# Nodules found - getting more tests



## Shandit66 (Oct 24, 2012)

Hi, I'm new here (and to thyroid problems) so was hoping for some guidance.

About 6 weeks ago I woke up to find a large lump on the right side, low on my throat. Its very obvious since I have to shave over it every day.

*Background*


There's no pain, unless I poke hard at it, no discoloration etc. 
Mother and aunt both have low thyroid and have been on Synthoid for most of their lives.
I've been tested repeatedly before and during this. Thyroid levels are "normal", not sure what that means, or how to drill down on this data. I can get records from my doc.
No history known on father's side
I've not noticed any other changes in my health, Tired, but there's been quite a bit of stress due to other matters.

I requested tests the same day from my GP. Was informed that there was a slight chance to cancer, but thyroid nodules were common and normally not cancerous. (mildly reassuring, but any mention of cancer obviously makes one nervous)

*1st test*: was a needle biopsy, no ultra sound. 3 needles, tiny samples.

(Note: the conduct/dialog in the clinic was not reassuring - didn't seem professional. Mentioned that if lumps are found they've remove a chunk or all of the thyroid and I'd just go on Synthoid = there's no risks involved. That didn't make any sense. Total removal of the thyroid seems to have all sorts of problems associated.)

Results were in conclusive due to lack of sample.

*2nd test*: Ultra sound. Found lots of fluid, some "debris". Was the basis for follow up testing.

*3rd Test*: Needle biopsy under ultra sound. 2 Needles, each poked for about 5 min. Withdrew a lot of old dead blood - lump went down.
Private lab, much more professional seeming, but tech didn't seem experienced.
Results: inconclusive due to lack of samples of follicular cells.
Sent for 4th test

*4th Test*: 10 needle biopsies at Toronto General, under ultra sound. Was pretty sore after and still have nice big, green bruise

Tech seemed very experienced. Explained that my case was tricky to test since there's a lot of fluid and getting the follicular cells is difficult. Hence the 10 pokes.

I can get pics from the hospital if this is useful in any way.

I'm waiting on the 4th set of test results now. 
Hopefully there will be something more indicative. 
The odds of cancer seem to be low, but waiting around for 2 months is wearing on my nerves.

*Questions*
1 - is there anything else I should be considering? Looking at? Researching?
2 - as indicated above, my level of faith in the thyroid clinic above, is not high. 
While I'm clearly not an expert in these matters, there were enough warning signs that I'm concerned about the quality of expertise. In the Toronto (or Southern Ontario) area are there any clinics which people like/prefer/have good experience with?
3 - any wild guesses as to what causes such a lump appear so suddenly?

Thanks for your help and comments, I very much appreciate it.


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## joplin1975 (Jul 21, 2011)

1 - is there anything else I should be considering? Looking at? Researching?
See if you can get copies of your blood work results *with the reference ranges* -- you should have had (or be asking for if not yet completed):
TSH
free t4
free t3
TPO
TSI 
Thyroglobulin and TgAB

2 - as indicated above, my level of faith in the thyroid clinic above, is not high.
While I'm clearly not an expert in these matters, there were enough warning signs that I'm concerned about the quality of expertise. In the Toronto (or Southern Ontario) area are there any clinics which people like/prefer/have good experience with?

I dunno know...you'll find that, around here, we're big proponents of thyroid removal. Are there risks? Sure. But they are generally minimal, recovery is usually quick and taking a pill the rest of one's life is really not that big of a deal.

3 - any wild guesses as to what causes such a lump appear so suddenly?

Not really, but some times thyroid inflammation can appear quickly. There's a greater incidence in faster-growing thyroid cancers in men...but most thyroid cancers are slow-growing.


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## Shandit66 (Oct 24, 2012)

As of Aug 31 2012

TSH = 1.68 (scale: .035 - 5.00
free t4 = 20 (scale: 9-23)
free t3 (triiodothyronine?) = 5 (scale: 3.5-6.5)
TPO = ?
TSI = ?
Thyroglobulin and TgAB

The nodule is 5.5 cm, with pockets of fluid, mostly old blood.

So the forth test came back inconclusive.
So after 15 samples, there's not enough info to make any determination. Seems to me like the test is not very good.

