# Ultrasound Nodule Description - Help please



## dantetila (Jul 24, 2010)

Can I get a little help interpreting this nodule description:

The left lobe, in the middle portion, shows a 0.8cm x 0.5cm well defined slightly hypoechoic nodule and the echo suggests an adenoma.

1. Does slightly hypoechoic mean it is both solid and cyst like? I'm trying to figure out if it is solid or not.

2. He says the echo suggests an adenoma, what does he mean?

Thanks.


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## HoneyBee (Jul 28, 2010)

Hypoechoic Nodules return fewer and weaker echos and are normally associated with the development of cancer. Where as Hyperechoic nodules are the opposite and are always benign.

I wouldn't worry to much though. Hypoechoic nodules still have a lower occurance of being cancerous in the thyroid.

I have the hypoechoic nodules all over my thyroid. They are benign so far. So, expect your doctor to want to watch these over time.

If I remember correctly, hypoechoic nodules can be complex to solid.

An adenoma is not exactly a bad thing and can prove that the nodule(s) are non-cancerous because they do not metastasize or spread to other organs and tissue in most cases, but there is the occurance where this type of tumor can develop a malignancy, but once again the rate of this is low.


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## dantetila (Jul 24, 2010)

Thanks HoneyBee,

Sorry to be a pain, but I just have a few followup questions.

1. Since it says it is only *slightly* hypoechoic, does that mean it is both hypoechoic and hyperechoic? Is it normal for US to not state whether it is solid, cystic or complex?

2. I read the following on emedicine:

Most thyroid nodules (42-77%) represent adenomatous nodules. Most are multiple, and multiplicity is demonstrated at US, scintigraphy, and surgery. When solid, the nodules are poorly encapsulated and not well defined, and they merge into the surrounding tissue. Cystic adenomatous nodules are hemorrhagic, with irregular internal walls and particulate fluid content. Intratumoral calcification is occasionally seen.

Follicular adenomas (15-40%) arise from follicular epithelium and are usually single, well-encapsulated lesions. On sonograms, adenomas may be hyperechoic or hypoechoic solid nodules with a regular hypoechoic area surrounding ring called the halo sign. 

At the Massachusetts General
Hospital in Boston, we reserve the diagnosis of ''follicular
adenoma'' for those nodules that are solitary or dominant,
have a well-defined fibrous capsule, and are histologically
distinct from the surrounding normal thyroid parenchyma.
For other nodules that do not meet these criteria, a
diagnosis of ''adenomatous nodule'' is made.

Since my Ultrasound said that it is well defined. Does this mean it is likely a Follicular Adenoma?

Thanks a lot.


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## Andros (Aug 26, 2009)

dantetila said:


> Can I get a little help interpreting this nodule description:
> 
> The left lobe, in the middle portion, shows a 0.8cm x 0.5cm well defined slightly hypoechoic nodule and the echo suggests an adenoma.
> 
> ...


Hi there! It means it may be solid.

Hypoechoic nodules cast off fewer or weaker echoes than the surrounding normal tissue, while hyperechoic nodules cast more or stronger echoes than the surrounding normal tissue.

Typically, benign thyroid nodules appear hyperechoic on the sonogram, while malignant (cancerous) thyroid nodules are more likely to be hypoechoic, casting off fewer or weaker echoes

This is a good article........
http://www.umm.edu/endocrin/thytum.htm

So, will doctor be scheduling FNA (fine needle aspiration?)

Just for your edification. The doc seems on top of this and I just know ultimately everything is going to end up being fine. You hit a bit of a bump here but I want you to know we are all here for you.

We will help you anyway we can.


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## HoneyBee (Jul 28, 2010)

I find it odd that the ultra-sound report did not disclose the substance of each nodule. I would conclude that if the nodule is slightly hypoechoic it would mean it is complex and this consists of the nodule being both solid and liquid filled. Complex nodules are very common.

I would expect them to schedule you for an FNA Biopsy or at least an uptake scan to be on the safe side, and I wouldn't worry until the pathologist worries.

Did it mention the presense of any halos around the nodule(s)? Just curious.
And, are your nodules only on one lobe or on both (bi-lateral)?


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## dantetila (Jul 24, 2010)

It was the least informative radiologist report I've ever had. They found a coarse thyroid surface, an adenoma, swollen lymph nodes in neck and axilla, yet the report didn't even give any suggestions of followup care or any real details.

What I pasted to you was all it reported on the nodule, no details at all.

