# Complex cyst/noduke? Ultrasound report



## Negative101 (May 23, 2011)

First off, Merry Christmas everyone!

Looking for some insight on moms ultrasound report...

Her blood tests are perfect... No antibodies, good free t3 and 4, and tsh at 1.
She has no symptoms, and this was her first routine ultrasound:

Age: 45
Thyroid gland is homogeneous and not enlarged.
There is a 3mm septated cyst in the left mid pole.
Parotid and submandibular glands are normal.
There is left upper anterior cervical lymph node without fatty hilium measuring 1.8 x 1.0 x 0.5 cm. It is not enlarged.
No other abnormal lymph nodes are seen in the neck.

Summary:
Tiny left thyroid nodule.
Left lymph node is likely physiologic (normal)
Suggest 3 month followup.
------------------------------------------------------------------------------

Ok, so it says septated cyst, which means theres a seperation/fence of sorts. I believe this means this is not a simple cyst, unless simple cysts can be septated?

In the summary, its referred to as a nodule... From my understanding, a cyst and a nodule are completely different things, no? This being a septated cyst, it could be half solid and half liqud, but its only 3mm.

Is this a complex cyst? If yes, isnt that worrisome?
The abnormal lymph node on the same side doesnt sit well with me either, even tho the report says its likely normal. Her GPntold her all is fine and sent her off. I just yesterday saw her report and am thinking a FNA may be needed.... Is that possible on a 3mm cyst?

Opinions?


----------



## joplin1975 (Jul 21, 2011)

I'm no expert, but my knee jerk reaction would be to wait & repeat the u/s at 6 months or a year. It would be hard to biopsy a module if that size. A complex module is more concerning, but not as concerning as, say, a solid one. The node is something to watch too, but if its not enlarged, it could be slightly abnormal for any number of reasons.

Is there a specific reason she had the u/s?


----------



## angel1976 (Nov 15, 2011)

Septated cyst is composed of two simple cysts fused together (like soap bubbles) and therefore are USUALLY not cause of worries.


----------



## Negative101 (May 23, 2011)

angel1976 said:


> Septated cyst is composed of two simple cysts fused together (like soap bubbles) and therefore are USUALLY not cause of worries.


That's what I'm hoping it is, but from my research, a septated cyst seems to be half fluid and half solid... It's separated by a "wall" (septation). Although, I can certainly see how two Simple cysts can lead to this as well.

The ultrasound report doesn't say anything else about it's characteristics, so I'm assuming it's either normal or too small to know.

Joplin: she had the u.s because I found out I have hashis and wanted to see if there's a genetic connection with her... So her doctor ordered her blood tests, all which came back normal (shocking to me), and the u.s while waiting for the results... No symptoms or discomfort... Just a worrisome son


----------



## Andros (Aug 26, 2009)

Negative101 said:


> First off, Merry Christmas everyone!
> 
> Looking for some insight on moms ultrasound report...
> 
> ...


Please scroll down to Figure 7a and Figure 7c
http://radiographics.rsna.org/content/27/3/847.full

It is worrisome to me; so much so that I spent a goodly amount of time researching to find this. It may be worth getting a second opinion at the very least.

Always listen to your first instinct. You are right to be concerned.

Has she had Thyroglobulin and Thyroglobulin Ab done?


----------



## Negative101 (May 23, 2011)

Andros said:


> Please scroll down to Figure 7a and Figure 7c
> http://radiographics.rsna.org/content/27/3/847.full
> 
> It is worrisome to me; so much so that I spent a goodly amount of time researching to find this. It may be worth getting a second opinion at the very least.
> ...


Thank you Andros.
Yes, she had a Thyroglobulin Ab test which showed her well below the range needed for autoimmune... Unfortunately, no Thyroglobulin test tho.

Also, the lack of the report indicating anything else leaves me to wonder whether this is a complex or simple nodule (2 fused together). No mention of calcification or anything else... Just septation. 
Perhaps at 3mm it's too small to see? Either that or there was no other concerns by the ultrasound tech.

From my research, complex nodules have about a 10% chance if being cancer depending on whether it's 50% more solid than liquid. Unfortunately, I don't know my moms status. I really wish these techs would explain further in their reports!

The doc didn't seemed concerned, at all. He didn't even mention to follow up in 3 months like it says in the report! How can doctors be this negligent? Just thus weekend, as I'm home for Christmas, did I look at her report and told her she needs to go back and get to an endo. Hopefully all is well and this is something to put behind us in the new year.


----------



## Andros (Aug 26, 2009)

Negative101 said:


> Thank you Andros.
> Yes, she had a Thyroglobulin Ab test which showed her well below the range needed for autoimmune... Unfortunately, no Thyroglobulin test tho.
> 
> Also, the lack of the report indicating anything else leaves me to wonder whether this is a complex or simple nodule (2 fused together). No mention of calcification or anything else... Just septation.
> ...


This is the place to find out about "Doctors not being at all concerned!" Let me tell you!

Here is what peaked my concern. "Undefined borders" which of course would be the case with septated. You see? I am sure you do.

Also, bear in mind that ultra-sounds do have their limitations re operator error/experience and equipment as well.

Wonder if RAIU would be a good idea in this case. Of course, if possible, FNA would be good as well.

Of course we all hope for the best for your mom and you but I have to tell you "assuming all is well" just doesn't cut it when it comes to a person's health status. No way!


----------



## lainey (Aug 26, 2010)

No offense but, 3 mm is not even as big as a grain of rice. They want it at least 10 mm to do an FNA--this is far too small.

Structures such as this can come and go in the thyroid, and are extraordinarily common in the normal healthy population.

I don't think your doctor is being negligent. Watch and wait would be the typical course on something of this size--3 months follow up is more than soon enough and even 6 months is not unwarranted.


----------



## Negative101 (May 23, 2011)

I mentioned negligent because he didnt recommend any follow up at all... 3, 6, or 12 months.

Thank you though lainey, i was hoping youd respond 
Im going to see if she can get a 2nd opinion from an endo. No harm there.


----------



## lainey (Aug 26, 2010)

Agreed on the second opinion.

In the meantime, there is not a lot of cause to be overly worried at the moment IMHO.


----------

