They say I have large nodule on thyroid

[CindiW2]

I was just diagnosed with a large nodule on the left side of my thyroid. The nurse practitioner showed me the pictures from the ultrasound and declared that there was a large nodule (over 4 cm) but said it was not hot or cold. Can this be? (I have lots of other questions, but this is my first one about this.)

[Red_Star]

You would need to have a radioactive iodine uptake (RAIU) test to see if the nodule is hot or cold.  

[CindiW2]

I had one radioactive uptake before the ultrasound today, and the only nodule detected was a cold one on the right side. But today that was not even discussed, although the thought was that they would aspirate if it was over 1 cm. The radiologist reading the ultrasound said the right cold nodule was not in the question, for some reason and he didn't think it really needed to be aspirated. Why, I don't know. Then he started talking about heterogeneous thyroid, not sure if he specified the left side, and the P.A. began telling me they didn't even see the big nodule on the left side when they did the RAIU test, but that it is neither hot or cold. I specifically asked if it was hot or cold, and she said neither. (shrug, since I am not the expert.) She then said it wouldn't kill me. My next question to her or the doctor, before I go to someone else, is, if it won't kill me, why should I have it removed? Oddly enough, both the doctor and the P.A. said it won't kill me, and that is before the left side was seen with a large nodule as they saw today.

[Red_Star]

Endocrine web states 85% of thyroid nodules are cold, 10% are warm and 5% are hot. 85% of cold nodules are benign, 90% of warm nodules are benign, and 95% of hot nodules are benign.

Heterogeneous echogenicity of the thyroid gland is associated with Hashimoto thyroiditis and Graves disease.

[CindiW2]

So if it is a nodule then it should be either hot, cold, or warm. She did mention thyroiditis today. I'll wait to speak with the doctor and then see if I can figure out what they're saying and why so far they're recommending the side of the thyroid with the large nodule to be removed. Thanks.

[Red_Star]

If your 4 cm thyroid nodule is benign,  it does not need to be removed unless it is causing symptoms like choking or difficulty swallowing. Hashimoto's thyroiditis is a cause of nodules. Treating Hashi's may reduce the size of nodules.

[CindiW2]

Thanks. The PA said her first choice is to remove the whole lobe on the left side and biopsy it, but I said I'd rather aspirate. She said she didn't think fna is conclusive but I still want to watch.  And not have it removed right away. But now I wonder since if it is cancerous, it could spread to lymph nodes. But I still think I'll wait a few months to have it aspirated. For some reason she said it won't kill me. When I asked her how she knew, best she could come up with is that I'm 74. I think I should take D3 again, I stopped taking it. How is Hashi treated?

[Red_Star]

Yes, ask for an FNA biopsy.  Treatment is thyroxine. Most doctor will not treat until TSH labs are out of range unfortunately.  I had plenty of hypothyroid symptoms for years with my labs in range and both thyroid antibodies high.  Selenium is shown to lower TPOAb (thyroid peroxidase antibodies). This is interesting...

Excerpt from Hypothyroid Mom - 92% of Hashimoto’s patients with Vitamin D deficiency...

"In 2011 a great scientific study looked specifically at Hashimoto’s patients and Vitamin D.

The researchers took 161 confirmed Hashimoto’s patients (meaning these people had positive TPO antibodies and/or positive TGB antibodies) and measured their Vitamin D levels.

The results of their study are downright scary.

92% of the Hashimoto’s patients had Vitamin D deficiency.

This study defined Vitamin D deficiency as less then 30 ng/dl.

148 out of 161 had Vitamin D deficiency. Crazy, right?

It gets worse.

They even broke down the results into three categories of Hashimoto’s patients:

Overt Hypothyroidism
Subclinical Hypothyroidism
Euthyroid

Let me explain what those mean.

Overt Hypothyroidism Hashimoto’s means:

The person has high TPO and/or TGB antibodies.
Their TSH is high.
The person has low thyroid symptoms (I see these every day).

Subclinical Hypothyroidism Hashimoto’s means:

The person has high TPO and/or TGB antibodies.
Their TSH is high.
The person does NOT have low thyroid symptoms (I don’t see many of these).

Euthyroid Hashimoto’s means:

The person has high TPO and/or TGB antibodies.
Their thyroid lab test numbers are “normal.” (I see quite a few of these people in my practice).

Now here’s how they broke it down.

94% of Overt Hypothyroid Hashimoto’s patients had Vitamin D deficiency.

98% of Subclinical Hypothyroid Hashimoto’s patients had Vitamin D deficiency.

86% of Euthyroid Hashimoto’s patients had Vitamin D deficiency."