# Newbie trying to get an understanding...



## BrianC (Sep 28, 2011)

Hi,

I'm male 44yo in Atlanta. I went in to the GP earlier in the month for a physical. Just to she how things were going. I didn't have any real issues. (side note, this was my first visit with him, he's my in-law's GP that was referred to me). Well he heard bruit (turbulence) in my carotid. So, due to family history of heart disease, he setup stress test, carotid ultrasound and an Echo. My thyroid was noted as "No goiter, no masses or nodules". Blood work for physical ok, cholesterol a little high. Stress test came back good, echo and ultrasound also good.

But during my ultrasound, the tech said the thyroid was abnormal and asked to ultrasound it, and I OK'ed. Well here are the results:

<start results>
Right lobe: 3.9 x 1.3 x 1.5 normal in size, normal in echotecture without cyst or mass.

Left lobe: 4.9 x 2.0 x 3.21 - enlarged irregular in echotexture. It looks like there is a lobular mass or masses here. and there may be a very large nodule that expands the whole lobe. Diffucult to see in two planes.

Opinion:
The left lobe is enlarged be a sizable lobular mass. Whether there is simply one nodule here or a number or nodules, it is a little difficult to say. If it is a single nodule with multiple lobulations, it certainly meets the size criteria for biopsy.
<end results>

Well, I have an appt with the Endo this Thursday, with the FNA that same afternoon. After reading up on the thyroid, I am having difficulty swallowing. I had thought it was just age, but when I described my symptom to a NP friend of mine, she said that was difficulty swallowing.

First off, the GP didn't catch that on the physical. Should that size have been caught when he check my neck with his fingers?

From what I read briefly, I'm expecting benign but surgery due to swallowing issues. Am I close?

If surgery is the case, I'd like a 2nd and like a 3rd opinion on which procedure they'll use and why. How can I find qualified Endo's, or any recommendations?

Finally, I've seen some talk about ENT's. Why would a person go to an ENT instead of an Endo?

Brian


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## Andros (Aug 26, 2009)

BrianC said:


> Hi,
> 
> I'm male 44yo in Atlanta. I went in to the GP earlier in the month for a physical. Just to she how things were going. I didn't have any real issues. (side note, this was my first visit with him, he's my in-law's GP that was referred to me). Well he heard bruit (turbulence) in my carotid. So, due to family history of heart disease, he setup stress test, carotid ultrasound and an Echo. My thyroid was noted as "No goiter, no masses or nodules". Blood work for physical ok, cholesterol a little high. Stress test came back good, echo and ultrasound also good.
> 
> ...


I am glad you are getting FNA on Thurs.. I presume that is tomorrow? 9/29/11?

It sounds very suspicious and it's a good thing you went in to get a check-up. I too hope it is benign. Keep our fingers crossed here.

Aside from the swallowing, are you symptomatic?

Did anyone run any of these tests?

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/

That ultra-sound tech was on the ball. The bruit could be from the mass on the thyroid; interesting.

So, Thursday is tomorrow? 9/29/11???

It's a good thing you are getting FNA and we all wish you the very best outcome!

When you are able, let us know and by the way; ice down when you get home. The sooner the better. It should not hurt too much but icing does make it better.

ENT's do a lot of surgery!

Go here for referrences. These folks know every doctor in the Atl. Metro Area!
http://health.groups.yahoo.com/group/Georgia_Thyroid_Groups/


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## BrianC (Sep 28, 2011)

Yes, my biopsy is 9/29. The results will take 5-7 days. I haven't any thyroid tests done yet. I only had the standard blood work done for a physical. Should I ask about those tests before the FNA?

Are there any risk factors that affect the chance of cancer? Such as smoking. I'm thinking that my chance of cancer is pretty small, since I haven't smoked and I'm a software engineer, so there isn't any work place risks for cancer.

It's time to start learning a whole new vocabulary. One good thing for me is my wife is going back for a 2nd degree, she's trying to become a PA. And endocrinology is one of the areas that interest her. So we'll be over all the self-education.

Brian


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## BrianC (Sep 28, 2011)

FYI, other than the difficulty swallowing, I don't know that I have any other symptoms.


