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hello was wondering if anyone can help?
I am 59-year-old male in Canada About a month ago I noticed swelling in my neck my doc sent me for a ultrasound.. results are as follows..The right lobe measured 5.1x2.7x3.2 and left at 4.6x1.3x2.0cm in size .there is a bilobular nodule in the interpolar region of the right lobe containing both cystic and solid componets measuring 3.8x2.4x2.8cm in size no other abnormalitiy on right.a 4mm cyst on left is of doubtful significance..Conclusion complex nodule in interpolar region of right lobe is a concerning finding ultra sound needle biopsy is recommended.At minimum a follow up in one years time should be carried out. my mother had her thyroid removed in her 40s but it wasnt cancer ..im freaking out..what do you think? hope you re
Hi andrea59,
I am not a doctor, but I have recently had some thyroid ultrasounds and thyroid surgery so I'm a little familiar with reading ultrasounds. Your right thyroid lobe size looks slightly enlarged (looking at all three dimensions, I think normal would be 4.0-4.8cm by 1.0-1.8cm by 0.8-1.6cm). This enlarged size may be due to that nodule on the right side though.
As for your thyroid nodule - most thyroid nodules are benign (90%). The size of your nodule (>2cm), its shape (bilobular), and the fact that it has both cystic and solid components make it more suspicious, and I would definitely get it biopsied sooner than a year from now, but there is a good chance it is not cancer. When you do the FNB, there are three (or four) possible results - benign, suspicious, malignant, and inconclusive. Malignant means cancer and you definitely want to have the nodule removed (usually a total thyroidectomy). Suspicious usually means it looks like it could be a follicular cancer or could be a benign adenoma, so you often have a choice of watching it or having surgery (I had a suspicious neoplasm and ended up having a lobectomy - it was papillary thyroid cancer so I had a "completion" surgery later). Inconclusive often means they just don't get enough cells out of the biopsy to make a determination, and I bring that up because I know with nodules with cystic components sometimes the cyst interferes with getting enough cells.
I wouldn't immediately jump to the conclusion that you have thyroid cancer, your nodule has some more suspicious characteristics which increases the likelihood, but doesn't mean cancer. My suspicious nodule was small (1.1cm) with smooth margins, no calcification or blood vessel infiltration, and ended up being papillary thyroid cancer, but my 60 year old aunt was going through thyroid biopsies at the same time I was, and her nodules had more suspicious characteristics by ultrasound (larger, calcifications, blood vessel infiltration, irregular borders) and hers were benign, so just having more suspicious characteristics does not mean it is cancer!
Please don't freak out. Odds are low that yours is cancer. Even if it is, most thyroid nodules grow very slowly, and most thyroid cancer is very treatable.
As for thyroid surgery - living dependent on thyroid hormone for the rest of my life (I'm 38 years old) is not something I look forward to (I had my surgery in August and I'm still trying to get to the right level of hormone), but my grandmother had her thyroid removed at 47 and lived for 30 years after that, so I know it's doable, and now thyroid cancer is one less thing I need to worry about. I was nervous before both surgeries, but I had an excellent surgeon and no complications.
My thoughts - get a fine needle biopsy. It's hard to give advice on whether it is cancer or not, because until the biopsy, (and sometimes not even until surgery), it is impossible to tell. When you have more information about your nodule, you'll be in a better position to know what the next step is in your treatment or follow up.
Best of luck with your biopsy, and let us know if you have any more questions - I'm pretty sure I was most anxious when I was at the biopsy stage of my thyroid cancer journey, so I can empathize with what you are going through!
I am not a doctor, but I have recently had some thyroid ultrasounds and thyroid surgery so I'm a little familiar with reading ultrasounds. Your right thyroid lobe size looks slightly enlarged (looking at all three dimensions, I think normal would be 4.0-4.8cm by 1.0-1.8cm by 0.8-1.6cm). This enlarged size may be due to that nodule on the right side though.
