# "hot" nodules



## babygirl1 (Jun 8, 2010)

I have a multinodular goiter (3 one cm. nodules on one side and a 4 cm. nodule on the other side). I had an fna last year and no cancer was detected. I went back for a follow up ultrasound and blood work. The nodules had not changed in size which was good. My blood work was all normal with the tsh (I believe) being on the very high normal side. The doc said that he suspects that the large nodule is a little hot which made the levels a little high. I asked about meds because I have a lot of hypo symptoms such as brittle, splitting nails, inability to lose weight no matter what, cold and tired a lot, etc.... He said that even a little medicine would make me hyper. I asked about an RAI but he said that it would probably show the large nodule was hot and that we would still do the same thing-wait and come back in a year. He also said that that was an awful large nodule and that it was what was causing the choking sensation that I get sometimes. He said that we could schedule surgery whenever the symptoms got too severe (I do not want surgery)! I was just wondering if anybody had any suggestions or advice. Would the RAI be helpful? Is there anything that I can do to shrink the nodules? I tried acupuncture but that didn't shrink them at all. I also tried L tyrosine but that made my heart race a little and made me jittery. Thanks in advance.


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## GD Women (Mar 5, 2007)

A thyroid nodule which is larger than 3 cm, cystic/solid or large and cystic/solid may have a higher probability of malignancy (grade C). There is often a dominant nodule within a multinodular goiter that can cause concern for cancer. Remember, the incidence of malignancy within a multinodular goiter is usually significantly less than 5%. If the nodule is cold on thyroid scanning, then it may be slightly higher than this.

Most solid thyroid nodules generally will not shrink spontaneously and completely disappear. Patients with a hemorrhage into a thyroid nodule may commonly experience reduction in size of the expanded nodule once the hemorrhage resolves. Similarly, patients with a nodular variant of Hashimoto's disease may notice nodules gradually getting bigger or smaller. Nevertheless, the majority of solid nodules remain persistent and detectable for many years.

Several studies reveal that suppression with thyroid hormone does not decrease the size of thyroid nodules. Therefore, unless a nodule is growing or becoming symptomatic, it is not necessary to suppress the nodule. In addition, suppression of a thyroid nodule would require long-term thyroid-stimulating hormone (TSH) suppression, potentially increasing the risk of osteoporosis in these patients.
http://www.endocrinesurgery.ucla.edu/patient_education_adm_thyroid_nodule.html

For many years, patients with nodules were often advised to take thyroid hormone (thyroxine) indefinitely to shrink or prevent further nodule growth. Indeed, many studies show that most nodules, but not all, will exhibit some degree of size reduction after a year or so on thyroxine. However, the nodules do not usually go away, and the need for follow-up and occasional repeat biopsy remains the same. Furthermore, some studies (Slow growth of benign thyroid nodules after menopause: no need for long-term thyroxine suppressive therapy in post-menopausal women. J Endocrinol Invest. 2004 Jan;27(1):31-6) show that nodules may not increase in size, even in the absence of thyroxine. 
http://www.mythyroid.com/thyroidnodules.html

Radioiodine therapy (iodine-131) is effective in most patients with non-toxic multinodular goiter and compressive symptoms decrease in the majority of patients. 
Then you'll probably go hypo and have to be on thyroid meds. for life.

Two of the 6 indications for treatment are compression of trachea or esophagus and/or neck discomfort.

Perhaps you should discuss this further with your doctor.

Good LucK!


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## Andros (Aug 26, 2009)

babygirl1 said:


> I have a multinodular goiter (3 one cm. nodules on one side and a 4 cm. nodule on the other side). I had an fna last year and no cancer was detected. I went back for a follow up ultrasound and blood work. The nodules had not changed in size which was good. My blood work was all normal with the tsh (I believe) being on the very high normal side. The doc said that he suspects that the large nodule is a little hot which made the levels a little high. I asked about meds because I have a lot of hypo symptoms such as brittle, splitting nails, inability to lose weight no matter what, cold and tired a lot, etc.... He said that even a little medicine would make me hyper. I asked about an RAI but he said that it would probably show the large nodule was hot and that we would still do the same thing-wait and come back in a year. He also said that that was an awful large nodule and that it was what was causing the choking sensation that I get sometimes. He said that we could schedule surgery whenever the symptoms got too severe (I do not want surgery)! I was just wondering if anybody had any suggestions or advice. Would the RAI be helpful? Is there anything that I can do to shrink the nodules? I tried acupuncture but that didn't shrink them at all. I also tried L tyrosine but that made my heart race a little and made me jittery. Thanks in advance.


GDWomen has put you on the right track w/ credible information. Really, my only comment is that I think you should go doctor shopping.

RAIU (Radioactive Iodine Uptake Scan) is always a good thing to do; much better than a sonogram and much better about just "wondering" what the heck is going on.

I do think that because the nodule appears to be growing around your esophogus that this should not be taken lightly and I don't see why you should have to wait and suffer.

Now....................what do your last labs look like? We also need the ranges.

And................have you had any of these tests which I do recommend that you have.............

TSI (thyroid stimulating immunoglobulin),TPO (antimicrosomal antibodies) TBII (thyrotropin-binding inhibitory immunoglobulin), Thyroglobulin Ab, ANA (antinuclear antibodies), (thyroid hormone panel) TSH, Free T3, Free T4.

You can look this stuff up here and more.........
http://www.labtestsonline.org/unders...s/thyroid.html


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