Thyroid Cancer Spreading

[Gina04]

I have been having pain associated with my thyroid for a couple months now.  I had an ultrasound done last week which showed I have nodules on both sides of my thyroid.  It sounds like it is going to be a couple months before I can see the endocrinologist.  Most likely, it will be another month or two beyond that before further testing is done and treatment is begun.  I don't know yet if this is cancer or not.  I know that thyroid cancer can spread to other parts of the body and would like to know about how long that takes.  The nodules are very small but are large enough that they started causing pain in January and are doing so more and more.  If I don't see a doctor and have further testing done until three or four months from now, it is likely that the cancer, if this is cancerous, would spread by then?  Or, does it take much longer than that before it would likely spread?

[Barb135]

With your FT4 at only 1.0, I can understand why you have hypo symptoms.  When mine was that low, I felt horrible.  Being hypo can also cause cholesterol levels to be elevated.

If you had a Free T3 test, that would tell us exactly how much of the active hormone (T3) you have.  Free T3 correlates best with symptoms.

It does sound like you might benefit from a low dose of thyroid medication, even though your levels are "normal"; however, since you have both lower FT4 and TSH, it might be a good idea to get your pituitary gland tested as well.  You might want to put that on your list for when your endo appt rolls around.  

I'm sorry, there's not much of anything I can say to help ease your husband's mind, except to say that 95% of thyroid nodules are not cancer; however, I'm sure that's not much help because we all wonder "what if I'm in that other 5%?"....  I do feel that things would be moved forward more quickly, if there were really concern that this might be cancer.  

It is unusual for nodules as small as yours to cause that much pain.  

[Gina04]

Yes, I do have hypo symptoms.  My doctor’s impression of my labs were that they were okay overall.  She said my thyroid was fine.  I don’t think she was going to do anything about the pain since the thyroid levels were in range.  When the nurse called with my lab results, I asked her what the next step was for the pain.  She talked to the doctor about it and said we could do a referral to an ENT or we could do an ultrasound.  I chose the ultrasound but the nurse wrote down that I wanted the referral.  The ENT office called and scheduled an appointment for Mmid-May.  I called my doctor back and asked about the ultrasound.  That’s when I found out that the nurse had said I didn’t want to do that.  They then got the ultrasound scheduled for later that week.
When my doctor got the ultrasound results, the nurse was initially going to schedule a nuclear thyroid scan.  She called back later and said they were going to do a referral to an endocrinologist and let him decide what to do next.  That appointment has not even been scheduled yet but the receptionist at the endo office said it would likely be towards the end of May.
My understanding (from the internet and a friend of mine with thyroid issues) is that the scan will show whether the nodules are hot or cold.  That would then indicate whether they were cancerous or not.  If I am able to have that done now, it would likely put my husband’s mind at ease.  He actually was hyperventilating and nearly passed out the other day because of the POSSIBILITY that this MIGHT be cancerous, even though that is not likely.
I am not concerned about the possibility of cancer.  I just want to have the nodules shrunk or removed so I don’t have to deal with the constant pain.
I am aware that I only have one thyroid gland and that it has two lobes.  I, too, thought some of the wording in my ultrasound report was a bit odd.
I will put the Free T3 on my list of stuff to discuss at my appointment.  Thank you for mentioning that.

[Gina04]

Thank you for posting.  As I mentioned above, I do not particularly think that this is cancer.  It seems a bit strange that I would have to wait so long to be seen given the effect this is having regarding pain, breathing, and swallowing.  If thyroid cancer spreads quickly (which is what I was asking about) then it seems like they would want to get me in even sooner.  If it doesn’t spread quickly, then that wouldn’t really factor in to whether I was seen right away or a few months later.
The thought of cancer concerns my husband because he lost his mom to cancer.  I am curious as to whether this is cancer or not but am not concerned about it.  I want the appointment sooner because I deal with enough pain every day from other conditions.  This seems like a source of pain that can easily be eliminated and I would like that done as soon as possible.  Whether that means radiation, thyroidectomy, or whatever, I want to get rid of the pain.

[Barb135]

Your Free T4 is quite low in its range; do you have hypo symptoms?  One of the main things you should ask for when you get the appt with the endo, is for a Free T3 test as well.  Free T3 is the main thyroid hormone, and its levels more accurately correlate with symptoms.

You only have one thyroid gland, which consists of two lobes and and isthmus; your ultra sound report doesn't sound a whole lot different from my own, and I agree with MANmom that they wouldn't even be able to a needle biopsy on them at this stage.  

You might benefit from a small dose of thyroid replacement medication; you might want to mention this to your doctor, since your FT4 is so low.  

I do understand your concern, but I think you're safe in relaxing till your endo appointment.  Thyroid cancer is one of the most treatable cancers.

