# Thyroid Nodule Growth



## macklulu

Hi all,

I had an ultrasound done in July of 2010 which showed no nodules. I had another ultrasound done in November of 2001 which showed a thyroid nodule with a size of 7mm x 5mm x 6mm. My family doctor asked me to go back for another ultrasound this month because she felt lymph nodes on my neck. During the ultrasound, the lymph nodes looked benign (about 1 to 1.8cm), but the thyroid nodule was now measured at 11mm x 7mm x 7mm. Is this change is size over a couple months enough to warrant a FNA?

Thanks a lot for the help.


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## Andros

macklulu said:


> Hi all,
> 
> I had an ultrasound done in July of 2010 which showed no nodules. I had another ultrasound done in November of 2001 which showed a thyroid nodule with a size of 7mm x 5mm x 6mm. My family doctor asked me to go back for another ultrasound this month because she felt lymph nodes on my neck. During the ultrasound, the lymph nodes looked benign (about 1 to 1.8cm), but the thyroid nodule was now measured at 11mm x 7mm x 7mm. Is this change is size over a couple months enough to warrant a FNA?
> 
> Thanks a lot for the help.


Oh, boy! YES!!! What are they waiting for? Lymph node involvement suggests papillary cancer!

http://www.endocrineweb.com/conditions/thyroid-cancer/papillary-cancer

Thyroid cancer symptoms
http://www.cityofhope.org/patient_care/treatments/thyroid-cancer/Pages/symptoms.aspx

In addition, I do recommend further testing of antibodies.............(has anyone run antibodies?)

TSI (thyroid stimulating immunoglobulin),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/

Are you symptomatic? Are you male or female?

Welcome to the board and I hope we can help you and be supportive as well as informational on your behalf.


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## macklulu

Thank you Andros.

Before I answer your questions, let me correct myself. I was going by the radiologist worksheet with my previous measurements, but on the final report apparently the radiologist rounded the 10.8mm and 6.8mm sizes down. The actual size on the report says 6mm x 6mm x 10mm. I have typed the Ultrasound report of the thyroid below. As for the lymph nodes, the largest is 1.8cm x 0.5cm and appears benign, so they are not worried about that. What confuses me is the "very subtle" part. I'm assuming that is a good thing, but I don't really know what it means. Any inside would be appreciated 

Now on to your questions.

1. I have had the following blood tests ran last year. My endocrinologist said they look perfect.

TPO - NEGATIVE **I did get the report, no numbers given**
Thyroglobulin Ab - NEGATIVE **I did get the report, no numbers given**
ANA - NEGATIVE **I did get the report, no numbers given**
TSH - 1.41 (range .30 - 5.0)
Free T4 - 18 (range 12 - 24)
Free T3 - 5.2 (range 2.8 - 5.5)
TSI/TBII - Endocrinologist said they were not needed, he would not run them.

2. I read the list of cancer symptoms and no I don't have those. All I notice is my throat feels a bit "full" in my thyroid area, but my Endo says that is not possible because 1cm is not big enough and very common.

3. I am male and am 25 years old.

Thanks for the info and let me know what you think of my US report 

Feb 16 - Ultrasound Report
---------------------------
The left lobe of the thyroid is 4.6cm x 1.4cm x 1.1cm and the right lobe is 4.3cm x 1.5cm x 1.4cm in size. The isthmus is 2mm in thickness. There is a very subtle slightly hypoechoic ill defined solid nodule in the upper pole of the right lobe posteriorly measuring 6mm x 6mm x 10mm. Compared to the previous Ultrasound in November, the nodule has increased in size by 3mm in the largest dimension.

Suggestion: 6 month follow-up ultrasound


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## Andros

macklulu said:


> Thank you Andros.
> 
> Before I answer your questions, let me correct myself. I was going by the radiologist worksheet with my previous measurements, but on the final report apparently the radiologist rounded the 10.8mm and 6.8mm sizes down. The actual size on the report says 6mm x 6mm x 10mm. I have typed the Ultrasound report of the thyroid below. As for the lymph nodes, the largest is 1.8cm x 0.5cm and appears benign, so they are not worried about that. What confuses me is the "very subtle" part. I'm assuming that is a good thing, but I don't really know what it means. Any inside would be appreciated
> 
> Now on to your questions.
> 
> 1. I have had the following blood tests ran last year. My endocrinologist said they look perfect.
> 
> TPO - NEGATIVE **I did get the report, no numbers given**
> Thyroglobulin Ab - NEGATIVE **I did get the report, no numbers given**
> ANA - NEGATIVE **I did get the report, no numbers given**
> TSH - 1.41 (range .30 - 5.0)
> Free T4 - 18 (range 12 - 24)
> Free T3 - 5.2 (range 2.8 - 5.5)
> TSI/TBII - Endocrinologist said they were not needed, he would not run them.
> 
> 2. I read the list of cancer symptoms and no I don't have those. All I notice is my throat feels a bit "full" in my thyroid area, but my Endo says that is not possible because 1cm is not big enough and very common.
> 
> 3. I am male and am 25 years old.
> 
> Thanks for the info and let me know what you think of my US report
> 
> Feb 16 - Ultrasound Report
> ---------------------------
> The left lobe of the thyroid is 4.6cm x 1.4cm x 1.1cm and the right lobe is 4.3cm x 1.5cm x 1.4cm in size. The isthmus is 2mm in thickness. There is a very subtle slightly hypoechoic ill defined solid nodule in the upper pole of the right lobe posteriorly measuring 6mm x 6mm x 10mm. Compared to the previous Ultrasound in November, the nodule has increased in size by 3mm in the largest dimension.
> 
> Suggestion: 6 month follow-up ultrasound


Hoh, boy!! Sure wish you could get copies of those antibodies' tests. They always say negative if they are within the range and some of those antibodies just plain should not be there at all. The range is only to detect movement either up or down once a "baseline" is established.

