# Ultrasound findings?



## Christinals (Sep 9, 2010)

What does this mean....

Right lobe: Heterogeneous in echotecture. Lobular. The previous nodule within the midpole is now surrounded with more heterogeneous echotexture and is not seen as a discrete lesion, however the overall size of this area measures 3.6cm X 1.7 X 2cm. There is no evidence of hyperemia.
Size of lobe 5.2 X 2 X 2.1

If they can measure it, but it isnt a "discrete lesion"....does that mean it has no rim? Or is it gone?

Just curious.


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## Andros (Aug 26, 2009)

Christinals said:


> What does this mean....
> 
> Right lobe: Heterogeneous in echotecture. Lobular. The previous nodule within the midpole is now surrounded with more heterogeneous echotexture and is not seen as a discrete lesion, however the overall size of this area measures 3.6cm X 1.7 X 2cm. There is no evidence of hyperemia.
> Size of lobe 5.2 X 2 X 2.1
> ...


A thyroid nodule is a discrete lesion within the thyroid gland that is radiologically distinct from the surrounding thyroid parenchyma.

It means that they do NOT see a nodule but that the tissue is not normal. It also implies cancer. And yes, it could be that it is just not distinct having no rim which could suggest that it is metastatic cancer.

Please read and also get w/your doctor on this next week if you can.
http://radiology.rsna.org/content/237/3/794.full

Figure 1. is a good explanation.

Please keep in mind that the above comments are from a layperson. Talk to your doctor.

I'll tell you one thing; you do ask very very good questions. Nothing wrong with your brain cells, that is for sure!


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## Christinals (Sep 9, 2010)

Thank Andros,

Now that you think Im smart....lol...I have a (maybe) silly question. Since the nodule has been biopsied a year ago...would that cause it to look "undefined" ? 
I haven't read your link yet. I will now. Thx

~christi


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## Andros (Aug 26, 2009)

Christinals said:


> Thank Andros,
> 
> Now that you think Im smart....lol...I have a (maybe) silly question. Since the nodule has been biopsied a year ago...would that cause it to look "undefined" ?
> I haven't read your link yet. I will now. Thx
> ...


It sure could. There is such a thing as "seed cancer" where if the area is disturbed, it metastasizes. And it could change the geography of the original nodule or tumor.

There are some cancers that should not be surgically disturbed for this reason.

http://www.karlloren.com/biopsy/p32.htm

Few people know this stuff and sadly, that includes some doctors as well. Wah!


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## Christinals (Sep 9, 2010)

Okay, I read your links. Scary thought of seeding, however my fna came back negative (let's just assume it is correct). After biopsy, I wonder if it would change the overall appearance of that area..for lack of a better description, scar tissue?

Andros...I have read many many many posts on these boards. I have come to the conclusion you must be an angel! Thank you for alllll the support you give to each of us here. You are on my prayer list. My thank you prayer list. God bless you Ms. Andros.
:hugs::hugs::hugs::hugs:hugs3hugs3


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## Christinals (Sep 9, 2010)

I saw pictures of the "nodules". It looks completely benign if I do say so myself...lol
Staying positive!

Tomorrow is my appt with new ENDO. Crossing my fingers.


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## Andros (Aug 26, 2009)

Christinals said:


> Okay, I read your links. Scary thought of seeding, however my fna came back negative (let's just assume it is correct). After biopsy, I wonder if it would change the overall appearance of that area..for lack of a better description, scar tissue?
> 
> Andros...I have read many many many posts on these boards. I have come to the conclusion you must be an angel! Thank you for alllll the support you give to each of us here. You are on my prayer list. My thank you prayer list. God bless you Ms. Andros.
> :hugs::hugs::hugs::hugs:hugs3hugs3


Aw; shucks!








very very much!

Not sure about the Angel part but I do care; a lot! Passing it forward!

Glad about the FNA coming back benign and you know I am all for positive! Absolutely!


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## Andros (Aug 26, 2009)

Christinals said:


> I saw pictures of the "nodules". It looks completely benign if I do say so myself...lol
> Staying positive!
> 
> Tomorrow is my appt with new ENDO. Crossing my fingers.


Hope your appt. goes well and cannot wait to hear all about it! We are always learning.


