# surgical consult



## mstar1125 (May 6, 2014)

I posted in another thread but figured I would be better off here. I have a multinodular thyroid with a dominant nodule on the right lobe. At ultrasound in April 2014, the nodule was measuring 37 x 23 x 12 mm. It is predominantly cystic (50-75% according to the report). I had it biopsied in June 2014, which came back benign. I had a follow up ultrasound yesterday because my endo thought the nodule had grown significantly by palpation, but it turns out that the growth has been minimal. I don't have the actual report yet, but according to what I saw on the screen, one measure had increased to 39 or 40 mm and the other measure had increased to 25 mm (I didn't see the third measure). No other changes were seen, the nodule is still predominantly cystic. None of my other smaller nodules had changed. My thyroid function is otherwise normal, I'm not on any medications, but I do have a family history of Hashi's (mother and sister).

I have a surgical consult on Wednesday. I'd prefer to not have the nodule out, but everyone here seems to advocate for surgery when the nodule is this large. What are other options that people have tried? I'd rather have it drained, but I'm afraid that would just anger the nodule and make it grow back bigger. Someone on another board mentioned that I could ask to have RAI - wouldn't that just kill off the entire thyroid and not just the nodule? I do worry that a nodule this size is harboring some sort of cancer despite the benign FNA last year.


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## joplin1975 (Jul 21, 2011)

Usually when things get that large, other structures in your neck are impacted. Hence the recommendation for surgery.

RAI will kill both healthy and non-healthy thyroid cells. It is not specific.

Have you had your thyroid antibodies tested? If you do have antibodies, you could try a low dose of synthroid. Sometimes, suppressing TSH can shrink (although usually minimally) thyroid nodules.


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## mstar1125 (May 6, 2014)

I have been tested for TSI and TPO, but not the third one (thyroglobulin?). Both TSI and TPO were negative, although the lab did not report specific numbers. I can ask if suppressing TSH would help, but the nodule was actually found when I was hyperthyroid during early postpartum, and so they assumed it was a functioning hot nodule. However, my levels went back to normal by 9 months postpartum, but the nodule remains.


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## Octavia (Aug 1, 2011)

mstar1125 said:


> I have a surgical consult on Wednesday. I'd prefer to not have the nodule out, but everyone here seems to advocate for surgery when the nodule is this large.


Just for your own understanding, the surgeon won't remove just the nodule. It's the entire thyroid lobe (half of the thyroid) or the whole thyroid that will be removed. Maybe you already knew this, but just in case. We're all learning here!


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## joplin1975 (Jul 21, 2011)

mstar1125 said:


> I have been tested for TSI and TPO, but not the third one (thyroglobulin?). Both TSI and TPO were negative, although the lab did not report specific numbers. I can ask if suppressing TSH would help, but the nodule was actually found when I was hyperthyroid during early postpartum, and so they assumed it was a functioning hot nodule. However, my levels went back to normal by 9 months postpartum, but the nodule remains.


Ah, ok...

Yes, TSH suppression might not be an option. If you levels are normal and its not causing symptoms, is there a reason your doctor is pushing for a surgical consult?


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## mstar1125 (May 6, 2014)

So I finally got a copy of my more recent ultrasound results. Usually when I have an ultrasound, a tech does the measurements and then a doctor comes in to review the results and take additional measurements. This time around, the tech went to talk to the doctor but the tech just came back and said "the doctor says it hasn't changed". The report suggests otherwise:

April 2014 measurement: 37 x 23 x 12 mm

Oct 2015 measurement: 39 x 33 x 22 mm

So it grew 1 cm in two out of three directions...that seems significant. Also I have multiple small nodules on my other lobe (< 5mm). Last year they were noted as "predominantly cystic" and this year they were noted as "predominantly solid". I'm glad I have the surgical consult scheduled for this week, because those results seem more concerning than I was led to believe.


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## Octavia (Aug 1, 2011)

Yes, that is significant growth. I'm glad you're meeting with a surgeon.


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