an ultrasound 9 months ago (the u/s was ordered because of constant hoarseness of voice and my PC at the time felt my thyroid seemed enlarged - u/s showed it was not, but did discover the small nodule).
9 months ago the nodule was 5mm and now it is 7mm.  Is this a normal rate of growth over 9 months?  7mm still seems very small to me, but I'd hate to have it keep growing and end up being some kind of visible goiter.  And of course I want to be thorough as thyroid disease runs very prominently in my family.  My doctor is recommending FNA to be safe, though it is almost definitely benign.  

Also, could this nodule, small as it is, be causing my voice troubles?  I get hoarse throughout the day, and by the end of the day my voice feels "strained" as though it's been overused, even if I've barely talked all day.  (I also tend to get food stuck in my throat that makes me choke or cough, no matter how small a bit I take or how careful I am, and a feeling of "thickness" in my neck, but this has been going on for several years, where the hoarseness is only within the last 10 to 12 months or so.)

Also, nine months ago my TSH was normal at 1.17 (a year before that it was 1.79 and a year before that it was 2.1) - I do have many symptoms of thyroid disorder, which I know can also be attributed to many other things (though all my blood work has been normal, including the usual suspects like iron and B12).  My main symptom is unrelenting severe fatigue, for which we've not been able to pinpoint any cause.  (depression has definitely been ruled out) Is it possible that although 1.17 falls within the normal range it's just not quite an optimum level for me?  Or would this just be impossible to tell?

[myohno]

HI there! I have had so many issues in the past several years but I saw your post and it's close to what my results turned out to be so I wanted to know if you found anymore out? I had blood work done in 2002 and it showed my TSH low so the doctors office called me to repeat it and then the second one was .68. Normal range there was 0.40-5.50. So he said I was fine and on I went. Never to think anything again until now. In 2006 I came down with Congestive Heart Failure. I'm only 48 now so I was 45 then. They couldn't explain it so they said it was from a virus. Just recently I changed doctors because I am ALWAYS SICK, I've lost almost 50 pounds without trying and I'm cold all the time! My voice gets hoarse then soft, back and forth. I am so tired all the time, I just don't have energy for anything! So, the new doctor orders labs and my TSH is .24. He calls me back in, tells me this and we repeat the test. Second time it's in the lowest part of normal but it was normal. I remember the time in 2002 so I tell him that and I ask him to repeat it for a 3rd time so we can get 2 out of 3. Thier range here is normal .47-.4.68. To no surprise the 3rd one was low again, .26. My Free T3 & T4 were always and still are normal. So they did the MRI of the brain thinking papulary tumor but it was negative. So then he sends me for an ultrasound of the thyroid and here are the results as of today:
Scans throught the thyroid were obtained and demonstrate multiple hypoechoic nodules. 1 in each lobe of the thyroid and 1 in the isthmus; all of which measure less than 5 mm in diameter. Right lobe measures 45.9x16.2x14.9mm, left lobe 30.4x12x10.4. Isthmus measure 5.1 mm.
IMPRESSION
Multinodular goiter without other abnormality
I have had strep throat 4 times this year. My throat hurts all the time. I feel like there is something in the right side of my throat and I can't swallow it down. I have no energy whatsoever and I'm exhausted as to doctors and their medicine. Any input or advise you might have, I would be interested to know! Thanks!
Sandra

[tiredpoet]

Thanks very much.  That definitely answers my question.  I think my doctor must have seen something suspicious and just isn't telling me, otherwise there would not be such a need to biopsy this.

[Mark Lupo, M.D.]

Growth of 5 --> 7mm may well be a technical difference in measurement.  Would not FNA usually in this case unless there are very suspicious ultrasound characteristics or the patient prefers FNA over observation.

[tiredpoet]

Thanks for your response.  My doctor is insisting on a biopsy, that's why I'm wondering if the rate of growth from 5 to 7mm was normal if that's something that's worrying her.  

[Mark Lupo, M.D.]

Theses are small nodules that do not require FNA biopsy at this time and are not likely to be causing your symptoms.  You do need follow-up ultrasound in 6-12 months to make sure they are not changing.  You don't need thyroid meds based on TSH (the slight fluctuation is normal) and your symptoms are not likely due to thyroid.

The voice change, etc is likely due to acid reflux laryngitis - would see an ENT to look at the vocal cord area to confirm this and start treatment plan.