That is the only nodule found, on the left lobe. The right lobe had no nodules.

The other thing I find odd that the radiologist didn't report is that my lobes are far apart in sizes. He just wrote that both lobes fall into normal sizes but with the measurements of:

Left: 3.7 x 1.6 x 1.0 cm (contains 8mm adenoma)
Right: 5.0 x 1.4 x 1.5 cm (clear)

That is quite a difference in length and depth, yet the US report said nothing of this. I'm assuming that my Endo can interpret the sizes are something to look at without the US reports help, but it would be nice.

Do you really think they would schedule a FNA on a nodule of only 8mm, I would like one, but I didn't think they would unless it was larger.

Thanks.


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## Andros (Aug 26, 2009)

dantetila said:


> It was the least informative radiologist report I've ever had. They found a coarse thyroid surface, an adenoma, swollen lymph nodes in neck and axilla, yet the report didn't even give any suggestions of followup care or any real details.
> 
> What I pasted to you was all it reported on the nodule, no details at all.
> 
> ...


Either the FNA or a radioactive uptake scan in my humble opinion "because" of the swollen lymph nodes. Actually, I would do both. Sonograms sometimes miss stuff. The expertise of the operator, the miniscule nodules..............stuff like that.


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## HoneyBee (Jul 28, 2010)

I do think they will schedule one, yes. If you just have the one leison then this is cause for concern and they should.

Not to frighten you...Isolated nodules are one common sign of a pre-cancerous or a cancerous condition.

It most cases having multiple nodules is less likely to be an environment for cancer cell growth, but having just one lonely one raises some eyebrows.

It doesn't matter the size of the nodule now...where is the proof it will not grow bigger later???
Mine grow and some shrink. It's a constant changing environment for me.

I have swollen lymphs in my neck as well all the time. My right bothers me the most and I get pain in my right ear as well.

I do not have a super big goiter, but it is noticable and my goiter is caused from my nodules. I can't see those 2 tendons at the bottom of my neck anymore when I swallow. I just see a fat thyroid with wings. Sometimes I wish it would just fly away and never come back...LOL

I would call the doctors nurse and see if you can get some follow up answers and voice your concern. And, talk to them about the findings and having it biopsied.

IMO, if they won't do the FNA, then have them give you the reports and find a good Endo or ENT that will help you.

I hope I could help some...Maybe someone else will come along that has more knowledge than I.

But, again do not worry just yet!!! When the docs worry then you can.


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## dantetila (Jul 24, 2010)

Thanks for your help HoneyBee and Andros, it is much appreciated.

I'm not too worried, but I'm hoping all of this ends up being nothing at all or at the worst, Hashimoto's. My US showed coarse thryoid echotexture, which can be a sign of Hashi, so maybe my nodule is because of that. I'll likely get those anti-body blood tests done soon, if my Endo ever decides my case is worth seeing.

Thanks for your help again!


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## HoneyBee (Jul 28, 2010)

He took an oath...You bet your butt your case is worth seeing.


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## dantetila (Jul 24, 2010)

Confusing but good news!

My doctor just called and said my TSH/Free T3/Free T4 all came back normal. She sent a referral to my Endo requesting he do a FNA on the nodule, but I unfortunately I'm not confident he will based on its size.

I guess this is good news about the Thyroid though because if something was wrong I'd assume my numbers would be off.

The only part I don't understand is why is the surface coarse and why are the lobes such different sizes. Oh well, but I'm assuming Endo will say everything is OK based on the fact that my blood levels are good.

It's not that I'm not happy...I am, just confused as to why its like this because it doesn't sound normal.

My family doctor also dismissed the lymph nodes since my white blood cells were ok. Once again not sure, but I have to go with their judgement.

Anyways, just wanted to update you.

Thanks!


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## Andros (Aug 26, 2009)

dantetila said:


> Confusing but good news!
> 
> My doctor just called and said my TSH/Free T3/Free T4 all came back normal. She sent a referral to my Endo requesting he do a FNA on the nodule, but I unfortunately I'm not confident he will based on its size.
> 
> ...


I don't happen to agree that if your thyroid panel results are within the designated parameters that nothing is wrong w/your thyroid. For one thing, you have the sonogram which suggests otherwise.

And for another, have you had antibodies' tests? I can't remember if your info in another thread or not.

If you have not had these tests, I advise that you should.

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/understanding/conditions/thyroid.html

Please let us know about the FNA and whether one is scheduled or not. And a little tip; always always listen to "your" instincts. Who would know their body better than the owner of that body?