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## Christinals (Sep 9, 2010)

Just a note....the FNA I was speaking of was the one last year. I was just trying to put some pieces of the puzzle together. That's all. I will be going for another FNA soon (on different nodules and the other non-discrete "tissue" that once was a nodule).

Okay, maybe not an angel, a saint? :tongue0015:


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## Andros (Aug 26, 2009)

Christinals said:


> Just a note....the FNA I was speaking of was the one last year. I was just trying to put some pieces of the puzzle together. That's all. I will be going for another FNA soon (on different nodules and the other non-discrete "tissue" that once was a nodule).
> 
> Okay, maybe not an angel, a saint? :tongue0015:


Glad you clarified that about the FNA!


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## Christinals (Sep 9, 2010)

Just got back from my consult with new ENDO. He is sending me for another fna, but this time he wants it to be done at the hospital lab??? He said he could do it at his office but he wants all of the nodules tested and he wants to make sure enough cells are sampled. I'm waiting for a call from the lab to schedule me. He said the radiology report is a bit confusing. He was not thrilled with their explanation. He will call me with results. The waiting game begins.


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## Christinals (Sep 9, 2010)

Just great......just got a call from my GYN....now I have to have a ultrasound on my uterus. When it rains it pours. FABULOUS!!!! I go in today.  Still waiting on a call from the lab to schedule my fna. At least I am getting all of this out of the way at the same time. 

This weekend I'm having a HUGE garage sale! It's only 109 here in sunny Phoenix. It looks like it will be a little hot, but I have to get this stuff out of my house lol!

This week is flying by! I hope you all have a great Wednesday!


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## Andros (Aug 26, 2009)

Christinals said:


> Just got back from my consult with new ENDO. He is sending me for another fna, but this time he wants it to be done at the hospital lab??? He said he could do it at his office but he wants all of the nodules tested and he wants to make sure enough cells are sampled. I'm waiting for a call from the lab to schedule me. He said the radiology report is a bit confusing. He was not thrilled with their explanation. He will call me with results. The waiting game begins.


You know what? I think you finally hit pay dirt w/ this doc! I am impressed. Are you? Did you like him? He seems thorough and interested in helping you!

Hate you have to have more FNA but I would hate for you to not know if you have cancer even worse.

We would like to keep you around for a long long time!


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## Andros (Aug 26, 2009)

Christinals said:


> Just great......just got a call from my GYN....now I have to have a ultrasound on my uterus. When it rains it pours. FABULOUS!!!! I go in today.  Still waiting on a call from the lab to schedule my fna. At least I am getting all of this out of the way at the same time.
> 
> This weekend I'm having a HUGE garage sale! It's only 109 here in sunny Phoenix. It looks like it will be a little hot, but I have to get this stuff out of my house lol!
> 
> This week is flying by! I hope you all have a great Wednesday!


I am going to take a lot of stuff to the Mission here. Things just pile up and I figure if we have not used it for 2 years; it is going O U T!!!

Hope you have a great turn out! We have had temps of over 100° this year, highest being 105°. But in Ga., we get that high humidity also and you just cannot breathe.

In past years, we have had temps in the 100 teens. You talk about hot!! Egads!

Wishing you the best today on the ultra-sound.


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## Christinals (Sep 9, 2010)

Thanks Andros,

We also donate to the Mission here as well.
We have so many sales at our house - I don't know HOW we end up with so much stuff...and clothes! People must think we are hoarders! LOL - I am beginning to think so too. 

Thanks for your kind words. Yes, I like the doctor and I just have a hunch, things will be just fine. I am really not worried any more. It is what it is and I can't change any of it at this point - and only God is in control. I have finally released it all to Him....Maybe that is my lesson in all of this stuff. Just had a BING BING moment...lol

Have a great day!


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## Andros (Aug 26, 2009)

Christinals said:


> Thanks Andros,
> 
> We also donate to the Mission here as well.
> We have so many sales at our house - I don't know HOW we end up with so much stuff...and clothes! People must think we are hoarders! LOL - I am beginning to think so too.
> ...


There you go; once we give up control and give it over to God, things start to get decidedly better. I am a big "have to be in control kind of person" so this was an obstacle I had to overcome and I did. LOL!

Will be waiting to hear from you.


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## Christinals (Sep 9, 2010)

Thanks Andros.

I had the ultrasound of my uterus (the tech indicated normal  )
I have a swollen node under my jaw. I will keep an eye on it and make sure it goes away.