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## Andros (Aug 26, 2009)

BrianC said:


> Yes, my biopsy is 9/29. The results will take 5-7 days. I haven't any thyroid tests done yet. I only had the standard blood work done for a physical. Should I ask about those tests before the FNA?
> 
> Are there any risk factors that affect the chance of cancer? Such as smoking. I'm thinking that my chance of cancer is pretty small, since I haven't smoked and I'm a software engineer, so there isn't any work place risks for cancer.
> 
> ...


FNA should not interfere w/any lab tests. However, medication could so you would want to get some "baseline" results prior to starting any thyroid meds. This way you can track improvments or not.

Since you are a male (and there sure is nothing wrong w/that), your risk for cancer is increased. Also any previous exposure to radiation in excess. Genetic (familial) tendencies.

men more likely to have cancer than women
http://www.umm.edu/endocrin/thytum.htm

Thyroid cancer, cold nodules, men, uptake etc.
http://www.aafp.org/afp/2003/0201/p559.html

I am all for self-education. All for it!


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## Octavia (Aug 1, 2011)

Brian, welcome! Ditto what Andros has said, and I'll add a few of my own thoughts...

First, your desire for a second (and possibly third) opinion is understandable. Here's another perspective: If you are already having difficulty swallowing, that may indeed serve as all the second opinion you need. I went to two ENTs, and they both said the exact same thing...in my case, I needed to have surgery because my FNA was suspicious/inconclusive, plus my voice was hurting, and my nodule was very visible from the outside (as in, if you were to look at me, it would be staring you in the face). These things all added up to a need for surgery. I'm glad I got a second opinion because I liked the second ENT a lot better, and ended up choosing him to do my surgery (which turned into surgeries, but that's a whole other post).

Second, you asked about going to an ENT vs. and Endocrinologist. ENTs are trained in head and neck surgery, and most do a lot of it (you'll want to choose one who does thyroid surgeries on a very regular basis). Not all Endocrinologists specialize in thyroid, and not all do surgery.

Third, just to clarify and add to what Andros said about being male... thyroid cancer is much more common in women than in men. BUT, a nodule found on a man has a higher likelihood of being cancerous than a nodule found on a woman. So, for the average man, odds of having thyroid cancer are extremely slim. But since you have at least one nodule, the odds of it being cancerous are higher than they would be if you were a woman. Hope that makes sense. 

And fourth, regarding your self-education. I'm sure you've heard the phrase (I think it's in a song, but I can't recall) "If it wasn't for bad luck, I'd have no luck at all..." Well, to paraphrase that: if it wasn't for self-education, many of us would have almost no thyroid education at all! Many docs aren't that forthcoming with the information, so we have to educate ourselves. Have at it!


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## BrianC (Sep 28, 2011)

Octavia,

I actually was looking for a 2nd opinion on what procedure they would use, and with the pros/cons of it. In my mind, I expect it to be benign, but surgery non the less due to my swallowing issues.

Also, should I be concerned that my GP missed the thyroid size during my physical? He did the typical running of the fingers down my throat.

Brian


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## Octavia (Aug 1, 2011)

BrianC said:


> Octavia,
> 
> I actually was looking for a 2nd opinion on what procedure they would use, and with the pros/cons of it. In my mind, I expect it to be benign, but surgery non the less due to my swallowing issues.
> 
> ...


I think that's a good approach.

As for concern about missing the thyroid size...I'm not sure. It sounds like even the ultrasound results show a little bit of confusion about the cause of the size. With mine, there was a definitive single lump that clearly stuck out from the rest of the thyroid, so it was pretty easy to see and feel. Yours seems more ambiguous than that. It may have "felt right" to your doctor becase it was relatively smooth (felt like a normal thyroid gland), as in a "nothing jumped out at me" kind of thing. Your doctor may be more accustomed to looking for nodules, which are pretty common and relatively easy to feel. He/she may not have been on the lookout for the entire side of your thyroid to be out of whack. Regardless, you're on the right track now, so you didn't lose time as a result of it.

I don't recall a doctor ever listening to my carotid artery...not even when I went to the ER because all of a sudden I had this huge lump RIGHT THERE where the carotid artery lives (which turned out to be thyroid). I would give the doc bonus points for that!


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## BrianC (Sep 28, 2011)

Well, just got back from my FNA. The doctor drew blood to get my thyroid levels. Before the biopsy, the he was talking likely benign and no surgery. When he looked at it during the FNA, he saw that were so many nodules on my left side that he couldn't be sure to biopsy them all. Nodules with others coming up under other nodules. He took 5 samples going down the side. He said if it's Hashimoto, we could try drugs. But Hashimoto isn't seen on one side with the other normal.

