I have a sneaking suspicion.

[Adepta]

Hi, I have a family history of thyroid cancer (grandmother at age 28, I am currently 25) which I mentioned to my GYN at the age of 16 and from there was recommended to be on watch for any changes. By 19 I was feeling fullness in the front of my neck and sometimes experiencing pain so my PCP suggested I get a thyroid ultrasound. At this time the thyroid was slightly enlarged but otherwise unremarkable. Concerned about my family history they suggested I keep an eye on the situation and return if it continued. By age 21 the symptoms had returned and I was referred once again to ultrasound. At the time they found a single oval-shaped 5mm hypoechoic nodule in the medial left parenchyma which was serrated (?). My TSH, FT3 and FT4 were all within normal limits. I was referred to an ENT to possibly do a FNA and get a better answer. They refused the FNA citing the nodule was too small and decided to 'wait and see' claiming that it was extremely rare for any adenoma under 1cm to be cancerous and claimed it would go away within a few months so they would do an ultrasound in 6 months. This cycle repeated for about two years I believe, the adenoma never went away, and has actually grown although VERY slightly. Last January during my 'checkup' they found a second, 5mm hypoechoic nodule on the right anterior medial lateral parenchymal margin, also oval in shape, and the first had not changed in size. Thyroid panels were still normal. By this time I had developed an on and off hoarseness in my voice, which made me sound like an old lady and sometimes even squeak like a young male. Last November I developed cervical lymphadenopathy, painless and of unknown origin. Figuring it was due to a previous illness I ignored it until this February when I noticed not only had the node swelling become much larger, it had spread to at least four other nodes, including one on the opposite side. I finally went in for the full blood workup which came back normal (with some exceptions which I found myself due to the negligence of a previous PCP: a thrombocyte count of over 500 over a period of 4 months and two tests, along with some other minor irregularities like an increased monocyte count and lowered nuetrophil count, I also seemingly have no basophils in my blood.) I was referred for an ultrasound of the neck to check the thyroid yet again along with the swollen nodes. The results read that my entire posterior cervical chain, most of the deep cervical chain, and the lowest node of the right side posterior cervical chain were all within the range of about 1.2 to 1.9 cm, most were very elongated in shape, and one in particular just below the sternocleidomastoid on the left deep cervical chain just inferior to the jawline was a 1.1 x 0.7 x 1.2cm, a nearly spherical lymph node. All showed signs of increased doppler flow around the margins. The results read possible Lymph Adenitis; however, since the nodes are all both persistent and painless, this was quickly ruled out. The thyroid nodules had increased by about a millimeter or two in size on the transverse and lateral margins however were put down as "grossly unchanged." I was then referred for an excisional biopsy on one of the "clustered" lymph nodes in the medial left region 5. The pathology results revealed no signs of lymphoproliferative disorders; however, did reveal a diagnosis of "focal, sinus histiocytosis." I have not seen or spoken to my actual doctor since the pathology has come back, only a medical student in his clinic who didn't seem to know what he was talking about (he appeared confused while reading my diagnosis and had to think about it for a moment before he translated it to mean "a high white blood cell count possibly from some kind of cold or maybe asthma." I have no known medical conditions.) The final result was a "reactive" lymph node. I need to know reactive to WHAT. The biopsy was a little over two weeks ago and despite actually having and attending an appointment scheduled with the ENT, he has not seen me nor will return my calls. Usually he has a nurse call me for him, this is also making me quite frustrated.

I am a pre-med student (I finish pre-requisites at the end of the summer) so I am capable of (for the most part) reading my own charts and translating my results with the help of my instructors. I try not to, but the ENT clinic I attend is at the medical school, since it is free and they take ages to do anything, most will not even look at your results unless you ask them to. I am, as are my instructors, very concerned, given the persistent nodules and my family history and I'd like to get a second opinion on the situation so I can decide whether I should fire my ENT. Thank your for your fastidious response.

[Adepta]

The lymph nodes were actually the ones with increased surrounding (and not interior) blood flow. The thyroid nodules themselves light up like christmas trees on the doppler (like the surrounding artery almost,) they appear to have their own blood supply (I like to watch the tech's while they work) however no radiologist has thought to say anything about that on the report yet, I'm guessing this is due to a combination of both my age and the size of the adenomas. I keep getting the response "You're not in the correct age range for this to be cancer" despite my family history. It's sort of infuriating, I can only compare it to having a gaping wound that's obviously becoming more and more infected but the doctor insists that the way you harmed it wouldn't cause an infection.

[MANmom]

The only thing I am aware of is that measurements can be a few mm off depending on who actually does the ultrasound, they may have measured slightly differently. Also, increased blood flow around but not in the nodule is a sign that is probably isn't something to be too concerned with yet.  Cancer needs a blood supply, if you get a nodule with hypervascularity throughout, then you may be needing further tests.  BUT, do stay vigilant, you never know, better safe than sorry.