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5878106 tn?1376274271

Thyroid Cancer? Ultrasound results...

I have had a single nodule on my thyroid for the last 4 years that I know of.  At the time it was discovered, an FNA was recommended and it came back indeterminate.  My endo advised me to do nothing and check on it in a year.

Of course I'm a chump and didn't have it checked again until last December (December '12) because I felt (and still feel) a fullness in my throat that feels like there is something stuck in there. My PCP ordered the ultrasound and ultimately told me it's nothing to worry about, no follow up necessary.

I recently switched PCP's and the new guy looked over my charts and past ultrasounds and sent me to an ENT doctor who told me that the nodule on my thyroid appears to have some markers for cancer so he sent me for another ultrasound.

I have another FNA tomorrow but the ENT doc said regardless of the results he would recommend surgery.  The results of my ultrasound are below.  What do you think?  Is this actually suspicious of cancer or am I getting hyped up for no reason?  Is this significant growth in a nodule over a period of 7 months?  Thank you in advance for your time.

FINDINGS:
Right lobe:  Measures 5.0 x 1.8 x 2.1cm and is normal in echotexture and contour.  1 nodule.
1.  Central gland heterogeneous slightly hypoechoic lesion with moderate internal vascularity and scattered coarse calcifications 2.2 x 1.6 x 1.4cm, previously 1.8 x 1.5 x 1.2cm.

Left lobe:  Measures 5.1 x 1.4 x 0.9 cm and is normal in echotexture and contour.  There are no nodules.

Isthmus:  3mm

IMPRESSION:
1. A large dominant right lobe nodule is growing compared to December 2012. Recommend FNA if not previously performed.
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5878106 tn?1376274271
I should also mention that my thyroid levels are all within the normal range. :)
Helpful - 0
Avatar universal
Coarse calcification is usually sign of inflammatory process, while snowflake microcalcifications are more associated with the cancer.
If cancer is suspected a good look at low level lymph nodes is needed (your ultrasound report has no info regarding this)
Finally, the questionable sample can be sent for Afirma testing.
It is icorrect to recommend the surgery without getting all of the necessary information.
My GP tried to diagnose me with thyrotoxicosis just because I had a fast pulse during the visit
Helpful - 0
5878106 tn?1376274271
Thank you VERY much for taking the time to read through my little novel.  I have read quite a few of your posts and I don't know your story, but you obviously know your stuff and your answers are generally pretty positive and quite frankly make me feel relieved to read.  I really appreciate that, and I think a whole lot of people on this site feel the same!

Now, I had the biopsy as mentioned and am still waiting on results.  The doctor (who I had never met before) ended up trying to extract..  material..  from the nodule 5 different times.  The first 3 times, the needle would not penetrate the nodule, instead it "bounced" off of it and the doctor commented that it was pretty firm. (Thankfully I had been numbed prior to this, but it did actually ache pretty nicely after the lidocaine wore off.)  He had to change the gauge of needle and was successful in getting the samples needed after 2 more tries.

Also, I had mentioned that I have a feeling of something in my throat.  I asked my ENT and he said it was likely not the thyroid as the nodule (2.2cm) would be too small to feel.  However, when the FNA was being done, I could feel the pressure right where the nodule is and it intensified in the exact same spot as I have been feeling a "lump" in since December.  The soreness I felt in my neck for the next day or so was centralized right over the "lump" in my throat.  This can't be my imagination, can it?

I am supposed to find out the results of the FNAB tomorrow.  I will post when I know more.

Thanks again!
Helpful - 0
Avatar universal
The CALCIFIED nodule of 2 cm in size can cause discomfort if it is located close to the nerve, or interferes with the muscle. Although fine anatomic features vary from person to person, the midpole location coincides with the area where the voice box joints with trachea.
There are several old school tests which can be used by ENT to check if the nodule causes problem. The patient is asked to swallow several times with the head tilted down,  turned to the left, turned to the right and with neck fully extended; after that the patient reports which condition aggravates or relieves symptoms. Same test is repeated but patient is asking to sing at this time. Finally, if the nodule is planned to be removed, the patient is asked to talk or sign while light finger pressure is applied to the tumor. Change in the voice means that the nodule is located close to the voice nerve and removal must be carefully done.  
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5878106 tn?1376274271
Well, I received an email from my doctor simply stating that my biopsy results came back as a "benign nodule" which is somewhat comforting.  

I do think I am going to go through with the surgical removal of at least the right lobe along with the nodule for two reasons.  1.  As you described, when I tilt or turn my head to the right or back, I experience a more pronounced feeling of a "lump in my throat" and feel like my airway is more constricted.  When tilting my head forward or to the left, I feel like the sensation lessens quite a bit and breathing is comfortable.  2. The FNA sample was from only 1 pass of the needle.  (If you'll remember, the first four times were unsuccessful)  I assume there is a slight possibility that something nasty could be missed and if I am experiencing compression symptoms on top of that I feel like at least that part of it has got to go.

Granted, any surgery is kind of a big deal but I feel confident that the benefits outweigh the risks.  What do you think?  What might you suggest your family member do if they were in my position?
Helpful - 0
5878106 tn?1376274271
I also want to note that my doctor said that we can only be certain of what's in the nodule with surgical removal and he does recommend that I go that route. I'm not just being paranoid for no reason! LOL
Helpful - 0
Avatar universal
It’s a hard question to answer.
So far there are no alternatives to surgery to shrink the calcified nodule if later causes problem. The experimental laser ablation procedure may not work on this either. Based on the head position test results (I somehow surprised it was useful, because not many doctors are using it; perhaps you should make a video of that test :) I am not so lucky due to the limited neck motion thanks to the artritis) I could speculate that the nodule is located under the strap muscle.
It will be interesting to see the details of cytology report to make sure it is complete (your ultrasound does not describe the condition of your lymph nodes.
If you are going for the surgery find an experienced doctor because fixed calcified nodule is harder to remove
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