My doctor has me on hydrocodone for pericarditis as needed (i havent taken it in a long while)....that has ibuprofin in it....i will stick to tylenol if I need it until after my fna. Thanks for the info!

Sale was great! Im glad to have my house back!!!! This place is clean. And we donated lots of good stuff too.

Have a great weekend everyone!!!!


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## Andros (Aug 26, 2009)

Christinals said:


> Thanks Andros.
> 
> I had the ultrasound of my uterus (the tech indicated normal  )
> I have a swollen node under my jaw. I will keep an eye on it and make sure it goes away.
> ...


How do you know it is pericarditis? Geez!!! I used to get pleurisy and costalchronditis all the time. Come to find out it was a symptoms of Lupus. Extremely painful to the maximum degree! Is the pericarditis painful like that?

Glad all else is good to go. Thank God for that. You don't need more.

Keep us in the loop about the lymph node.

Glad you had a good garage sale and now you have more room for other things or no things as the case may be! LOL!


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## Christinals (Sep 9, 2010)

I had pericardial effusion and they put in a pericardial window a few years ago. Now when I get sick...cold...flu...anything, I have a "flare up". I was feeling around my thyroid....is there a lymph node in the front of the thyroid? Upper part of the isthmus?


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## Christinals (Sep 9, 2010)

Tomorrow is FNA day explode. 7:30am Sharp 
Can't wait to get it OVER - again!

Dr. called and let me know that the uterine ultrasound was great. All looks good (dodged a bullet there...lol).   

Pericarditis is very painful! It feels very much like a bad pleurisy. I have had that too  I was never given a reason for why the pericardial effusion even happened. The Dr. said it was just a fluke. Oh well. When it flares up, every breath hurts....laying down hurts...I'm glad it doesn't happen often.

Hope you are all having a great week.
:hugs:


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## Andros (Aug 26, 2009)

Christinals said:


> Tomorrow is FNA day explode. 7:30am Sharp
> Can't wait to get it OVER - again!
> 
> Dr. called and let me know that the uterine ultrasound was great. All looks good (dodged a bullet there...lol).
> ...


Oh, you poor dear! My heart goes out to you. And...................I am keeping you in my thoughts and prayers for your FNA tomorrow morning.

You can "count" on it.


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## Christinals (Sep 9, 2010)

FNA was yesterday.
Got a call today....going in for results this afternoon, that was quick.
I have a pounding headache today. I wonder if it's from the FNA?
Anyone experience this? It's almost migrane worthy (I need to be in a dark quiet room)

I will post tonight with results. I'm sure it's all good 

Hope your day is going well!


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## Octavia (Aug 1, 2011)

May the force be with you!

Do let us know.

Hopefully your headache goes away soon...


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## Christinals (Sep 9, 2010)

Interesting...no results. They thought they had pathology reports but they only had more ultra sound reports. NOW it says something different. I will summarize....

There is a cluster of nearly isoechoic solid nodules measuring 3.6 cm on right lobe.
Very heterogeneous.
There are more clusters on the left , nearly isoechoic solid measuring 2 cm.....
Heterogeneous as well.

Okay...i think im in the clear. They appear Isoechoic now. That is better, yes? 
Im still waiting for pathology. Maybe Monday....i hope.:rolleyes:


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## Christinals (Sep 9, 2010)

Thx Octavia!


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## Christinals (Sep 9, 2010)

What is the difference between isoechoic and hypoechoic? My reports have never said isoechoic until now. That is better right? Still solid though. Hopeuflly I will get results back today.


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## Andros (Aug 26, 2009)

Christinals said:


> What is the difference between isoechoic and hypoechoic? My reports have never said isoechoic until now. That is better right? Still solid though. Hopeuflly I will get results back today.


Isoechoic could mean cancer.
http://www.mghradrounds.org/index.php?src=gendocs&link=2005_march

Isoechoic nodule

Essentially a nodule that on scan returns an image that reflects the signal the same as an adjacent tissue structure. Makes it more difficult to "see" the desired tissue structure

Read more: http://wiki.answers.com/Q/What_is_an_isoechoic_nodule#ixzz1Y8N9gTZP

hypoechoic
Imaging adjective Relating to an abnormal ↓ in echoes by ultrasonography, due to a pathologic change in tissue density


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## Christinals (Sep 9, 2010)

Thanks Andros.
Still haven't heard anything. Probably Monday 

Have a great weekend.


