Unsure of how serious this is

[fergy1128]

In 2008 it was accidentally discovered that I had a nodule on my thyroid, a few months later there were 2 nodules.  PCP suggested I see an endocrinologist, a year later there were 3 nodules.  2010 FNA - completely benign, not even suspicious cells.  Follow up 6 mos and again 1 yr later no change.  So I stopped following up.  Dec 2014 my hair starts falling out way more than usual.  PCP orders TSH, it's normal.  He also ordered a thyroid ultrasound but I lost my insurance so couldn't get it done.  I have felt like something is stuck in my throat for about a year.  Just got the ultra sound done and PCP wants me to see endocrinologist and have another FNA done.  I called and found one that couldn't get me in until Sept 11th and would see nurse practitioner.  When I told my PCP they called and got me a referral for Aug 18th with a doctor.  I didn't want to go back to my original endocrinologist because I really didn't like him, very arrogant.  The new endocrinologist is a woman, hoping she will be more understanding.

Ultrasound results: IMPRESSION: 1. Findings most compatible with bilateral multinodular goiter with interval increase in sizes of nodules as well as an interval solid nodule (0.7 x 0.9 x 1.2 cm) at the inferomedial aspect of the right lobe.  2.  No extrathyroidal masses.  ISTHMUS: This portion remains normal.

COMMENTS:  LEFT LOBE: this lobe has overall dimensions of 1.8 x 1.6 x 4.5 cm (AP x tansverse x longitudinal respectively) and exhibits a hypoechoic but nevertheless solid nodule (1.0 x 1.2 x 1.8 cm) in the superior one third aspect, increased from prior study.  There is also a relatively hypechoic but nevertheless solid nodule (0.7 x 1.1 x 1.3 cm) near the inferior pole, also increased from the prior study.  There are no extrathyroidal masses.

RIGHT LOBE: This lobe has overall dimensions of 1.8 x 1.1 x 4.2 cm and exhibits a somewhat hypoechoic but nervous solid nodule (0.4 x 0.6 x 0.8 cm) in the lower one third aspect, slightly increased from the prior study and interval somewhat hypoechoic but nevertheless solid nodule (0.7 x 0.9 x 1.2 cm) at the inferomdial aspect.  There are no extrathyroidal masses.

So from what I have read, they don't get concerned until the nodules are larger than 1 cm.  It appears from the ultrasound that I now have 4 nodules and 3 of the 4 are over 1 cm.  But it doesn't say anything about calcifications or vascular flow, which I understand is bad, or smoothly marginated, which I understand is good.  I expect that the endocrinologist will run additional blood test other than TSH.  I have had all the symptoms of hypothyroidism for years but have not been given medication due to my blood test being "normal".  

What is the size of a "Normal" thyroid and how is the size of mine in comparison to that?

[fergy1128]

I think the problem is, since I haven't had an ultrasound in 5 yrs they don't know if they have been growing all this time or if it just had a growth spurt recently.  I believe that is why my PCP wants a FNA biopsy done, just to be sure.

My sister started having tumors on her thyroid when she was 11 yrs old and by the time she was 16 she had no thyroid or para thyroid and has been on thyroid meds, vitamin D and calcium pills since.  She is 62 now.  A few years ago she started getting more tumors in her neck and had to have them removed again.  She said the ones when she was a kid were cancer but she has no proof of that and I never heard anyone in my family speak of it, so I believe she misunderstood what it was.  She also had radiation as a toddler to shrink her tonsils back in the 50's and they think that could have caused her tumors.  I don't know if I had it or not but it wouldn't surprise me if I did and my Mother never said anything about it.

[fergy1128]

No I don't believe that I have ever been tested for antibodies.  Most of my monitoring was done by and endocrinologist that was very arrogant and condescending.  I once asked him about checking my vitamin D because I don't get much sun and he actually laughed at me and said all the rage about vitamin D was just a fad.  My PCP tested me and my Vitamin D was very low....19!  That is when I stopped going to him.

I will ask this new doctor about  the antibodies tests.  And then I will tell her I want them done if she doesn't suggest them.  

[fergy1128]

Thank you for that information.  If that is the Normal size then my left lobe looks like at the top of the normal size and the right lobe is just a bit smaller.  Which leads me to believe it is something to keep and eye on but not really anything serious yet.

[Barb135]

Have you ever been tested for thyroid antibodies to determine if you have Hashimoto's?  Nodules are very common with Hashimoto's and it's also very common for symptoms to appear long before standard blood tests (TSH, Free T3 and Free T4) go out of range.  The antibody tests you need are Thyroid Peroxidase Antibodies (TPOab) Thyroglobulin Antibodies (TgAb).

[Red_Star]

Endocrinologist Dr Mark Lupo noted on one of his Medhelp answers:

"I do 6-8 ultrasounds a day in the office and usually the measurements of normal thyroids are 4-4.8 x 1.0-1.8 x 0.8-1.6cm which is consistent with published dimensions."

http://www.medhelp.org/posts/Thyroid-Cancer-Nodules--Hyperthyroidism/Normal-Thyroid-Size/show/263195