# New - Ultrasound Report of Solitary Nodule



## ChrisP (Oct 29, 2013)

Hi guys!

I'm new here, good to see many people with thyroid issues like myself.

I'm quite frustrated. :confused0003: It's been about 8 months since I discovered I had a nodule. I ended up going to the hospital because I felt something in my throat and couldn't breathe right because I had a panic attack when I realised something was stuck in there.

Got to the hospital and the doctor seemed irritated. He said I was having a panic attack and gave me a pill, then sent me on my way home, even after I explained something was in my throat. (He said it's common during an attack).

A gut feeling hit me and I knew something was up, so I took it upon myself to get it all checked out.

Back in May they found the nodule and it was complex at the time, but could only partially see it.

Had another US about 3 weeks ago and managed to snatch a copy of the report from my doctors office. It reads the following:

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Thyroid ultrasound with Doppler. Doppler to show flow to lobes and to any measured nodule.

History: Followup thyroid nodule.

Comparison study: Thyroid ultrasound 5/3/2013

Thyroid isthmus: 0.3cm

The right thyroid lobe measures 1.8 x 2.0 x 5.2 cm. The echotexture is homogeneous. The Doppler flow is average.

The left thyroid lobe measures 2.1 x 1.7 x 4.5 cm. The echotexture is homogeneous. The Doppler flow is average.

Right lobe nodules 
1. Posterior lower pole: 3.3 x 1.7 x 1.2 cm (previously partially visualized measuring 1.2 x 1.4 cm) ill defined region of hypoechogenicity with a small area of vascularity. No calcifications or hypervascularity.

Left lobe nodules: 
None.

Lymph nodes: 
None seen.

Posterior extrathyroidal masses question parathyroid masses: 
None.

Impression: Ill-defined confluent, hypoechogenic region in the posterior lower pole of the right thyroid lobe appears increased in size since prior examination. This is of indeterminate etiology, however may represent confluent hypoechoic nodules; alternative consideration includes atypical focal thyroidits. Recommend correlation with thyroid function tests and short-term followup in 2-3 months. 
------------------------------------------ --------------------------------

I've done loads of research on the key terms throughout the report and must say that it's quite a complicated report. I've been referred to an endocrinologist here, who is the only one in the entire country. I've been put on for JANUARY the 17th... I know, so far away. But I managed to phone the office and ask for a earlier appointment, and they put me on the cancellation list.

If anyone has any advice or insight on the report of the situation, I'd rather appreciate it.

Thanks!

Chris :a1Thyroid:hugs3


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## Octavia (Aug 1, 2011)

Are there any ENTs in Bermuda? (Ear, Nose, Throat doctors? Also known as otolaryngologists.)


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## ChrisP (Oct 29, 2013)

Octavia, yes they're about four or five of them. I guess my GP referred me to the endo because she also is quite qualified in pediatrics (I'm 17), also she is the director of Endocrinology at our main hospital.

I never would of thought of an ENT though, do they deal with the thyroid as well as an endo?


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## Octavia (Aug 1, 2011)

An easy way to think about it is this:

- An endo will deal with the thyroid hormones

- An ENT will deal with the thyroid gland...or nodules

If you have a 3 centimeter nodule (not lobe, but nodule, which it appears you have), you may want to see an ENT. But keep your appointment with the endo.


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## joplin1975 (Jul 21, 2011)

I have to agree with Octavia. You'll need a biopsy and an ENT is more than qualified.

If that doesn't work, you might inquire as to whether of not your doctor (GP) is willing to order a radio iodine uptake scan. It's not as great as a biopsy, but it could give you some information.


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## ChrisP (Oct 29, 2013)

Octavia, hmmm didn't know that, and I thought my nodule was 1.2cm, guess it's the first set of numbers in the measurements, thanks! Didn't realise it was 3.3, that's quite bigger than expected...

joplin, I agree. My GP referred me to the endo specifically for a biopsy and a radio iodine uptake scan actually. I guess i'll have to go ENT searching throughout the island.


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## Andros (Aug 26, 2009)

ChrisP said:


> Octavia, yes they're about four or five of them. I guess my GP referred me to the endo because she also is quite qualified in pediatrics (I'm 17), also she is the director of Endocrinology at our main hospital.
> 
> I never would of thought of an ENT though, do they deal with the thyroid as well as an endo?


I agree w/ Octavia and Joplin about seeing an ENT. The one word I don't care for is "vascular" which does suggest that there is an exogenous blood supply. And "complex" leaves a lot to be desired as well.


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## ChrisP (Oct 29, 2013)

Andros,

Yes it's weird... Back in May they found it to be complex, now they've stated it's degenerated within cystic terms and is completely solid. Is that possible?

Right now it's feeling quite large and swollen explode


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## ChrisP (Oct 29, 2013)

Managed to snatch a copy of my FIRST ultrasound report, never saw it. Funny how much this nodule has transformed in 6 months.

It reads:

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Thyroid isthmus: 0.2cm

The right thyroid lobe measures 5.5cm long and 2cm across. The echotexture is homogeneous. The Doppler flow is normal on color images.

The left thyroid lobe measures 4.8cm in length and 1.9cm across. The echotexture is homogeneous. The Doppler flow is normal on color images.