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## Andros (Aug 26, 2009)

Christinals said:


> Thanks Andros.
> Still haven't heard anything. Probably Monday
> 
> Have a great weekend.


You as well! Try to not worry this weekend and get some relaxation time in. Monday will be here soon enough!


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## Christinals (Sep 9, 2010)

I got my results. They were accidentaly mailed to me.....not the dr?
It says....
Ill defined 3.6cm nodule right. No calcifications
Ill defined 2.8cm nodule left. No calcifications

Follicular cells
Hurthle cells
Coloid
Neutrophils
Erythrocytes

Slides adequate for evaluation

Okay.....since it says coloid....benign right?

I am waiting for a call from dr.


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## Andros (Aug 26, 2009)

Christinals said:


> I got my results. They were accidentaly mailed to me.....not the dr?
> It says....
> Ill defined 3.6cm nodule right. No calcifications
> Ill defined 2.8cm nodule left. No calcifications
> ...


Nearly half of all single nodules have on gross inspection a gelatinous appearance, are composed of large colloid-filled follicles, and are not completely surrounded by a well-defined fibrous capsule. These nodules are listed as colloid variants of follicular adenomas in our classification. Many pathologists report these as colloid nodules, and suggest that each is a focal process perhaps related to multinodular goiter rather than a true adenoma.

These tumors are usually not surrounded by a capsule of compressed normal tissue, and often show degeneration of parenchyma, hemosiderosis, and colloid phagocytosis (Fig. 18-2). Recent studies indicate that most adenomas, as well as carcinomas, are truly clonal -- derived from one cell -- whereas colloid nodules, at least in multinodular goiters, tend to be polyclonal (2).

Colloid nodules. These are one or more overgrowths of normal thyroid tissue. These growths are noncancerous, may grow large, but do not spread beyond the thyroid gland.

http://www.thyroidmanager.org/Chapter18/18-noduletxt.htm

It sure sounds like you are out of the woods and I sincerly hope so. As you can see, for the most part, cancer derives from one cell; colloids are "usually" polyclonal (2 cells) and most "usually" benign.

Let us know the doc's interpretation when you can.

Do you think the above report is compete? There does not seem to be any comments by the pathologist.


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## Christinals (Sep 9, 2010)

Im just waiting for the benign call. From what i have read it all looks good hugs6

Thx. :hugs:


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## Andros (Aug 26, 2009)

Christinals said:


> Im just waiting for the benign call. From what i have read it all looks good hugs6
> 
> Thx. :hugs:


Well be sure to let us know!


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## Christinals (Sep 9, 2010)

Nurse Called. Benign. No diagnosis.
No comments on the report either.
Hurthle cells are normal to have? Along with follicular?
Just to confirm....all fna show follicular cells correct?

Im so happy to put this behind me for now.
They want me back in six months. Yeah!!!!


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## Andros (Aug 26, 2009)

Christinals said:


> Nurse Called. Benign. No diagnosis.
> No comments on the report either.
> Hurthle cells are normal to have? Along with follicular?
> Just to confirm....all fna show follicular cells correct?
> ...


I don't know; I did not exactly understand the report per se the way everything was listed.

There are 2 kinds of Hurthle cells, that I know. One is indigenous to Hashimoto's and the other is indigenous to cancer.

Benign follicular adenomas. The word follicular means the cells look like a group of small circles under a microscope. If the follicular cells are contained within the nodule, the condition is called benign. If the cells have invaded the surrounding tissue, the diagnosis is cancer. The nodule must be surgically removed and examined under a microscope to look for evidence of invasion into the normal thyroid tissue or blood vessels.

The above is a good example of why there should have been pathology comments. Like are they contained or not? Know what I mean here?

http://www.cedars-sinai.edu/Patients/Health-Conditions/Thyroid-Nodules.aspx


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## Christinals (Sep 9, 2010)

It is very vague on this report. I am assuming that since the Dr.s office is saying benign.....maybe they have a more detailed report. I will go back for more punishment in six months i guess. Another ultrasound and then decide if another fna is really needed.

Adventually this mess needs to come out!