As for your thyroid nodule - most thyroid nodules are benign (90%). The size of your nodule (>2cm), its shape (bilobular), and the fact that it has both cystic and solid components make it more suspicious, and I would definitely get it biopsied sooner than a year from now, but there is a good chance it is not cancer. When you do the FNB, there are three (or four) possible results - benign, suspicious, malignant, and inconclusive. Malignant means cancer and you definitely want to have the nodule removed (usually a total thyroidectomy). Suspicious usually means it looks like it could be a follicular cancer or could be a benign adenoma, so you often have a choice of watching it or having surgery (I had a suspicious neoplasm and ended up having a lobectomy - it was papillary thyroid cancer so I had a "completion" surgery later). Inconclusive often means they just don't get enough cells out of the biopsy to make a determination, and I bring that up because I know with nodules with cystic components sometimes the cyst interferes with getting enough cells.
I wouldn't immediately jump to the conclusion that you have thyroid cancer, your nodule has some more suspicious characteristics which increases the likelihood, but doesn't mean cancer. My suspicious nodule was small (1.1cm) with smooth margins, no calcification or blood vessel infiltration, and ended up being papillary thyroid cancer, but my 60 year old aunt was going through thyroid biopsies at the same time I was, and her nodules had more suspicious characteristics by ultrasound (larger, calcifications, blood vessel infiltration, irregular borders) and hers were benign, so just having more suspicious characteristics does not mean it is cancer!
Please don't freak out. Odds are low that yours is cancer. Even if it is, most thyroid nodules grow very slowly, and most thyroid cancer is very treatable.
As for thyroid surgery - living dependent on thyroid hormone for the rest of my life (I'm 38 years old) is not something I look forward to (I had my surgery in August and I'm still trying to get to the right level of hormone), but my grandmother had her thyroid removed at 47 and lived for 30 years after that, so I know it's doable, and now thyroid cancer is one less thing I need to worry about. I was nervous before both surgeries, but I had an excellent surgeon and no complications.
My thoughts - get a fine needle biopsy. It's hard to give advice on whether it is cancer or not, because until the biopsy, (and sometimes not even until surgery), it is impossible to tell. When you have more information about your nodule, you'll be in a better position to know what the next step is in your treatment or follow up.
Best of luck with your biopsy, and let us know if you have any more questions - I'm pretty sure I was most anxious when I was at the biopsy stage of my thyroid cancer journey, so I can empathize with what you are going through!
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Nodules are very common and it's not time to freak out... :-) First, you should know that less than 5% of all thyroid nodules turn out to be cancer; however, your nodule is quite large and I'm assuming your doctor has arranged for an FNA to be sure.
The report doesn't give a lot of information so it's hard to draw a conclusion. That, along with the statement that "At minimum a follow up in one years time should be carried out" tells me there's a good chance your nodule is not cancerous. If the radiologist really thought it was cancer, the report would give more details of the ultrasound and recommend FNA immediately. Get the FNA anyway, just to be sure, because that's the only way to rule out or confirm cancer.
That said, have you been diagnosed with a previous thyroid condition, such as hyper or hypothyroidism? Do you take any thyroid medication of any kind? Have you had any blood tests done to test thyroid function? Nodules often appear with Hashimoto's or Graves Disease, which are autoimmune conditions that cause hypothyroidism and hyperthyroidism. Hypo or hyperthyroidism can cause goiter (swollen thyroid), along with nodules.
The report doesn't give a lot of information so it's hard to draw a conclusion. That, along with the statement that "At minimum a follow up in one years time should be carried out" tells me there's a good chance your nodule is not cancerous. If the radiologist really thought it was cancer, the report would give more details of the ultrasound and recommend FNA immediately. Get the FNA anyway, just to be sure, because that's the only way to rule out or confirm cancer.
That said, have you been diagnosed with a previous thyroid condition, such as hyper or hypothyroidism? Do you take any thyroid medication of any kind? Have you had any blood tests done to test thyroid function? Nodules often appear with Hashimoto's or Graves Disease, which are autoimmune conditions that cause hypothyroidism and hyperthyroidism. Hypo or hyperthyroidism can cause goiter (swollen thyroid), along with nodules.
