# Thyroid U/S - Errors?



## dantetila (Jul 24, 2010)

Hi all,

I have recently had an ultrasound that showed two small hypoechoic nodules and a very small cyst. I took a look at the image CD myself and noticed some issues with the final report, worksheet and the actual images. On the images, the left thyroid has a measurement tool highlighting the nodule. It shows 10mm x 5mm and another image showing the height of 7mm. So I would expect 10mm x 5mm x 7mm, but the final report says 8mm x 7mm x 5mm, which I don't see anywhere in the images. Also on the radiologist worksheet, she has wrote 8mm x 5mm x7mm, but on the final report, she wrote 8mm x 5mm x 7mm. This has a big difference in meaning because if the nodule is taller than wide, that is a bad sign from what I've read. Also writing 8mm vs 10mm will mean my endo will likely not biopsy it. Is this something I should bring to my Endo's attention?

I have attached the pictures of everything I was explaining to you.

Thanks.


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## lainey (Aug 26, 2010)

The problem in giving the records directly to the patient is exactly what you have outlined above:

you are looking at the report, comparing it to the pictures, looking at the notes AND....

trying to draw conclusions.

What training do you have to do this?

A radiologist is a doctor who has been trained to read these scans--so, years of medical school, then advanced training afterwards.

Could there be margins of error in the measurement tool? The precision you're looking for here is 2mm, or slightly more than the diameter of the wire in a paper clip .... I'm going to go with, perhaps you are expecting the measurement to be too exact.

Did you ask the radiologist directly about this "discrepancy"? Perhaps there is a good reason for it???

The nodules are small. Very small. Visit an endocrine surgeon that specializes in ultrasound guided biopsies and see what they say about them--but from personal experience, it's likely they're going to say--no worries yet, rescan in 6 months.

When is your next scan again?


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## Andros (Aug 26, 2009)

dantetila said:


> Hi all,
> 
> I have recently had an ultrasound that showed two small hypoechoic nodules and a very small cyst. I took a look at the image CD myself and noticed some issues with the final report, worksheet and the actual images. On the images, the left thyroid has a measurement tool highlighting the nodule. It shows 10mm x 5mm and another image showing the height of 7mm. So I would expect 10mm x 5mm x 7mm, but the final report says 8mm x 7mm x 5mm, which I don't see anywhere in the images. Also on the radiologist worksheet, she has wrote 8mm x 5mm x7mm, but on the final report, she wrote 8mm x 5mm x 7mm. This has a big difference in meaning because if the nodule is taller than wide, that is a bad sign from what I've read. Also writing 8mm vs 10mm will mean my endo will likely not biopsy it. Is this something I should bring to my Endo's attention?
> 
> ...


Has the radiologist made a recommendation on the final report? I think that discussing this with your endo or even the radiologist might be the way to go here.

I would not have a clue and as pointed out by another poster, Radiologists require years and years of training and hands on experience in order to interpret these things.

Good luck and please let us know so we all can learn something.


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## dantetila (Jul 24, 2010)

Thanks for the response.

Saw endo today...he did recommend followup scan in 6 months. He said nodules are common, don't worry about it and wasn't going to do any followup scanning until I demanded it. I know I may be just worrying too much, but I don't feel like it is "common" or "normal" for a 24 year old male to develop 2 nodules both near a the CM mark over the course of a few months. I know he is the endo and I am just the patient, but it just doesn`t seem normal. I`m not at all saying it is cancerous, just think it could be early thyroid problems that haven`t showed in blood work yet.

As far as the US report goes, you are right, the radiologist is the trained one. But she already made a mistake that anybody can see, she put 8 x 5 x 7 on report and 8 x 7 x 5 on her worksheet. Which is it because taller than wider is important. Also the nodule is very well defined and the borders are easy to see. I can see the tool is right at the edges and it says 1cm. Also the radiologist used the all the other image measurements from the tool, in the final report, with no changes. Seeing as my old US was 8mm instead of 10mm, I think it was likely an error. I am likely wrong though, just worried so sorry if I seem bitter. it is not towards anybody here, I appreciate the help and agree I am over exagerating the situation. Just health has been bad in other areas and am worried since I`ve had doctors make errors on reports before.

Thanks again


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## lainey (Aug 26, 2010)

You realize that the nodule is a 3 dimensional object, yes, but are you taking into account the position of the transducer for the sonogram relative to the nodule? In other words, the view, according to the notes, may be from one direction, while the report reflects another. Usually the measurements are based on several "views" to determine the size of something that is not necessarily regularly shaped.

If you have a 4 cm nodule, that means that in some places, it could easily be 4.2 or 3.8, it depends on the angle and location of the transducer to give you the view and the measurement. Each time the technician does this it can be different.

As for notes vs report, taller vs wider--I am going to be very blunt and say that the mistake is that you are analyzing both, when you don't have the training to do so.

It's an inexact science to some extent, that relies on extrapolations to come to an overall size. But to doctors that see a lot of these, there are certain things that ring alarm bells, and if it were the case with you, they likely wouldn't be wasting any time to direct you toward further testing.

If you're that worried, ASK THE DOCTOR about what you see as a discrepancy.

What do you suppose are the chances, that if you had the scan right now, the numbers would be slightly different? By this I only mean to imply that they could be smaller or larger, that the state is not static, and you are spending a lot of time focusing on some small differentials.

Get a second opinion if that will set your mind at ease.


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## dantetila (Jul 24, 2010)

You`re right lainey, I don`t have the training and I should leave it in there hands.

I agree with everything you said, the only part I have to disagree with is the taller than wider. There was no interpreting for me there, I just am going by what the doctor wrote in two different spots. I am just curious is to which one is correct. Either way it doesn`t matter, this report will have no effect, it will be my followup ultrasound that will matter.

Thanks for setting me straight, it is just hard to not worry when you have a pacemaker, celiac disease, low blood pressure, on betablockers at the age of 24 lol Thanks though, I need blunt sometimes


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## Andros (Aug 26, 2009)

dantetila said:


> You`re right lainey, I don`t have the training and I should leave it in there hands.
> 
> I agree with everything you said, the only part I have to disagree with is the taller than wider. There was no interpreting for me there, I just am going by what the doctor wrote in two different spots. I am just curious is to which one is correct. Either way it doesn`t matter, this report will have no effect, it will be my followup ultrasound that will matter.
> 
> Thanks for setting me straight, it is just hard to not worry when you have a pacemaker, celiac disease, low blood pressure, on betablockers at the age of 24 lol Thanks though, I need blunt sometimes


Lainey "is" good. I would not miss her posts for the world. Good education and it's free!! LOL!!

Young man, you know that I care about you and so do others on this board. We have followed your posts for a while now.

We both know that when men have nodules, extra care must be taken to rule out cancer so I hope the doc is going to order FNA? Do you know?

Let us know and in the meantime, take one day at a time here and trust in all that you believe to be true in regards to your personal beliefs.

We are here for you!


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## dantetila (Jul 24, 2010)

Thanks all!

I want to apologize if I came across a little rude with my comments, as this was not my intention. I did appreciate the advice and do agree this is not my area to try and figure out, it is the doctors. Thanks again for setting me straight.

Thanks also for caring about me, it is nice to have people there to stop you from worrying. As far as an FNA goes, my doctor said being male and young was no concern with him, so he is not going to biopsy them until they are closer to 1.5cm. I asked him what about the US saying hypoechoic, round shape and potentially taller than wide (depends which measurement was right, worksheet or report). He also dismissed all of those characteristics and did not seem concerned. All in all, I`m following his advice on an ultrasound in 6 months.

Thanks again for everything, you are all great


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