So, we wait for the blood work. He's wanting to remove the left side, and if the surgeon sees anything wrong with the right, they'll take it all out.

So, any suggestions on things I should ask about or read? I was glad to hear that he has a surgeon do the procedure. Experience is what I was looking for.

Brian


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## bigfoot (May 13, 2011)

Personally, if I was to go in for thyroid surgery, I'd ask for them to remove it completely. You're going to have to likely take medication (levothyroxine) for the rest of your life, whether half your thyroid remains or not. Then there is the nagging doubt of "what if" down the road, or if the remaining half starts to act up or sputter.

Just my newbie opinion here; do it once and get it over with.


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## Andros (Aug 26, 2009)

BrianC said:


> Well, just got back from my FNA. The doctor drew blood to get my thyroid levels. Before the biopsy, the he was talking likely benign and no surgery. When he looked at it during the FNA, he saw that were so many nodules on my left side that he couldn't be sure to biopsy them all. Nodules with others coming up under other nodules. He took 5 samples going down the side. He said if it's Hashimoto, we could try drugs. But Hashimoto isn't seen on one side with the other normal.
> 
> So, we wait for the blood work. He's wanting to remove the left side, and if the surgeon sees anything wrong with the right, they'll take it all out.
> 
> ...


My goodness, Brian. This sure has mushroomed. It's a darn good thing that you have a good doc and things are underway.

I do hope you will be able to share your path report w/us when you get it.

Don't forget to ice your neck down so it won't be so sore! Pamper yourself also!


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## BrianC (Sep 28, 2011)

Ok, I received my results. Here they are:

Blood:
TSH, 3rd Gen 2.78 in-range (range .40 - 4.50)
Thyroid Peroxidase Antibodies 116 - out of range (range <35 IU/mL)

Biopsy : 6 samples benign but as noted above it was a sampling of the nodules, not each nodule.

The lab report doesn't say this, but the office's note reads: 
"Lab shows Hashimotos (thyroid antibodies)"
"Thyroid level is normal"
"Does he want to have surgery?"

So, I'm a little confused. Has anyone else seen or heard of Hashimotos affected only half the thyroid? I've asked for him to give me a call, since when I had the appointment he thought it should be removed. I'm not sure if that's still his recommendation with these results.

Also, if I went on a drug treatment, would that reduce my enlargement back to normal? My wife also did some searching, does gluten in my diet affect this (and how much)

I just don't know which treatment I should take.

Thanks,
Brian


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## Andros (Aug 26, 2009)

BrianC said:


> Ok, I received my results. Here they are:
> 
> Blood:
> TSH, 3rd Gen 2.78 in-range (range .40 - 4.50)
> ...


I would like to reserve comment until we hear what your doc has to say.


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## BrianC (Sep 28, 2011)

Ok, just got off the phone with the doctor. He's still recommending surgery, with removal of the left side. He's concerned about the number of nodules, and that my right side looks normal. My wife and I asked about drug treatment to address Hashimoto's. He said that we could try drugs, for a few months, to try to shrink the thyroid and then see what it look like. He also said that the drugs won't change the level of anti-bodies, that it's genetic. My wife believes that diet (gluten free and/or dairy free) can affect that.

So, I need to decide if I go surgery or drug treatment. Or potentially get a 2nd opinion.

Brian


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## joplin1975 (Jul 21, 2011)

BrianC said:


> Has anyone else seen or heard of Hashimotos affected only half the thyroid?


I'm only answering this question (because its the only one I can comment on)...I had a TT and my path results showed evidence of long term thyroiditis. Based on that and high antibodies, there is a presumption that I was dealing with untreated Hashi's for some time. By the time I got treatment, it was cancer, hence the TT. But, to get back to your question, the pre-surgical tests (u/s, RAIU) made it appear as if the right lobe was near normal while the left lobe was enlarged with three nodules (two solid and larger than 2cms and one minimally complex and 9mm).

Did they biopsy just the left side or the right side as well?


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## BrianC (Sep 28, 2011)

The right side looked normal, so they didn't biopsy. The doctor said that if they do surgery, they'll test the left for cancer and decide, during the surgery, if they would remove the right side.