[MANmom]

Here's the deal.  Your nodules are very small, they can't test them for cancer yet.  It is very hard to hit a nodule with a fine needle biopsy until it is at least 1 cm or close to that.  If they get bigger in a few months, then they can test them.  The only cancer that grows extremely rapidy is Metastatic thyroid cancer, which is extremely rare, and it would be seen growing significantly in a few months. Out of all nodules, only @ 15% are cancerous and out of those, the cases of Metastatic cancer are way less than 10%.  Your chances of having cancer of any kind are remote.  The pain doesn't mean cancer, I had cancer, and I had no pain whatsoever.  Relax and wait for the next appointment.  If they grow bigger, then take action.  You will always have to monitor them, they won't go away.  If at the next ultrasound they grow rapidly, have irregular borders, have calcifications, or are very vascular on doppler, then you need to be worried.  By the way, when in the RARE case thyroid cancer spreads, it usually metastisizes to the lungs and bones.

[Gina04]

Thanks ladies.  I am not on any thyroid medication, nor have I ever been.  I do not particularly think this is cancer but am a little concerned about how long I have to wait to find out.  The wait bothers me more so because I am in pain as a result of this.
I went for my routine physical on February 28th.  At that time, I had the following tests with these results.  The ranges are in the () and the ones that are out of range have an *.
POCT Perform Urine Dipstick
*ketones 80 (neg)
*protein  30 (neg)
*blood trace (neg)

T4 Free 1.00 (0.81 to 1.70)

TSH 0.52 (0.27 to 4.20)

CBC with Differential
*Monocytes 11.7 (2 to 10)
*Monocytes Absolute 0.7 (0.1 to 0.6)

Comp Metabolic Panel
glucose 97 (70 to 100)
*AST 37 (12 to 32)
*ALT 38 (4 to 36)
*GFR 56 (>60)

Lipid Panel
Cholesterol 171 (100 to 200)
Triglyceride 46 (0 to 150)
HDL 53 (40 to 60)
*LDL Calculated 109 (58 to 100)
*Chol/HDL ratio 3.23 (3.27 to 4.44)

The ultrasound was done on 03-11-11 with the following report:
Findings:  Right thyroid gland measures 4.2x1.3x1.6cm.  Left thyroid gland measures 3.9x1.2x1.1cm.  The isthmus measures 0.4cm.  There are several hypoechoic nodules in the right thyroid lobe the largest in the mid to upper pole measuring 0.3x0.3x0.2cm.  There is a hypoechoic nodule in the lower pole of the left thyroid gland measuring 0.3x0.2cm. No lymphadenopathy is seen.
Impressions:  1. Indeterminate subcentimeter hypoechoic nodules in both thyroid glands.  If clinically warranted, nuclear medicine thyroid scan may be helpful for further characterization.

The blood in the urine could be due to the PAP that she had just done or to kidney stones.  I have an extensive medical history but had not had any problems with my thyroid until January.  Now I have nearly constant throat/neck, facial, and ear pain as well as headaches.  It seems like something will need to be done to either shrink or remove the nodules causing this pain and I am not looking forward to waiting a few more months for that to happen.  At this point, we don't know if this is cancer or not.  If thyroid cancer takes many months or even years to spread, I could see that they wouldn't be overly concerned about getting me in right away for more tests or a doctor's appointment.  If however, it spreads quickly, then it seems they should try to get me in for an appointment sooner or at least do more testing while I wait for that appointment so they can rule out cancer.
I don't have extra money right now so I don't want to push for testing if there is no rush on things.  However, if thyroid cancer is something that spreads very quickly, then I want to have further testing done so we can rule out cancer now rather than waiting until a few month from now to find out that it is cancer and has spread.  I would also like to be able to assure my husband that this is probably not cancer and that, if it is, it will be easily treatable and won't have spread to other places.  His mom died of ovarian cancer when he was about 20 so he is not handling this super well.  He also knows that my mom had colon cancer when she was 34.  That doesn't help either.

[Barb135]

I agree with Stella; it's very common to have nodules on the thyroid if one has Hashimoto's. Many of us, here on the forum have nodules, but do not have cancer.

What tests have been done so far, other than the ultra sound?  What makes you think this could be cancer?

Please post whatever labs you have, along with reference ranges, since the ranges vary lab to lab, so must come from your own report.

Are you currently on any thyroid medication?  If so, what med(s)/dose(s) are you on?

[stella5349]

There a slim chance that the nodules are cancerous. On the thyca.org website you can find some very valuable information - however it fills you with alot of information that may not be what happens to you.

A non-cancerous thyroid condition that can develop nodules is Hashimoto disease. Basically its the gland getting sick and dying off so nodules can form. -

If you could, list your labs you had done and tell more on why you lean this to be cancer.