OK, a large nodule was evidently discovered on my left thyroid lobe

[CindiW2]

So -- the PA showed me the ultrasound diagram. The radiologist said my thyroid was -- what's the word? -- multifaceted, convoluted, or whatever, I forgot the word he used -- but then the PA showed me a 4 cm nodule on the left side. Honest -- my question is: how long would such a large nodule be growing like that? Maybe 30 years? (Just guessing here..and wondering...)

[Red_Star]

That's interesting. The nodule is bigger than a normal thyroid gland. Eek!

Heterogeneous thyroid gland, goiter and nodules are all typical findings of Hashimoto's thyroiditis.

Isoechoic nodules are usually benign which is the good news.  Thyroid medication can shrink nodules to some degree.

[CindiW2]

Goiter is an enlarged thyroid gland, is that right? I was getting goiter confused with a nodule, but they're not the same thing, right?

[Red_Star]

A goiter is an enlarged thyroid gland. Thyroid nodules are solid or fluid filled lumps that form within the thyroid gland. Have you had thyroid antibodies tested yet?

[CindiW2]

I don't know. I had TSH test (very low), and the Free T4 (normal range). Are those antibodies? The PA showed me the image of the nodule and it looked kind of circular, (swirling) I didn't know if it was abnormally large (which it seems to be from these discussions, but I am going to check with the dr. about the size of the nodule, who kindly wrote me and told me I can ask her any questions. So I hope she won't get upset and wring her hands and tell me in so many words I'm just so much trouble. -- It's happened. ) Not with her yet though.

[Red_Star]

They are not antibody tests. I wrote more info on your other question. The only doctor I ever saw who was very knowledgeable in regards to thyroid issues was my endocrinologist.

[Barb135]

Have you gotten a new report or is the same nodule you've posted about twice before and to which both, Red_Star and myself have responded?

In case you haven't been able to find the previous threads, they can be accessed via the following links:
https://www.medhelp.org/posts/Thyroid-Disorders/Living-without-a-Thyroid-Gland/show/324227#post_14387279

https://www.medhelp.org/posts/Thyroid-Disorders/They-say-I-have-large-nodule-on-thyroid/show/3035666

[CindiW2]

I got two reports. I may have been reading the dimensions of the ultrasound (the 2nd report) wrong. I'll look at it again, but what I realize from this is that although I spent a lot of time (1/2 hour?) with the PA, I still do not understand what they were saying, except that she recommended I have the entire left lobe removed, then see if it was cancerous, and if it is, remove the right lobe too. I am not convinced that the nodule they say is there is anything particularly worrisome enough to have the lobe removed immediately, in the meantime, however, I decided to have a Fine Needle Aspiration instead, being advised that it may not uncover the cancer if it is there. I put the entire report up (the US) on one of my posts.

[CindiW2]

Here is a copy of the findings of the US (the 2nd test, after the radioactive iodine test)

US THYROID performed on 9/13/2018 12:46 PM.

REASON FOR EXAM: E04.9: Goiter

COMPARISON: A nuclear medicine thyroid study from August 7, 2018 which
demonstrated a cold nodule in the right lobe of the thyroid.

FINDINGS: The right thyroid lobe measures 5.1 x 2.2 x 2.9 cm and the left
measures 7.4 x 3.3 x 4.6 cm. The isthmus measures 2 mm. . The thyroid is
markedly heterogeneous. Vascularity is normal.

In the left thyroid, there is a 4.9 x 2.6 x 3.3 cm isoechoic nodule. No
nodule is identified in the right thyroid."

So let me see if I understand the results. First of all, it says the "Reason for Exam" is Eo4.9 Goiter. What does that mean? (I'll start there..

[Barb135]

Are these new reports or are they the same reports that Red_Star and I have already discussed with you?  They appear to be the same as the ones I discussed with you a couple of weeks ago.  That thread is the first one I linked above in case you've forgotten.  