Thx Andros


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## Andros (Aug 26, 2009)

Christinals said:


> It is very vague on this report. I am assuming that since the Dr.s office is saying benign.....maybe they have a more detailed report. I will go back for more punishment in six months i guess. Another ultrasound and then decide if another fna is really needed.
> 
> Adventually this mess needs to come out!
> 
> Thx Andros


Who would think such a little gland could mess up life so bad?


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## Christinals (Sep 9, 2010)

Andros,

Well, no luck!
I cannot get any additional information re: Hurthle cells.
I called the Dr.'s office and spoke with a nurse and she said if he was concerned about the Hurthle cells, he would have sent me to a surgeon. So benign is BENIGN. lol

I was looking back at my previous FNA results I had posted last year to compare...

Numerous clusters of bland follicular cells. For the most part they are of a benign atrophic pattern. Cytoplasm is delicate and weblike. Microfollicular & papillary atypias are absent. On one slide clusters of pigmented histocytes with involutional change or perhaps microcystic change.

Assessment: Boipsy is benign 3cm nodule. 
Biopsy due to positive anti-thyroid antibodies. 
Follow up with physician.

THIS year it is much more vague?

Ill defined 3.6cm nodule right. No calcifications
Ill defined 2.8cm nodule left. No calcifications

Follicular cells
Hurthle cells
Coloid
Neutrophils
Erythrocytes

Slides adequate for evaluation.

I wish I had gone to medical school......lol


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## Andros (Aug 26, 2009)

Christinals said:


> Andros,
> 
> Well, no luck!
> I cannot get any additional information re: Hurthle cells.
> ...


Ditto, that GF!! I would like to have gone into medical research! In our next life; we will pursue our dreams! LOL!

Anyway, does your copy have the phone # and the pathologist who read the FNA? Could you call the pathology department?


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## Christinals (Sep 9, 2010)

I got my RAIU report today.
Just thought you might find this interesting.

It is EXACTLY the same as before.
After 4hrs the uptake was 3%
After 24hrs the uptake was 6%

None of my nodules "show up" on the RAIU.
I did the diet correctly.

What does it mean if nothing "shows up" ?
The nodules are still there on ultrasound and palp.

Very odd.

THX,

Christi


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## Andros (Aug 26, 2009)

Christinals said:


> I got my RAIU report today.
> Just thought you might find this interesting.
> 
> It is EXACTLY the same as before.
> ...


It could mean that the nodules are solid and therefore did not uptake the contrast material.

What has your doctor said?


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## Christinals (Sep 9, 2010)

Since the FNA was benign (w/ benign Hurthle cells)...he said nothing. Come back in 6 months.


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## Christinals (Sep 9, 2010)

He said we would not do another RAIU, but redo ultrasound and FNA if needed in six months.

Hope everyone is feeling well, and having a nice day.


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## Andros (Aug 26, 2009)

Christinals said:


> He said we would not do another RAIU, but redo ultrasound and FNA if needed in six months.
> 
> Hope everyone is feeling well, and having a nice day.


Here is a plausable reason for a depressed RAIU:

Thyroiditis is a group of inflammatory thyroid disorders. Patients with chronic lymphocytic thyroiditis (also referred to as Hashimoto's thyroiditis) present with hypothyroidism, goiter, or both. Measurement of serum thyroid autoantibodies and thyroglobulin confirms the diagnosis. Subacute granulomatous thyroiditis (sometimes referred to as de Quervain's disease) is a self-limited but painful disorder of the thyroid. Physical examination, elevated erythrocyte sedimentation rate, elevated thyroglobulin level and depressed radioactive iodine uptake (RAIU) confirm the diagnosis. Subacute lymphocytic thyroiditis (silent thyroiditis) is considered autoimmune in origin and commonly occurs in the postpartum period. Symptoms of hyperthyroidism and depressed RAIU predominate. Acute (suppurative) thyroiditis is a rare, infectious thyroid disorder caused by bacteria and other microbes. The rare, invasive fibrous thyroiditis (Riedel's thyroiditis) presents with a slowly enlarging anterior neck mass that is sometimes confused with a malignancy. (Am Fam Physician 2000;61:1047-52,1054.)

http://www.aafp.org/afp/20000215/1047.html

If you have time; do some research about the different diagnosis' listed.


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## Christinals (Sep 9, 2010)

I have searched many places and have never found that page. Very informative!!!


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