# Changing nodules



## kimberk (Jun 24, 2013)

I have never really been troubled by previous imaging and FNA results on my thyroid before, but my most recent results do bother me.
I'm no stranger to waiting for news as I was dx with Stage III melanoma in 2004 and underwent complete axillary node dissection and 9 hellish months of interferon treatment.
My thyroid has always shown increased FDG uptake on PET/CT scans and whenever I change oncologists, they always seem a little troubled and order ultrasounds, Thyroid function tests, and FNA because nodules are over 1cm. I was also referred to an endocrinologist.
These results always come back with no suspicion of malignancy or abnormal thyroid function other than "multinodular goiter" For several years, I have felt a "catch"/"lump"&#8230;..something behind my esophagus when I swallow and yet endocrinologist says that is in no way associated with my thyroid so I decided not to even bother going to him anymore.

My most recent ultrasound results, however, seem to be more concerning to radiologist, oncologist, and quite frankly myself. Besides enlargement of the 2 largest nodules, a third large nodule has appeared and several US features point to PTC. See report below.

My oncologist has ordered bloodwork for thyroid function, auto immune disorders (lupus, RA, Hashimoto's,&#8230;..) and FNA next week. Scheduled to go over results July 5.

*Right lobe- 4.3cm x 1.5cm x 1cm, with volume estimated at 3.2cc. Left lobe - 4.9cm x 2.1cm x 1.4cm, with volume estimated at 7.2cc. Thickness of the isthmus is 0.2cm. Multiple thyroid nodules are present. The 3 largest are listed below in order of descending size.

1. Left inerpolar nodule measures 1.9cm x 1.7cm x 1.3cm. Echotexture is heterogeneous, with both isoechoic and hypoechoic components. Several small internal microcalcifications are present. Internal vascularity is present. Peripheral hypoechoic rim is present. Nodule is oval-shaped, wider than tall. (Radiologist Addendum: nodule has increased in size and is more rounded in shape since previous study)

2.	Left lower pole nodule measures 1.6cm x 1.4cm x 1.2cm. There are both solid isoechoic components and cystic components. Internal vascularity is present within the solid component. Peripheral hypoechoic rim is present. Nodule is rounded in shape. 
(Radiologist Addendum: nodule has also increased in size since previous study.)

3.	Lateral left lower pole nodule measures 1.5xm x 1.4cm x 1.1cm. Nodule is predominantly isoechoic, with a heterogeneous internal echotexture. Central hypoechoic portion is present. There is a peripheral hypoechoic rim. Internal vascularity is present, primarily peripherally. No associated calcifications are identified. Nodule is oval-shaped, wider than tall. 
(this nodule hasn't ever been mentioned in previous studies)

IMPRESSION:
1.	There are 3 discrete thyroid nodules measuring 1.5cm and larger, each of which contains some worrisome ultrasound features. Recommend comparison with prior examinations. Unless stability can be documented, biopsy of these nodules would be indicated for definitive characterization.

2.	Overall diffuse enlargement of the thyroid gland most likely reflects a benign multinodular goiter and me be associated with underlying thyroiditis. Recommend correlation with thyroid function studies
*

I am an avid research geek and have tried very hard to find studies that lean toward the benign end of the scale, and yet I am having a tough time. Most studies seem to indicate a strong chance of PTC. I have even read a couple of studies suggesting that there is some link between melanoma and PTC.

My mother was also diagnosed with PTC a few years ago and I'm not scared to go down this road because I'm certain it will be much less difficult as the melanoma dx , prognosis, and treatment. I just want to know so that I can make adjustments and move on.


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## joplin1975 (Jul 21, 2011)

There are certainly suspicious characteristics.

Are you scheduled for a FNA?


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