[Wendy77]

Hello-

In January I had a follow up thyroid ultrasound per my ENT's instructions from the year prior to monitor bilateral thyroid nodules. After reviewing the results of this year's ultrasound, my ENT is recommending a TT due to the nodules having microcalcifications. They are solid and have grown in the 10 months since my last ultrasound (Mar '16). He said there is a 30% chance they are malignant. I don't have any thyroid function issues that I know of but do have noticed some difficulty swallowing. I've pasted in the ultrasound report and lab results below. I would appreciate any input or advice. I am scheduled for a TT this Thursday, March 30th, and am still trying to convince myself that I'm doing the right thing. I'm really active with CrossFit and weightlifting and stay fit (18% BF) and track all my macros so am really concerned with weight gain and fatigue following my TT. I turn 40 next month. Also I'm concerned because I am on active duty and every time I move bases (average of every 2.5 years), I will have new doctors to deal with.

Test Name

Result

Units

Reference Range

Thyroxine Free

1.3

ng/dL

0.9-1.7

Test Name

Result

Units

Reference Range

Thyrotropin Sensitive (TSH)

1.04

mcIU/mL

0.3-4.5

FINDINGS:

The right thyroid lobe is homogenous in echotexture and measures 5.3 x 1.7 x 1.8 cm. There is a 9 mm spongiform nodule within the upper thyroid lobe. This has no concerning sonographic features. A second mixed solid and cystic nodule in the upper thyroid lobe measures up to 1 cm. There are microcalcifications within this nodule. This nodule is wider than tall and does not extend beyond the thyroid margin.

The left thyroid lobe is homogenous in echotexture and measures 5.1 x 1.5 x 1.6 cm. There is a hypoechoic solid nodule in the mid thyroid lobe measures up to 9 mm. There are microcalcifications within this nodule. This nodule is wider than tall and does not extend beyond the thyroid margin.

The thyroid isthmus measures 4 mm.

Normal vascularity is seen throughout the thyroid gland.

IMPRESSION:

Multiple thyroid nodules, largely unchanged in comparison. There are some microcalcifications within both a right and left thyroid lobe nodule. None of these nodules meet sonographic criteria for ultrasound guided fine needle aspiration at this time.

Thank you,

Wendy

 

[joplin1975]

Well...

I think your doctor is jumping the gun a bit.

First, unless you are certain you want the thyroid out, you should have a biopsy before surgery. None of your nodules even meet the criteria for biopsy (although it's close). I'd ask why he's skipping the biopsy.

Second, many many people go into surgery not knowing for sure if their nodules are cancerous. That's normal. And yes, your u/s does show some concerning characteristics. However, he should be ordering a boatload of more tests to give you as much information as possible, most pressing would be thyroid antibodies. TPO and TSI would point to autoimmune thyroid issues and Tg/TgAB would help indicate if it's thyroid cancer. You could also have a radioiodine uptake scan which can tell you how well (or not) those nodules are functioning. It can also point to cancer vs no cancer. Finally, the most important thyroid function test is free t3 and you don't have that...if your doctor won't test that, it'll be really difficult to regulate meds after surgery.

To be clear, 40 is the seemingly magic number for thyroid cancer. If they find a cancerous nodule and you are 40 or over, it tends to be more aggressive and they treat it with more urgency.

Finally, I'll say two more things: 1) there's a push now to take a watch and wait approach with thyroid cancer. Research has shown that cancerous nodules under 1 cm that have not extended beyond the margins of the thyroid capsule don't always require treatment (although they do require monitoring) and 2) the biggest factor in successful recovery from surgery is finding a "high volume" surgeon. Do you have that? What kind of questions did you ask? What is his background? How many thyroid surgeries does he do annually? How does he close the wound? Will he do a frozen section exam during surgery? What is his complication rate? Etc etc...

I tend to be pro-surgery and you may need it, but I'm not convinced you have all the information you need to make an informed decision. I'll try to find the watch and wait article from the ATA.

 

[joplin1975]

Michael Tuttle = top notch thyroid cancer expert.

https://www.google.com/amp/s/www.mskcc.org/blog/papillary-thyroid-active-surveillance-may-be-best-choice%3Famp

 

[creepingdeath]

If I had no symptoms and I have no lump jetting out of my neck I'd leave it.

The symptoms of hypothyroidism are rough and take a long time to be relieved if at all by thyroid replacement.

I'd get a 2nd opinion and maybe a 3rd.