# first visit with ENT - need advice please



## ksgal (Nov 19, 2010)

My PC doctor sent me to an ENT because a sonogram she ordered showed a multinodular goiter. The ENT said my thyroid is enlarged and I have 4 nodules - the largest is 2.2 cm (and is solid), the next is 1.9 cm and that last two are each around 1 cm. The ENT wants to do a sonogram assisted biopsy on the largest nodule which he suspects will show signs of hashimotos and then he will send me to an endo. Should I just go to the endo now or have the biopsy first and then go? I think I should have an endo's opinion before doing anything major.

TPO was 516 and the rest of my results were still "in range" but were either on the high side or low side.

Thanks for the opinion!


----------



## Andros (Aug 26, 2009)

ksgal said:


> My PC doctor sent me to an ENT because a sonogram she ordered showed a multinodular goiter. The ENT said my thyroid is enlarged and I have 4 nodules - the largest is 2.2 cm (and is solid), the next is 1.9 cm and that last two are each around 1 cm. The ENT wants to do a sonogram assisted biopsy on the largest nodule which he suspects will show signs of hashimotos and then he will send me to an endo. Should I just go to the endo now or have the biopsy first and then go? I think I should have an endo's opinion before doing anything major.
> 
> TPO was 516 and the rest of my results were still "in range" but were either on the high side or low side.
> 
> Thanks for the opinion!


Hi ksgal!

Solid is always suspicious so it would be my humble opinion that you go ahead w/ the biopsy. ENT is very experienced; I do believe I would be inclined to follow his/her lead firstly.

Let's see what others have to say.


----------



## ksgal (Nov 19, 2010)

Hi Andros! I was able to get into the doctor much earlier than I had hoped - my appointment wasn't until December 16 so that is good!

Is there a benefit in having the nodules out rather than doing a biopsy? I am not familiar with nodules - if they will keep growing and eventually need out anyway? I would assume that a 2.2 cm nodule is on the "large" size but I am not sure.

He said my thyroid was enlarged - to the nodules and enlargement go with hashimotos? I have read about doing a biopsy to diagnose hashimotos I think but I am not sure.

Thanks! I have had tried to work with so many doctors to figure this out that I tend to question almost everything they say.


----------



## CA-Lynn (Apr 29, 2010)

And good for you for questioning everything they say! Keep them on their toes.

Patient education is empowerment.

Good luck!


----------



## ksgal (Nov 19, 2010)

I hope so! Seems like I sure do a lot of it!

I was wondering...my husband mentioned just having them take out the nodules rather than do a biopsy. Would that be a good move? Can they just take out the nodules or with nodules the size mine are do they have to take out the thyroid? I have a history of ovarian cancer in my family - I thought maybe thyroid cancer and ovarian cancer were related but I am not sure. Thanks!!


----------



## shirley1929 (Nov 24, 2010)

Hi KS,

I'm new here as well, but it sounds like we are in a similar boat. My story is in the "welcome new people" forum. I too have a multinodular goiter (found by PCP on routine physical) and have seen an endo 2x now (never saw ENT). Thyroid function is normal, but elevated antibodies. Biopsy was Wednesday.

We didn't ask about removing the nodules, but we're getting there. The biopsy is a very simple procedure, and I would thinking that removing the nodules (if that's even a possibility) would be much more invasive. I figure, if these are benign and causing a problem months or years from now...then we'll do something about it!

Good luck and keep us posted...


----------



## Andros (Aug 26, 2009)

ksgal said:


> Hi Andros! I was able to get into the doctor much earlier than I had hoped - my appointment wasn't until December 16 so that is good!
> 
> Is there a benefit in having the nodules out rather than doing a biopsy? I am not familiar with nodules - if they will keep growing and eventually need out anyway? I would assume that a 2.2 cm nodule is on the "large" size but I am not sure.
> 
> ...


I do think that biopsy is the best approach here. I have never heard of just taking the nodules out w/o taking surrounding tissue. There is such a thing as a partial thyroidectomy though.

When they do the biopsy, pathologist will also look for the Hurthle cells that are indigenous to Hashimoto's so you will know one way or the other about that diagnosis as well.


----------



## ksgal (Nov 19, 2010)

Yep! Sounds like we are in the same boat! The more I read about having the nodules removed the more it sounds like it would not be a good idea. I am scheduled for a ultrasound assisted biopsy on December 7....so at least that is not to far away. My sister had hashimotos...so I assume that is why the doctor is leaning towards that diagnosis.


----------



## McKenna (Jun 23, 2010)

A FNA biopsy sounds like the best route for now, IMHO. All your nodules are over 1 cm so they *should* be able to get some good sample tissue. Is he planning on sticking all of them? Or at least more than one, I hope.

As far as I know, I don't think they can remove nodules only. They would remove one or both lobes.

Are you currently on thyroid replacement? A thyroidectomy would make you hypothyroid after surgery.


----------



## ksgal (Nov 19, 2010)

Right now he is just planning on the largest one. I am not on replacement therapy yet - all my labs are "in range"....although at the very high or low of the range. When I first began thinking about having the nodules removed I didn't realize that they would have to take the lobes. I agree that the biopsy would be best for now...and go from there. Thanks!


----------



## McKenna (Jun 23, 2010)

This is just my opinion again...but I would be interested in having more than one biopsied. 
Good luck with the biopsy next week.


----------