[CindiW2]

Yes, that is the same report, just to make it clear that I did not misunderstand the size of the nodule. OK, so at least I have an understanding that the nodule is bigger than a normal thyroid gland.

[Red_Star]

Dr Lupo posted this (link below): "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

Your measurements appear to be the entire thyroid lobe. I've never seen a report for a thyroid nodule stating more than one number in either mm or cm.

[CindiW2]

OK, I will ask dr., thanks. Maybe that's what it was. This is confusing.

[CindiW2]

OK, I checked results from chart message from dr. And here's what it said:
Markedly heterogeneous and enlarged thyroid. So although I copied the dimensions, maybe I got them wrong as to what it was describing. If I were a scientist or student, I'd be pulling my hair out by now and probably pulling on the sleeve of the instructor. Thanks.

[CindiW2]

I am copying report from office on my chart --
"FINDINGS: The right thyroid lobe measures 5.1 x 2.2 x 2.9 cm and the left
measures 7.4 x 3.3 x 4.6 cm. The isthmus measures 2 mm. . The thyroid is
markedly heterogeneous. Vascularity is normal.

In the left thyroid, there is a 4.9 x 2.6 x 3.3 cm isoechoic nodule. No
nodule is identified in the right thyroid."

I know we're talking about the left thyroid. OK, at this point I don't know anything. I THINK we're talking about the left thyroid. Yes, the radiologist mentioned that the thyroid was heterogeneous. Why that is I don't know. But right now I'm concerned obviously about the nodule they found.

[Red_Star]

I found this..."Malignant thyroid nodules are more likely to grow at least 2 mm per year and increase in volume compared with benign thyroid nodules, according to findings published in The Journal of Clinical Endocrinology & Metabolism."

[CindiW2]

Thanks. I am expecting to have it aspirated and biopsied anyway. I GUESS if it is biopsied, being so large, it will reveal if there are cancer cells within it, but they say not necessarily. But if it's a nodule, why wouldn't it reveal if there are cancer cells within it? (Thanks for your answer, though.)

[CindiW2]

PS - and why can't they just take out the nodule instead of the entire lobe? The nodule is  4.9 x 2.6 x 3.3 cm , rather large.

[CindiW2]

Oh yes, why can't they kill the nodule?

[CindiW2]

Also, I am seeing that it is measured in centimeters? so 4.9 is almost 2 inches, really large I guess. I can't imagine how long it's been growing there ... two inches high would be almost the height of the lobe, I suppose. Many here are having measurements in mm, not cm, so I'm wondering.

[CindiW2]

Now I must be dumb, because I'm seeing on a website that a normal thyroid measures thusly: "The normal thyroid weighs approximately 15 to 25 g, with each lobe 4 to 6 cm in length and 1.3 to 1.8 cm in thickness. The isthmus measures less than 4 to 5 mm." So the measurements of the nodule on my report are: 4.9 x 2.6 x 3.3 cm. So I guess the first number (4.9) is 4.9 cm?

[CindiW2]

Now I want to say one more thing. The only symptom I complained about was being tired. BUT -- I have been tired for years. I think part of that is depression. Although the tests did show hyperthyroidism with a very low TSH. But -- other than being tired, I have no symptoms, despite the size of the nodule. Further, the doctor felt my neck, no pain, no protrusion. And now that I think about it, doctors have felt my neck for years with no comment, and I didn't even know why they poked around on my neck. I think I know now, maybe looking for a lump or enlarged thyroid? But they felt nothing. So I also guess the nodule may NOT mean the lobe is enlarged??

[CindiW2]

PS - As I'm researching this, I must say that as a teenager over 50 years ago, I had some pimples. And my mother sent me to a dermatologist who did "radiation therapy" on my face. For some reason (and I smile while I say this), they said my skin was glowing and looked beautiful. I was happy. No more pimples, glowing skin...
And then throughout my life I've had multitudinous x-rays on my teeth. And my reaction now is: "Oh, well..." So I guess we'll see what we'll see now. Thanks again for all your patience in coping with my nervousness and questions.