# Thyroid ultrasound



## titapwease (Aug 31, 2012)

Can anyone help me to understand this written report about my thyroid ultrasound?

This patient has a history of a nontoxic nodular goiter. This is compared to the thyroid scan on 06/19/2012. The right lobe of the thyroid gland measures 5.96 cm x 2.36 cm x 2.98 cm. The isthmus of the thyroid gland measured 0.55 cm. The left lobe of the thyroid gland measured 3.40 cm x 2.32 cm x 6.56 cm. The thyroid has a heterogeneous appearance bilaterally. 
There is noted to be increased flow.

*Impression*
Findings could be consistent with a multinodular goiter.


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## titapwease (Aug 31, 2012)

The scan they refer to comparing was my RAIU.


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## Octavia (Aug 1, 2011)

So...it looks like there weren't any "standout" measurable nodules, but perhaps there were nodule-like areas of expanded tissue??? (I just made that phrase up...nothing scientific about it.)


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## titapwease (Aug 31, 2012)

Octavia said:


> So...it looks like there weren't any "standout" measurable nodules, but perhaps there were nodule-like areas of expanded tissue??? (I just made that phrase up...nothing scientific about it.)


Thanks for your reply! 
If that is what it says; then I guess that is what it says. However, I will have you to note, I can clearly feel the nodule with my own hands. The nodule wasn't found on the RAIU, she found it when I had an office visit. I find it odd that they refer to the "thyroid gland", as opposed to the nodule. Which was the whole reason for the ultrasound in the first place.


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## titapwease (Aug 31, 2012)

Also, they say nontoxic nodular goiter. She termed it nontoxic for the billing of the ultrasound. So, seeing as how I was almost in thyroid storm; wouldn't that make me toxic?


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## Octavia (Aug 1, 2011)

Usually, if there's a distinct nodule, that will be called out with its own measurement.


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## titapwease (Aug 31, 2012)

I would also like to ask, how can the impression be a multinodular goiter and they don't mention the nodule once? I assumed it was coined as a uni-nodular goiter; as no other nodules have been found. Also, why would it not show up on RAUI. I am convinced that the nodule is not thyroid tissue at all.


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## Andros (Aug 26, 2009)

titapwease said:


> Can anyone help me to understand this written report about my thyroid ultrasound?
> 
> This patient has a history of a nontoxic nodular goiter. This is compared to the thyroid scan on 06/19/2012. The right lobe of the thyroid gland measures 5.96 cm x 2.36 cm x 2.98 cm. The isthmus of the thyroid gland measured 0.55 cm. The left lobe of the thyroid gland measured 3.40 cm x 2.32 cm x 6.56 cm. The thyroid has a heterogeneous appearance bilaterally.
> There is noted to be increased flow.
> ...


That is a very very vague impression. "could be?" That sounds very indeterminate to me.

Also, increased flow may mean vascularity. If vascular, that would raise an eyebrow.

Have you discussed the findings w/your doctor?


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## titapwease (Aug 31, 2012)

Andros said:


> That is a very very vague impression. "could be?" That sounds very indeterminate to me.
> 
> Also, increased flow may mean vascularity. If vascular, that would raise an eyebrow.
> 
> Have you discussed the findings w/your doctor?


Hey Andros! I had hoped to speak with you!

I have not talked to her about it, but I do go on the 21st for an appointment. My thoughts exactly about "Could be consistent". Not only that; but heterogeneous means abnormal. Now, that could mean that the large irregular shaped lobes made it abnormal. I am however, not able to accept the diagnosis "Nothing to worry about".


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## Andros (Aug 26, 2009)

titapwease said:


> Thanks for your reply!
> If that is what it says; then I guess that is what it says. However, I will have you to note, I can clearly feel the nodule with my own hands. The nodule wasn't found on the RAIU, she found it when I had an office visit. I find it odd that they refer to the "thyroid gland", as opposed to the nodule. Which was the whole reason for the ultrasound in the first place.


I found it weird that they said nodular yet did not comment on any of the nodules. Yikes.

A cold nodule usually does not uptake radioactive material and will not stand out as cold if the area surrounding is also affected negatively.

I am with you on your reservations.

Low RAIU uptake and cancer
http://journals.lww.com/nuclearmed/...cosis_Caused_by_Functioning_Metastatic.1.aspx


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## titapwease (Aug 31, 2012)

Octavia, you might be right about it not being distinct. I appreciate all the advice.

I have been suffering from hyperthyroid for almost eight years (I think longer). Eight years anyhow, that I was diagnosed. I did not receive the proper care, because of insurance issues. I have had abnormal cell growth on my cervix; which I think, may make it more important to do a biopsy anyway. I am most definitely going to push the FNA.

I have had some pain around my clavicle since all the testing, and have had back pain w/ rib pain. I attributed the back and rib pain to costochrondritis. I know I am in no way a doctor although I feel that with my ability to soak up medical knowledge and retain it, I should have been.

Thanks everyone for all the help! It means a lot to talk to people who have suffered with the same afflictions I have. hugs4


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## titapwease (Aug 31, 2012)

Andros said:


> I found it weird that they said nodular yet did not comment on any of the nodules. Yikes.
> 
> A cold nodule usually does not uptake radioactive material and will not stand out as cold if the area surrounding is also affected negatively.
> 
> ...


My whole thyroid lit up on the RAIU. If it were cold would it not leave what looked like a dark spot? I researched before I had it done, and made them let me see the scan. Well, low and behold, the whole gland lit up; which is indicative of Graves as well as the reason my levels were so insane. No nodule on the screen; I saw this myself! I even made sure they called to discuss the results. Here is what she told me..." Looks like it is a goiter and not a nodule, we will get your referral in; in the mean time keep taking the propranolol."

