solid thyroid nodules

[kae2010]

Below is a summary of my thyroid ultrasound and fine needle aspiration report.  I do have a family history of papillary and follicular ca (aunt) and my mother had a partial thyroidectomy as a teenager for unknown dx--limited follow up.  I am curious as to what you would recommend as a next step?  We are hoping to become pregnant shortly (almost 38 yrs old) and I want to make sure that this is not something that I need to worry about prior to that.  Initial ultrasound done d/t fam hx...no palpable nodules or thyroid related symptoms

US:   Rt lobe:  3 nodules, 2 upper pole (10x7x7, 10x9x6) solid heterogenous, some calcifications, 1 mid pole (9x7x5)        Lt. lobe nl

Bx - upper pole nodule, essentially no follicular cells, colloid and histiocytes "raising possibility of goiter"; population of smaller cells w/ nuclear atypia "question degenerating epithelial cells transforming into histiocytes but difficult to determine"; no overt malignancy but recommend close follow up and re-biopsy.

labs:  calcitonin 2, TSH 0.888, Free T4 0.88, negative thyroid antibodies

Do I need to be on synthroid suppression therapy?  Do  I need to wait on becoming pregnant?  How soon should I consider a repeat biopsy...of the same nodule or of a different nodule?  Should I consider a lobectomy?  These are all options that my primary care physician as raised.  

Thank you very much for your input

[kae2010]

I plan on having a repeat FNA in mid June approx. 6 weeks after the previous one.  Should they biopsy the same nodule (3 approx. similar size) or do more than one nodule?  Thank you very much for your advice.  

[Mark Lupo, M.D.]

would confirm benign FNA before trying for pregnancy

[kae2010]

Thank you so much for your input.  I will probably opt for a repeat FNA and will forward slides to one of the specialists that you mentioned.  Do you think that we should hold on becoming pregnant while waiting for these results?

[Mark Lupo, M.D.]

You do not need thyroid medication.  Nodules should not be "suppressed" in most cases.
With plans for pregnancy .... the TSH is perfect at 0.888 and antibodies negative - again, no indication for medication.

With the FNA results....tough to interpret, would consider sending slides for an expert opinion (Nicole Massoll at U Arkansas or Dr Baloch at U Penn).  It may be necessary to repeat the FNA, but would not jump to surgery based on this report.  It does not read as suspicious, but it also appears to be an insufficient FNA.