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## Andros (Aug 26, 2009)

BrianC said:


> Ok, just got off the phone with the doctor. He's still recommending surgery, with removal of the left side. He's concerned about the number of nodules, and that my right side looks normal. My wife and I asked about drug treatment to address Hashimoto's. He said that we could try drugs, for a few months, to try to shrink the thyroid and then see what it look like. He also said that the drugs won't change the level of anti-bodies, that it's genetic. My wife believes that diet (gluten free and/or dairy free) can affect that.
> 
> So, I need to decide if I go surgery or drug treatment. Or potentially get a 2nd opinion.
> 
> Brian


A second opinion never hurts. However, somehow I sense that surgery would be the best option. Why wonder every day of your life if you have cancer or not? Ya' know?


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## BrianC (Sep 28, 2011)

Well, I've decided to go with surgery. As a side note, cancer would piece everything together (antibodies and only enlargement of half the thyroid). We'll see. All I can do it get it taken out and looked at. If it is cancer, I've caught it very early since I have no symptoms. I only discovered it in a routine physical.

Now I'm just trying to figure out my flex spend and medical coverage. It's going to be a fun week.

Brian


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## joplin1975 (Jul 21, 2011)

Best wishes for an uneventful surgery and speedy recovery. I think you are making a wise decision.


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## Andros (Aug 26, 2009)

BrianC said:


> Well, I've decided to go with surgery. As a side note, cancer would piece everything together (antibodies and only enlargement of half the thyroid). We'll see. All I can do it get it taken out and looked at. If it is cancer, I've caught it very early since I have no symptoms. I only discovered it in a routine physical.
> 
> Now I'm just trying to figure out my flex spend and medical coverage. It's going to be a fun week.
> 
> Brian


Do you have a date confirmed for your surgery? I am relieved for I do think this is the right choice for you!


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## BrianC (Sep 28, 2011)

trying to figure my insurance situation...Just got off the phone with my insurance. I have a $100 deductible (met) and $1,000 Annual Out of Pocket. I've already paid $997.27. So if I go to an in-network surgeon and hospital, the surgery will cost $3.00 Something is going my way 

I'm trying to setup surgical consults with 2 surgeons, then I can get a surgery date.

Brian


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## Andros (Aug 26, 2009)

BrianC said:


> trying to figure my insurance situation...Just got off the phone with my insurance. I have a $100 deductible (met) and $1,000 Annual Out of Pocket. I've already paid $997.27. So if I go to an in-network surgeon and hospital, the surgery will cost $3.00 Something is going my way
> 
> I'm trying to setup surgical consults with 2 surgeons, then I can get a surgery date.
> 
> Brian


THAT is the best news of all. I am really really happy for you re the $3.00! Awesome! LHM!!

You "go", Brian!


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## BrianC (Sep 28, 2011)

Well, surgery tomorrow morning at 9:30am and I'll get back home Thursday afternoon.


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## Octavia (Aug 1, 2011)

Excellent! Best of luck to you. (Have you saved up that $3 yet?)


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## SnoodMama (Jan 11, 2011)

Good luck BrianC! We'll be thinking of you and eagerly awaiting news of your surgery. Hang tough! You'll be feeling better than you think I predict!


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## Andros (Aug 26, 2009)

BrianC said:


> Well, surgery tomorrow morning at 9:30am and I'll get back home Thursday afternoon.


Wow!!! Keeping you in thoughts and prayers here on my end!


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## Andros (Aug 26, 2009)

Octavia said:


> Excellent! Best of luck to you. (Have you saved up that $3 yet?)


Someone is being a funny bunny today!! ROLF!


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## BrianC (Sep 28, 2011)

Came home today. The good news is they only took the left lobe, and it didn't have cancer based upon the frozen section. I'll get the final pathology in another week, but it's very rarely different. So, I'll be going back to the endocrinologist in 3-4 weeks to get my levels tested. Now I only have to deal with Hashimotos on the right side, unless the anti-bodies magically go away.


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## Andros (Aug 26, 2009)

BrianC said:


> Came home today. The good news is they only took the left lobe, and it didn't have cancer based upon the frozen section. I'll get the final pathology in another week, but it's very rarely different. So, I'll be going back to the endocrinologist in 3-4 weeks to get my levels tested. Now I only have to deal with Hashimotos on the right side, unless the anti-bodies magically go away.


Sounds like you are good to go!! How are you feeling? How is the incision? Ice it down if it bothers you!


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