Fast forward a few months...Here I am with a palpable nodule (that eluded several doctors feeling and scanning), and a "vascular thyroid gland". And still not a clue if I have Graves for definite.


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## titapwease (Aug 31, 2012)

Anywho, I have my most recent blood work in case you were interested.

Creatinine, Serum: 0.36 Low 0.57-1.00​Bun/Creatinine Ratio: 22 High8-20​Alkaline Phosphatase, S: 208 High 25-150​TSH: <0.0006 Low 0.450-4.500​T4, Free: 2.29 High 0.82-1.77​RBC: 5.56 High 3.77-5.28​MCV: 78 Low 79-97​


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## angel1976 (Nov 15, 2011)

Increased blood flow in the whole gland with normal TSH suggests inflammation The term multinodular goiter sometimes used incorrectly to desribe the gland with coarse texture ("swiss cheese") appearance but no nodules larger than 5 mm perhaps.
"_The right lobe of the thyroid gland measures 5.96 cm x 2.36 cm x 2.98 cm. The isthmus of the thyroid gland measured 0.55 cm. The left lobe of the thyroid gland measured 3.40 cm x 2.32 cm x 6.56 cm_"
Your thyroid volume is roughly 43 cu cm which is 5 times larger than average size.
The RAIU scan is unnnecessary procedure unless patient is hyperthyroid.
The nodules smaller than 1cm will not show up on th RAI scan; cold noules do not mean cancer, while hot or warm nodules can be cancerous as well!


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## titapwease (Aug 31, 2012)

angel1976 said:


> Increased blood flow in the whole gland with normal TSH suggests inflammation The term multinodular goiter sometimes used incorrectly to desribe the gland with coarse texture ("swiss cheese") appearance but no nodules larger than 5 mm perhaps.
> "_The right lobe of the thyroid gland measures 5.96 cm x 2.36 cm x 2.98 cm. The isthmus of the thyroid gland measured 0.55 cm. The left lobe of the thyroid gland measured 3.40 cm x 2.32 cm x 6.56 cm_"
> Your thyroid volume is roughly 43 cu cm which is 5 times larger than average size.
> The RAIU scan is unnnecessary procedure unless patient is hyperthyroid.
> The nodules smaller than 1cm will not show up on th RAI scan; cold noules do not mean cancer, while hot or warm nodules can be cancerous as well!


My TSH is almost non-existent. It is less than 0.006 and should be no lower than 0.450. I am hyper with possible Graves. So hyper that I was about to go into thyroid storm. I have already had the RAIU. Which lit up in its entirety. Indicating a hyper-functioning goiter not a nodule. They told me this themselves. Cold nodule are more likely to be malignant. While warm or hot are more likely benign. There is no set standard but there are guidelines.

I do not know how big the nodule is; as no one has spoken much about it to me. My thyroid peroxidase Ab in my first set of blood work was 2812 when the range was 0-34. These levels can be due to Graves or malignancy or possibly some other disease.

There are a few other reasons why a nodule may not show up; one being, that it is not comprised of thyroid tissue.


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## titapwease (Aug 31, 2012)

I can feel the goiter as well as the nodule. I find it odd that it is palpable; yet no one seems to talk about it or notice it. RAIU showed no sign of nodule, just a goiter. Ultrasound makes no mention of the nodule either; but what size my lobes are instead.

I would like to think that if it is big enough to feel, then it is big enough to see on both scans and do a biopsy.


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## titapwease (Aug 31, 2012)

Nuclear imaging cannot reliably distinguish between benign and malignant nodules and is not required if nodules are present. FNA biopsy has replaced nuclear imaging as the initial evaluation procedure. However, in patients with a suppressed TSH level, a thyroid scan determines regional uptake or function and can be used as a secondary study.

The thyroid scan measures the amount of iodine trapped within the nodule. A normal scan indicates that the iodine uptake is similar in both lobes of the thyroid gland. A nodule is classified as "cold" (decreased uptake), "warm" (uptake similar to that of surrounding tissue), or "hot"(increased uptake). While a large proportion of thyroid nodules may be cold on radionuclide scan, only 5 to 15 percent of these are malignant. Radioiodine scans also are useful in nodules with indeterminate cytology results, because a hyper-functional nodule is almost always benign and can be managed medically with radioactive iodine or surgery.

Magnetic resonance imaging (MRI) has no place in the assessment of patients with thyroid nodules. Increasingly, however, thyroid nodules are being found incidentally during MRI of the neck for reasons not relating to the thyroid gland. The same is true for computed tomography.

Nodules are often discovered by the patient as a visible lump, or they are discovered incidentally during a physical examination. Thyroid nodules may be smooth or nodular, diffuse or localized, soft or hard, mobile or fixed, and painful or non-tender. While palpation is the clinically relevant method of examining the thyroid gland, it can be insensitive and inaccurate depending on the skill of the examiner.6,9 Nodules that are less than 1 cm in diameter are not usually palpable unless they are located in the anterior portion of the thyroid lobe. Larger lesions are easier to palpate, except for those that lie deep within the gland. Regardless, about one half of all nodules detected by ultrasonography escape detection on clinical examination.9 In addition to palpation of the thyroid gland, a thorough examination of the lymph glands in the head and neck should be performed. Indicators of thyroid malignancy include the following: a hard, fixed lesion; lymphadenopathy in the cervical region; nodule greater than 4 cm; or hoarseness.


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