*Right lobe nodule:*
Complex lobulated nodule of the posterior mid right lobe is 1.2 x 1.4cm and heterogeneous. It has some flow on color Doppler. It has no calcifications.

No left lobe nodule and no adenopathy.

Impression: [Lobular complex Nodule of the right lobe with no shadowing calcification; recommend followup imaging.
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Called my endo's office again but no one picked up, asked them to call me back to see if there were any cancellations yet, since I'm still on the waiting list and have been set up to come in on the 17th of January.

Gonna see if I can call an ENT today and get some information.


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## Octavia (Aug 1, 2011)

Good plan, Chris. By the way, this is what I'm seeing in your report that leads me to believe you have a 3+ centimeter nodule:



ChrisP said:


> Right lobe nodules
> 1. Posterior lower pole: 3.3 x 1.7 x 1.2 cm (previously partially visualized measuring 1.2 x 1.4 cm) ill defined region of hypoechogenicity with a small area of vascularity. No calcifications or hypervascularity.


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## joplin1975 (Jul 21, 2011)

ChrisP said:


> Yes it's weird... Back in May they found it to be complex, now they've stated it's degenerated within cystic terms and is completely solid. Is that possible?


I thought (and I could be wrong here!) that this was semi-normal path of abnormal nodules (how's that for a sentence!). That is, of my three largest nodules, two were solid and one was complex. I was told they pesky nodules usually go from cystic > complex > solid. Therefore the going "theory" was the solid nodules were "older" and, well, more pesky.


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## ChrisP (Oct 29, 2013)

Jop,

That's extremely interesting! It looks as if this is the case in my development as well. Must have been cystic, then complex (Back in May) now completely solid (now). And oh, I can even visibly see it when I swallow, too. My thyroid itself looks like a giant growing muscle, so big I swear people get it confused with a bicep. *grin* :tongue0013:

Doctors should definitely do research on that, though. Might help in future diagnostic methods for patients developing abnormal tumours in the thy. In my opinion, it's extremely difficult to work with these pesky little growths, and again; there's not enough research.


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## Andros (Aug 26, 2009)

ChrisP said:


> Andros,
> 
> Yes it's weird... Back in May they found it to be complex, now they've stated it's degenerated within cystic terms and is completely solid. Is that possible?
> 
> Right now it's feeling quite large and swollen explode


I would very much suspect that you could feel it; especially when swallowing. I sure hope you can find an ENT.

Please keep us apprised!


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## ChrisP (Oct 29, 2013)

Good news!

Called up my GP's office last friday and told them I needed a referral to an ENT, I had to come in this past Tuesday and see my doctor. I told him they were going to make me wait 3 and a half months to see the endo and he was outraged! God I love him, my hero. Anyway, he called up his 'friend' over at the ENT's offices and managed to snatch me a quicker date for November 21st, i'm so much more relieved. So glad I have built a strong relationship with my GP, I think it's really important when it comes to health to have that level of relationship with your doctor - it makes life so much more easy and comfortable knowing they've got your back!

Will keep everyone posted!


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## Endocrine_Surgeon (Oct 31, 2013)

Just want to comment on the ultrasound reports. Whenever we measure a nodule, we take 3 measurements - for a 3-D mass, we need height, width, and depth. 3.3 x 1.7 x 1.2cm nodule means that in one dimension it was 3.3cm, which is fairly large and I'm not surprised that you can feel it. The first report that you had only gave two measurements, which means that one was missing. It isn't clear why - maybe they had difficulty performing the ultrasound for some reason? Likely the largest dimension is the one they missed, since the other numbers are closer to the ones given (1.7 x 1.2 versus 1.4 x 1.2).

Also, both endocrinologists and surgeons (ENT or general) can do fine needle aspiration biopsies.


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## Andros (Aug 26, 2009)

ChrisP said:


> Andros,
> 
> Yes it's weird... Back in May they found it to be complex, now they've stated it's degenerated within cystic terms and is completely solid. Is that possible?
> 
> Right now it's feeling quite large and swollen explode


I have learned that when it comes to the endocrine system and especially the thyroid that anything is possible. Very very relieved to hear you have ENT appt. on Nov. 21st..


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## ChrisP (Oct 29, 2013)

Endocrine_Surgeon said:


> Just want to comment on the ultrasound reports. Whenever we measure a nodule, we take 3 measurements - for a 3-D mass, we need height, width, and depth. 3.3 x 1.7 x 1.2cm nodule means that in one dimension it was 3.3cm, which is fairly large and I'm not surprised that you can feel it. The first report that you had only gave two measurements, which means that one was missing. It isn't clear why - maybe they had difficulty performing the ultrasound for some reason? Likely the largest dimension is the one they missed, since the other numbers are closer to the ones given (1.7 x 1.2 versus 1.4 x 1.2).
> 
> Also, both endocrinologists and surgeons (ENT or general) can do fine needle aspiration biopsies.


Wonderful feedback, thank you! Yes, one the first report they couldn't locate the first dimension, I think it had to do with it being posterior and behind the thyroid cartilage rather than anterior? It's also the reason why I cannot see it very well (I can but not much), under my skin, because it's posterior-lower pole.



Andros said:


> I have learned that when it comes to the endocrine system and especially the thyroid that anything is possible. Very very relieved to hear you have ENT appt. on Nov. 21st..


Thanks Andros, me too. I am counting down the days until I step into his office! It's been a rough ride.


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