3 Comments
Just curious Barb The report doesn't give a lot of information so it's hard to draw a conclusion. That, along with the statement that "At minimum a follow up in one years time should be carried out" tells me there's a good chance your nodule is not cancerous. If the radiologist really thought it was cancer, the report would give more details of the ultrasound and recommend FNA immediately. I agree with you Sarahjogs is saying the size of your nodule (>2cm), its shape (bilobular), and the fact that it has both cystic and solid components make it more suspicious, what do you think?
Hi Andrea59,
I just want to clarify - being "more suspicious" does not mean it is cancer, it just means that the doctor needs to follow up and do a FNB. The majority of nodules with similar characteristics to yours end up not being cancer, but on my ultrasound there was a whole grading scale about what the recommendations are and if it falls into certain categories, the follow-up is ultrasound in 6 months or a year, FNB, etc. My suspicious nodule was "hypoechoic" which put it in a higher category than "isoechoic" (which all my other nodules fell into - I had lots of nodules both lobes), so even though it was a smaller size, that was the one they biopsied on the right side on my thyroid. I had a larger (2.8cm) nodule with blood vessel infiltration that was an oblong shape behind my carotid artery on the left side that was biopsied (that one was also in a "higher risk" category, and that one was benign (benign on FNB and pathology after surgery confirmed it was benign).
There is a very good chance your nodule is benign, but I wanted to inform you of what the possibilities are so you have a fuller picture going in to the FNB (I didn't want to scare you, but I can't tell you that your nodule is not cancer at this point because that's why they do the FNBs). I think my ultrasound put my hypoechoic nodule around a 20% risk for cancer (vs. 5-10% of all nodules), so your chances of it being cancer are probably similar to that, and you may be at a higher risk than a very low risk nodule, but I wouldn't automatically assume it is cancer. I wouldn't put off the FNB for a year, especially if the not knowing part is going to cause you a lot of anxiety, but you should know that most thyroid cancers are very slow growing and very treatable and that is why they often recommend a slow/wait and see approach to thyroid nodules.
Also, I agree with Barb135's answer - have you been tested for thyroid function or do you have symptoms of hyper or hypothyroidism? An enlarged thyroid often indicates Graves disease or Hashimoto's.
I know this part was very stressful for me when I was going through my diagnosis, but even if your nodule is at a slightly higher risk, it does not mean it is cancer, and I wanted to give you what my honest thoughts were reading your ultrasound. Being at a higher risk is a reason to get a FNB done, but there is a very good chance that your FNB comes back benign. There is no way of knowing until you do the FNB though.
I just want to clarify - being "more suspicious" does not mean it is cancer, it just means that the doctor needs to follow up and do a FNB. The majority of nodules with similar characteristics to yours end up not being cancer, but on my ultrasound there was a whole grading scale about what the recommendations are and if it falls into certain categories, the follow-up is ultrasound in 6 months or a year, FNB, etc. My suspicious nodule was "hypoechoic" which put it in a higher category than "isoechoic" (which all my other nodules fell into - I had lots of nodules both lobes), so even though it was a smaller size, that was the one they biopsied on the right side on my thyroid. I had a larger (2.8cm) nodule with blood vessel infiltration that was an oblong shape behind my carotid artery on the left side that was biopsied (that one was also in a "higher risk" category, and that one was benign (benign on FNB and pathology after surgery confirmed it was benign).
There is a very good chance your nodule is benign, but I wanted to inform you of what the possibilities are so you have a fuller picture going in to the FNB (I didn't want to scare you, but I can't tell you that your nodule is not cancer at this point because that's why they do the FNBs). I think my ultrasound put my hypoechoic nodule around a 20% risk for cancer (vs. 5-10% of all nodules), so your chances of it being cancer are probably similar to that, and you may be at a higher risk than a very low risk nodule, but I wouldn't automatically assume it is cancer. I wouldn't put off the FNB for a year, especially if the not knowing part is going to cause you a lot of anxiety, but you should know that most thyroid cancers are very slow growing and very treatable and that is why they often recommend a slow/wait and see approach to thyroid nodules.
Also, I agree with Barb135's answer - have you been tested for thyroid function or do you have symptoms of hyper or hypothyroidism? An enlarged thyroid often indicates Graves disease or Hashimoto's.