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## dantetila (Jul 24, 2010)

Thanks Andros.

I asked my family doctor if I could still have Hashimoto's because of the thyroid being coarse, she said it is unlikely since my TSH is normal and didn't do the antibody testing because of it. Like I said, I find here in Canada they don't do anything too fast.

She does want a biopsy done, but my Endo didn't sound like he cared too much.

Could it still be cancer if my thyroid levels are normal?

In regards to the lymph nodes, I've had three opinions on the case. One doctor scheduled me for a biopsy of my 2.5cm lymph node in the armpit even thought the US made it look benign, just to be safe. The other doctor said he didn't feel it needed to be rushed and my family doctor said she didn't want to put me through more testing since it was likely benign so lets watch it.

I have the surgeon date on the 12th of August, should I cancel or just see what the surgeon says. I've never had a biopsy, but I'm assuming if the surgeon doesn't feel it is needed, he will tell me there is no point correct?

Thanks the comments Andros, my neck feels tight at times and I feel like with dry food I notice a little rougher going down and my adam's apple area seems to be harder than normal. But there is no bump or anything stick out, so my doctor once again tends to not worry too much.

Sorry for all the questions. Do you know whether or not an Endo can refuse to do a FNA if my family doctor sent in a referral to do one?

Thanks a lot!!


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## Andros (Aug 26, 2009)

dantetila said:


> Thanks Andros.
> 
> I asked my family doctor if I could still have Hashimoto's because of the thyroid being coarse, she said it is unlikely since my TSH is normal and didn't do the antibody testing because of it. Like I said, I find here in Canada they don't do anything too fast.
> 
> ...


I am not exactly sure how your medical system operates in Canada. When it's good, it's really good and when it is bad, it is really bad. I have a friend who has been walking around w/ a broken elbow w/ a piece of bone floating around for 6 months. They finally sent her to a surgeon.

Yes, you could have cancer w/normal thyroid levels. When the antibodies are circulating or cancer is taking hold, the patient feels ill but it does not necessarily reflect in the ordinary thyroid panel.

The antibodies' tests, the uptake scan and FNA are now key to your well-being and improved health.

Take a glass of water. Stand in front of the mirror, take water, tilt head back and swallow. Do this several times to see if you see any unusual lumps or bumps on either side of the Adam's Apple.

I love questions!! Did you know the more questions I answer, the more I learn? Fancy that!! I love it.


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## dantetila (Jul 24, 2010)

Glad I could help educate you ;-)

I know this a thyroid board, but what is your opinion on the lymph node situation I mentioned above.

Do you think its a good idea to go ahead and see the surgeon or just let it go and follow them? I honestly feel even though they have benign characteristics, I'd like the peace of mind just to biopsy it, but then again it is about me, so an outside view might see that I'm worrying too much.

Thanks.


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## Andros (Aug 26, 2009)

dantetila said:


> Glad I could help educate you ;-)
> 
> I know this a thyroid board, but what is your opinion on the lymph node situation I mentioned above.
> 
> ...


I agree with you. Swollen lymph nodes always mean something is not kosher. If you rule out infections and other non-serious illness', you are left with the more serious options.

Papillary cancer is notorious for spreading to the lymphatic system.

Papillary carcinoma: About 80 percent of thyroid cancers are papillary carcinomas (also called papillary cancers or papillary adenocarcinomas). Papillary carcinomas typically grow very slowly. Usually they develop in only one lobe of the thyroid gland, but sometimes they occur in both lobes. Even though they grow slowly, papillary carcinomas often spread to the lymph nodes in the neck. But most of the time, this can be successfully treated and is rarely fatal.

http://www.everydayhealth.com/thyroid-cancer/thyroid-cancer-types.aspx

Sorry to be so persistent but I have a good track record on previous forums for saving lives even when doctors insisted the patient was fine, need not worry etc. only to find out that they indeed did have cancer.

All I want to know is that you don't have it. That is what I want to hear! And then we can consider other avenues.


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## dantetila (Jul 24, 2010)

I completely believe you have saved many people as you've been able to make me feel better about this and also have the confidence to get on my doctors to actually take it seriously.

