Need help interpretting my ultra sound report

[mamaof2wildboys]

Findings:

The right lobe measures 4.0 x 1.3 x 1.4. The left lobe measures 4.4 x 1.1 x 1.3 cm

Increased vascularity is seen in both lobes of the thyroid.

Hypoechoic nodule is seen in the right lobe of the thyroid peripherally measuring 0.6 x 0.4 x 0.5 cm

Submandibular and sublingual areas are normal. The isthmus measures 0.3 cm.

Impression:

1 .Solid nodule measuring 0.6 x 0.4 x 0.5 cm in the periphery of the mid portion of the right lobe of the thyroid.

2. Mild increased vascularity seen in both lobes of the thyroid.

Appointment with Endo is not for three more weeks.

Thanks for any help

[Sarahjogs]

Hi mamaof2wildboys,

I'm new to thyroid disorders, but I've had an ultrasound recently so I hope I can help.

First and foremost - lots of people have thyroid nodules and do not know they have them, and 95% of solitary nodules are benign.  I was told by my ENT that 20% of 20 year old women have nodules, 30% of 30 year olds, 40% of 40 year olds, etc.

Your thyroid measurements (left lobe, right lobe, and isthmus) indicate your thyroid is a normal size .  Increased vascularity in both lobes may be an early sign of Graves disease or thyroiditis, but the ultrasound says "mild".  Your doctor may want to give you a test for thyroid antibodies, especially if you have any hypo/hyperthyroidism symptoms.

The solid nodule you have is small, usually they will not recommend a fine needle biopsy unless it is >1 cm unless you have a family history of thyroid cancer or personal history of exposure to radiation (i.e. lived close to a nuclear power plant, X-rays on your neck as a child).  Hypoechoic means it shows up darker on the ultrasound and is a solid mass (as opposed to fluid filled cyst).  My ultrasound graded hypoechoic nodules as "higher risk" than isoechoic nodules, but most hypoechoic nodules are benign.

Submandibular and sublingual areas are normal -- I believe this is referring to looking for swollen lymph nodes in the neck.  No note of swollen lymph nodes is a good sign.

With a single nodule less than 1cm, the doctor will probably recommend following up with another ultrasound in 6 months or 1 year to see if it is growing in size, unless you have other factors (family history, personal history) that would suggest a more aggressive approach would be appropriate.  Doctors tend to take a "wait and see" approach with small nodules, which if you are worried it might be malignant can be frustrating, but most thyroid cancers are very slow growing and have an excellent prognosis.  Again, 95% of solitary thyroid nodules are benign, so the odds are very low that your nodule is malignant.

I hope this helps - I've found this site is very helpful in calming my anxiety as well as giving me more information so I can ask the right questions next time I see my doctor.

[Barb135]

Sarahjogs - you've given an excellent explanation of the thyroid ultrasound.  

A couple of things I'd like to add are that criteria have changed, according to the American Thyroid Association (ATA) and American Association of Clinical Endocrinologists (AACE).  They now don't recommend FNA/biopsy for nodules until they get to 2 cm unless they meet certain specifications.

Because mama's nodule is solid, they "may" recommend FNA when it's smaller, but possibly not until it reaches 1 cm since it's hard to get an adequate sample if it's too small.   Sometimes they won't even do that.  I have a solid nodule that's 1.1 cm and my doctor refused to refer me for biopsy because of its size.

I agree about the vascularity - it could be sign of early Graves or it could indicate a hyper phase of Hashimoto's Thyroiditis.  Antibody tests for both, Graves and Hashimoto's would be in order, in my opinion.  The antibodies for Hashimoto's are Thyroid Peroxidase Antibodies (TPOab) and Thyroglobulin Antibodies (TgAb).  The definitive test for Graves is Thyroid Stimulating Immunoglobulin (TSI).  

Thyroid function tests would also be called for:  Free T4, Free T3, and TSH if not already done.