I know this part was very stressful for me when I was going through my diagnosis, but even if your nodule is at a slightly higher risk, it does not mean it is cancer, and I wanted to give you what my honest thoughts were reading your ultrasound. Being at a higher risk is a reason to get a FNB done, but there is a very good chance that your FNB comes back benign. There is no way of knowing until you do the FNB though.
I think Sarahjogs clarified her position quite well. It's very important to understand that although something may be suspicious or that it needs to be further investigated, it's a long way from saying or even indicating that it's cancer.
A nodule that has solid components is more likely to be cancerous than one that doesn't have solid components, however, your ultrasound report gives no information regarding echogenicity, margin descriptions, it doesn't mention vascularity, microcalcifications etc - all of which may make it more suspect, which is why I said it's impossible to try to make any type of determination regarding your nodule.
As I noted previously, *I* have a completely solid nodule that no one is concerned about because it doesn't have any other characteristics of being cancerous, except its size. Does that mean it isn't cancer? No, it simply means that with only those characteristics, the chances are slim... Do I worry about it? Sure and I make sure I get regular ultrasounds to insure that nothing changes but I don't lose a lot of sleep over it. In addition to this larger nodule, I have multiple other nodules - it's what's called "multiple nodular goiter", which simply means I have multiple (numerous) nodules on a swollen thyroid, which is very common with Hashimoto's, an autoimmune condition I do have.
It's very difficult to compare my situation to yours for a variety of reasons and it's impossible for us to indicate what percentage your chances of cancer might be. All we can do is tell you that your ultrasound is too incomplete to give us enough information, so we have to go by the recommendation of the radiologist, which is to get an FNA "or" follow up at a minimum of a year's time. Common sense tells us that if the radiologist considered your chance of cancer at a high percentage, s/he would have 1) made your report more detailed and probably categorized it 2) made a single recommendation for the FNA, instead of providing options.
I, personally, feel that it's worth getting the FNA simply to have the peace of mind. Since you have one scheduled for the 14th, I think you've done the right thing; however, I'll also say that I'm not a doctor and am not qualified to make any medical determination.
You didn't tell us what prompted the ultrasound that showed the large nodule; therefore, as both, Sarahjogs and I have advised, I'd suggest that you go ahead and ask for the thyroid testing I recommended above so you'll have those results by the time your FNA is completed and you'll know whether or not you might require thyroid treatment.
A nodule that has solid components is more likely to be cancerous than one that doesn't have solid components, however, your ultrasound report gives no information regarding echogenicity, margin descriptions, it doesn't mention vascularity, microcalcifications etc - all of which may make it more suspect, which is why I said it's impossible to try to make any type of determination regarding your nodule.
As I noted previously, *I* have a completely solid nodule that no one is concerned about because it doesn't have any other characteristics of being cancerous, except its size. Does that mean it isn't cancer? No, it simply means that with only those characteristics, the chances are slim... Do I worry about it? Sure and I make sure I get regular ultrasounds to insure that nothing changes but I don't lose a lot of sleep over it. In addition to this larger nodule, I have multiple other nodules - it's what's called "multiple nodular goiter", which simply means I have multiple (numerous) nodules on a swollen thyroid, which is very common with Hashimoto's, an autoimmune condition I do have.
It's very difficult to compare my situation to yours for a variety of reasons and it's impossible for us to indicate what percentage your chances of cancer might be. All we can do is tell you that your ultrasound is too incomplete to give us enough information, so we have to go by the recommendation of the radiologist, which is to get an FNA "or" follow up at a minimum of a year's time. Common sense tells us that if the radiologist considered your chance of cancer at a high percentage, s/he would have 1) made your report more detailed and probably categorized it 2) made a single recommendation for the FNA, instead of providing options.
I, personally, feel that it's worth getting the FNA simply to have the peace of mind. Since you have one scheduled for the 14th, I think you've done the right thing; however, I'll also say that I'm not a doctor and am not qualified to make any medical determination.
You didn't tell us what prompted the ultrasound that showed the large nodule; therefore, as both, Sarahjogs and I have advised, I'd suggest that you go ahead and ask for the thyroid testing I recommended above so you'll have those results by the time your FNA is completed and you'll know whether or not you might require thyroid treatment.
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