I've been looking at ultrasound features that suggest doing a FNA no matter if < 1cm. I know it is sad, but I want to make sure I am prepared to show them to my endo if he feels there is no need to go through with it. I know I don't have a lot of symptoms, but from what I read, the most important features are:

1. Nodule taller than it is wide
2. Calcification
3. Hypoechoic
4. Blurred Margin (follicular have well-defined margins)
5. Lymph Node involvement
6. Male Sex
7. Single vs Multiple
8. Intranodular vascular spots
9. Halo

My nodule is taller than it is wide, slightly hypoechoic (might not count), lymph node involvement, I'm a young male, it is single and I have no idea about #8-9 because my report does not say either side.

I know if I bring to to my endo he will tell me he does not care because it is up to him, but it doesn't hurt. Do you see anything I am missing?

Thanks.


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## dantetila (Jul 24, 2010)

Family doctor finally sent in the referral to my endo's office today. Endo's office called me a few hours later and gave me an appointment tomorrow afternoon.

Wow that is fast!  Glad they gave me an appointment quick, usually in Canada you have to wait months. It's especially surprising since my nodule is so small and they wont likely biopsy it anyways. Either way I'm happy.

Just wanted to let you know I'll keep you posted.

Thanks


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## Andros (Aug 26, 2009)

dantetila said:


> I completely believe you have saved many people as you've been able to make me feel better about this and also have the confidence to get on my doctors to actually take it seriously.
> 
> I've been looking at ultrasound features that suggest doing a FNA no matter if < 1cm. I know it is sad, but I want to make sure I am prepared to show them to my endo if he feels there is no need to go through with it. I know I don't have a lot of symptoms, but from what I read, the most important features are:
> 
> ...


You got it. Also, and I have said this many many times to all; ultra-sound is highly dependent on the skill of the operator and is also notorious for not being able to pick up everything. I always favor a radioactive uptake scan. People don't like to hear this but once again; experience, mucho experience.

So, 8 & 9 could be a possible also.

Where did you find the above.? It is awesome information. Can you share the link? Or did you just put it together from all your research sources?


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## dantetila (Jul 24, 2010)

It is a information I've pieced together from all my poking around at medical studies. These characteristics are what I've seen repeated over and over in different studies.

Based on my radiologists lack of information, I have no idea if there was Calcification, if it was solid, halo, vascularity or any other fine details. I should of picked up my ultrasound images and brought them to another radiologist, but my Endo appointment is now tomorrow (posted about this a few minutes ago, should be post before yours.) and don't have time to do this.

Oh well...I'll let you know how things go.

Thanks


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## Andros (Aug 26, 2009)

dantetila said:


> Family doctor finally sent in the referral to my endo's office today. Endo's office called me a few hours later and gave me an appointment tomorrow afternoon.
> 
> Wow that is fast!  Glad they gave me an appointment quick, usually in Canada you have to wait months. It's especially surprising since my nodule is so small and they wont likely biopsy it anyways. Either way I'm happy.
> 
> ...


This is very very good news. Hopefully, you are getting somewhere. On the off chance they won't do it, you can appeal to the Premiere's Office, yes? Or could you pay out of pocket?


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## dantetila (Jul 24, 2010)

Well it took a lot of nagging, but my endo finally ordered an ultrasound guided biopsy and a CT scan to get another look.

He said that the standard at his hospital was to wait until it reached 10mm or more and since my nodule didn't have anything concerning about it, he just wanted to let it be. Didn't even mention monitoring it.

Then I requested a biopsy about 2-3 more times until he finally ordered it.

He also mentioned that the coarseness of my thyroid was nothing and my thyroid appeared completely normal based on the ultrasound.

Is this guy serious? I also had to nag him to give me the thyroid antibody tests as well.

Oh well...it may have been a lot of work, but at least I got what I went in there for.

Thanks for your help. He marked the biopsy as urgent, so it will be done in the next 4 weeks.

I'll update you with the good news!


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## dantetila (Jul 24, 2010)

I had the CT scan and Thyroid Antibodies this week, will get results Friday of next week.

On a worse note, I officially hate Canadian health care. My endo put on my FNA requisition that he wanted it done "Urgently within 4 weeks". I got a call from the hospital on Friday telling me my biopsy is scheduled for January 2011. I asked them why so long if my doctor requested urgent and they said they are backed up six months with urgent requests.

It is ridiculous sometimes the waiting people are stuck with. She has sent my requisition to another hospital, but she said there is no guarantee that the wait will be much less. Unfortunately with this doctor, he can only refer me to there two hospital since he is affiliates to them.

Anyways, could be worse but I wish it wasn't going to be so long to worry about it.

Thanks for listening to me complain. haha

Take care.


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