From various literature, is seems that if no definite diagnosis can be made, the default is to remove the thyroid, examine it and determine if there really is a risk of cancer. And the recommendation is to remove the right half of the thyroid.

I'm not crazy about taking out glands etc, just because the testing can't figure it out. 
Well, my lower back hurts and I don't definitively know the problem either...so maybe I should amputate that?!?!?

Questions
1 - Are there other tests which can be pursued? I've found the "Afirma Thyroid FNA Analysis test" which claims to increase accuracy. Not currently available in Canada however.

2- are there other references to look at?

thanks


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## joplin1975 (Jul 21, 2011)

You can ask about a radioiodine uptake scan to determine if the nodule is functioning or not.


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## Andros (Aug 26, 2009)

Shandit66 said:


> Hi, I'm new here (and to thyroid problems) so was hoping for some guidance.
> 
> About 6 weeks ago I woke up to find a large lump on the right side, low on my throat. Its very obvious since I have to shave over it every day.
> 
> ...












So...................first may I say that anytime FNA is indeterminate, that raises and eyebrow.

Secondly, males have an increased risk for cancer and I personally don't like that this came on so fast. Since you do shave every day, surely you would have noticed it way before you did if it was a slow mover.

Hopefully you will get your hands on some lab results and ranges for us? Do you feel symptomatic.................at all?

And here is a good list of suggested labs.

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

Trab
http://www.ncbi.nlm.nih.gov/pubmed/17684583

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/

And this may be of interest.

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 hope and pray you are in the clear but being sure of that is very important.


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## Shandit66 (Oct 24, 2012)

Thanks for the excellent feedback.
I"m trying to get my head wrapped around this and the info is very helpful

1 - I'll ask the radioiodine uptake scan
2 - I've attached the test results (Hope it works, I couldn't find an easy way to upload files)

http://www.thyroidboards.com/album.php?albumid=24&pictureid=111

http://www.thyroidboards.com/album.php?albumid=24&pictureid=112

thanks!


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## Shandit66 (Oct 24, 2012)

After not getting any decent answers from the current 
doc I've pushed to see another one - just waiting for 
the appointment now.

In the mean time the the nodule grew and was putting a lot of
Pressure on the my throat. Last Thursday I had it drained. 
They sucked out about 15 cc of old dead blood. Couldn't get it 
All but the reduced size hugely.

However after 3 days I've already got pressure back and it's 
Grown back to original size already

This would lead me to believe that I have internal bleeding. 
Any guidance on what usually happens next? I just to know the
Right questions to ask the new doctor.

Thanks
Olaf


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## Andros (Aug 26, 2009)

Shandit66 said:


> After not getting any decent answers from the current
> doc I've pushed to see another one - just waiting for
> the appointment now.
> 
> ...


This is "suggestive" of a vascular nodule which means it has an independent blood supply and that "suggests" that FNA should be done to make sure it's not cancer.

Please let us know when you have an appt. lined up!!

Keeping you in my thoughts and prayers for all of this!


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## BehindBluEyes (Dec 23, 2012)

Wow, Hun... I am honestly surprised that you went through so many biopsies! Dang.
I have had 2cm/9mm thyroid nodules for around 6 years (found when I was 16, now 22.)
Anyway, I haven't had one biopsy. I refuse, actually.

In my opinion, they are pointless. (False negatives happen, they are not uncommon.)
Mainly, because if my results did ever come out benign --
I'd still freak and worry, so if they grow...
They're out! What I am trying to say is, don't stress about this.

My nodules could be cancer, but they are stable and not killing me.
Surgery is a pretty big deal and I will only have it done if my life is on the line.

Sure, I worry about them - but, I'm only human.
Seize the day, every day.


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## Shandit66 (Oct 24, 2012)

BehindBluEyes said:


> ,
> They're out! What I am trying to say is, don't stress about this.
> 
> .


Actually I'm not stressed about cancer. Everything I've read indicates that I'm a very low risk. However this nodules has grown back to 70% of its ice in three days. And it's putting a lot of pressure on my trachea. Before the drainage it's was painful and prevented me from sleeping.

So something has to done IMO to stop or limit this. Options in my head:

1 - it's internal bleeding . So how does that stop? Surgery ?
2 - its an infection. so get it drained again but this time flushed with something to try and kill the infection?

Thanks


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