# Saw the endocrinologist yesterday for my nodule



## juliev (Feb 18, 2015)

Hello again, I finally saw the endocrinologist yesterday, 3 weeks after finding out I have a 4 cm nodule on my thyroid. I was hoping to get a sense of what they thought it was based on the ultrasound . A resident came in first and told me the nodule had some concerning characteristics which made me feel like it must look bad. She said my age (41), the size of the nodule (4 cm) and the fact that it has vascularity are concerning. Then the attending physician came in and he said he thought there was maybe a 1 percent chance it would be malignant. At that point I wasn't sure if he was just trying to make me feel better or if he was being honest.

*He mentioned that sometimes there is trauma to the thyroid and it fills with blood causing the nodule and the vascular appearance. Has anyone ever heard of this?*

So, I will have a biopsy next wednesday, with ultrasound and a pathologist. Then he said I would have the results 2 days later.

He also felt my thyroid and mentioned that it was enlarged as a whole, saying the isthmus was palpable. So he sent me to have a tsh done as well as thyroid antibodies.* I think that is to look for graves or hashimotos, is that correct? If the antibodies come back high does that mean that is probably the cause of the nodule?*

One thing I did find interesting is that he said if it is benign, they may not remove it. I thought they always removed nodules this size, but he said since it isn't really causing any symptoms that they could just keep monitoring it. He was kind of patronizing saying "well, you are awful young and pretty to have a big scar on your neck." I'm thinking, I don't give a crap about a scar, I would rather not have a large nodule threatening me.

*Does anyone know if there is a possibility that a biopsy would say benign but there could still be cancer? I guess that would be my worry.*

So, obviously, if the biopsy comes back bad or if I decide I want it out, they said I would then go see an ENT surgeon to discuss the options.

One other thing he told me that I wish he hadn't was that if they do a lot of passes with the needle during the biopsy then that was a good sign meaning that they weren't finding much to be concerned about, but if they saw something right away, that was a bad sign meaning they had found something to be conerned about right away. Yikes!

Any thoughts on this saga of mine? Thanks for being there!


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## Octavia (Aug 1, 2011)

HI there. I'm glad you'll be getting an ultrasound-guided biopsy.

If I were you, I would seriously consider surgical removal. That is a VERY large nodule. Surely it's causing some pain or discomfort in your neck/throat/voice...is it not?


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## juliev (Feb 18, 2015)

Not really. It is on the anterolateral aspect of my left thyroid lobe, so it is on the outside, arising from it, it is not within it. Because it is facing outward I really don't feel it.I can certainly see it and palpate it from the outside though. It is 26x29x40 mm. I am thankful it is not on the inside because I would certainly be uncomfortable. Honestly it would not cause me discomfort physically to keep it, I am more concerned with there being cancerous cells hiding inside.


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## Octavia (Aug 1, 2011)

I don't blame you for being concerned. Keep us posted on the biopsy.


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## joplin1975 (Jul 21, 2011)

> *He mentioned that sometimes there is trauma to the thyroid and it fills with blood causing the nodule and the vascular appearance. Has anyone ever heard of this?*


Eh, I suppose it's possible, but in the realm of all things thyroid, I wouldn't default to this explanation. Have you have any kind of neck trauma? Whiplash?



> *I think that is to look for graves or hashimotos, is that correct? If the antibodies come back high does that mean that is probably the cause of the nodule?*


It depends what antibodies were tested. The first thing to remember is that antibodies in and of themselves are suppose to be used for diagnosis. They help point your medical staff in the right direction, but no diagnosis.

So, with that said: TPO is usually associated with Hashimoto's (which can and does cause nodules); TSI is most often associated with Grave's (which, again, can and does caused nodules); and, Tg is most often associated with cancer.

The concerning issue, from what I'm reading, is that you are talking about a singular nodule. Usually (again, there are no hard and fast rules with thyroid) Hashi's and Grave's patients have multiple small nodules. Singular (and large!) nodules are more often seen in thyroid cancer patients (of course, I was an over-achiever and had six nodules, all of which were cancerous...again, no hard and fast rules here).



> *Does anyone know if there is a possibility that a biopsy would say benign but there could still be cancer? I guess that would be my worry.*


Yes, it's a possibility. If you read these types of boards long enough, you'll see many instances of people with benign results who underwent surgery only to end up with a cancer diagnosis. The needles that they use for a biopsy are teeny tiny. Even relative to a small thyroid nodule. They have to "hit" the right section of the thyroid nodule (the presumably cancerous part) to pull out cancerous cells. That is, unless you have completely cancer-filled nodules, they could very easily hit tissue that is comprised of very normal thyroid cells. Repeat biopsies happen for this reason.


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## juliev (Feb 18, 2015)

Thank you for your replies. They only did a tsi and tsh. So, it seems to me the consensus would be, even if it is benign, I should have it removed! That is how I am feeling too. One more question- what about the over all enlarged appearance of my thyroid and isthmus? Can cancer cause this? Or would it more likely be some other sort of disease process?


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## joplin1975 (Jul 21, 2011)

Usually enlarged thyroids happen with Grave's or Hashi's. But both Grave's and Hashi's are linked with thyroid cancer, so it's hard to tease out the cause of enlarged thyroid. Basically, it means you've got a grumpy thyroid. But not much beyond that.


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## Andros (Aug 26, 2009)

Very relieved that you are getting the biopsy!! Very glad!!! When is it scheduled? Keep us in the loop on this.


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## juliev (Feb 18, 2015)

Thank you! The biopsy is scheduled for next Wednesday at 1 pm. I will update when I know results.


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## etf007 (Apr 5, 2012)

I got mine removed and regretted it ever since. Knowing what I know now if I would do it over again I'd have my thyroid. I've cured all my ailments since using gum of turpentine and I believe it would of cured my nodules. That's just my two cents.


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