That is a shame about the TSI for this definitely has to be ruled in or out. The thyroid panels are often skewed by binding, blocking and stimulating antibodies. On paper, it can appear that you are not hyper but in fact the patient really is. Symptoms also cross over. Nothing is carved in stone.

That is a huge increase of that nodule. It really is! And the lymph nodes may not worry your doctor but they sure worry me.

I know I drive a hard bargain here, but I do believe you need FNA and also, how can someone tell by merely looking at the lymph node that it is benign? Guessing? When it comes to your health? I don't buy it.

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

We are in your corner here and I hope we are helping. A lot of us have been fluffed off for years and years so please forgive me for pushing so hard but bear in mind, there is a good reason. YOU!!


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## macklulu

Hi Andros,

Thanks a lot for the support and information, you don't know how much I appreciate it 

I spoke to my endo today and he is sending me for another U/S at his hospital on Thursday. He basically said he doesn't believe the results from any lab but his own. Seems like a waste of time to me, but if the results are the same, hopefully he'll schedule me for an FNA.

In the U/S report, it said the nodule was "very subtle". In this I take they mean it was hard to find. Do you have any experience with this. Does this mean it is a good thing if it is subtle, does that mean they could be wrong and it is not a nodule?

Thanks again!


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## Andros

macklulu said:


> Hi Andros,
> 
> Thanks a lot for the support and information, you don't know how much I appreciate it
> 
> I spoke to my endo today and he is sending me for another U/S at his hospital on Thursday. He basically said he doesn't believe the results from any lab but his own. Seems like a waste of time to me, but if the results are the same, hopefully he'll schedule me for an FNA.
> 
> In the U/S report, it said the nodule was "very subtle". In this I take they mean it was hard to find. Do you have any experience with this. Does this mean it is a good thing if it is subtle, does that mean they could be wrong and it is not a nodule?
> 
> Thanks again!


Ultrasound is very limited. It's too bad your doctor won't order RAIU (radioactive uptake scan.) That has been my experience and observation over the years.

Subtle means not immediately obvious or comprehensible. I do believe RAIU would better benefit you.

copy and paste
What are the limitations of an Ultrasound of the Thyroid?If a lump is detected on ultrasound within the thyroid gland, it is common that the radiologist cannot distinguish between benign and malignant lumps with complete certainty. A fine needle biopsy and review of tissue under a microscope is often necessary, while in some cases surveillance and a repeat sonogram after a few months looking for stability may suffice.

It is not possible to determine thyroid function-that is, whether the thyroid gland is underactive, overactive, or normal-with ultrasound. For that determination, your doctor may order a blood test or a radioactive iodine uptake test.

http://www.radiologyinfo.org/en/info.cfm?pg=us-thyroid

Hope this helps you. Knowledge is power!


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## macklulu

I agree, I would like an uptake done. I asked a couple times, but with no luck.

I am frustrated today.

I just got back from my doctors hospital where I had my confirmation U/S for the 1cm nodule. The tech had to go call the lab radiologist where I had the 1st one because she could not see it. Then when I left she said sometimes our opinions of masses differ.

I am just annoyed. This hospital is the original one to find this nodule when it was very tiny. Then this new lab says it is there, but larger. Now the hospital says they don't see it.

Anyways, I just needed to vent.

Thanks.


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## Andros

macklulu said:


> I agree, I would like an uptake done. I asked a couple times, but with no luck.
> 
> I am frustrated today.
> 
> I just got back from my doctors hospital where I had my confirmation U/S for the 1cm nodule. The tech had to go call the lab radiologist where I had the 1st one because she could not see it. Then when I left she said sometimes our opinions of masses differ.
> 
> I am just annoyed. This hospital is the original one to find this nodule when it was very tiny. Then this new lab says it is there, but larger. Now the hospital says they don't see it.
> 
> Anyways, I just needed to vent.
> 
> Thanks.


Not good and I would like to vent w/you. Why are they turning you down on doing RAIU? Is this an insurance problem?


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## nikimcn

I would think the doc would have already biopsied the nodules? weird they did not.
I had a multinodular thyroid and had my scan thxgiv time 2010 last year. I also then had a FNA~neg for cancer. I'm having a repeat ultrasound and lab check in April. Doc says if the thyroid 'gets bigger' in any sense he recomends taking the thyroid OUT. So I guess growth in any form is NOT GOOD. He's a pretty good doc. I've been feeling 'weird' lately, so I asked if I could do my labs early and he said OK but to still keep my Apr 6 appt. Labs will be back in a week and I'll know more. I'm on NO meds for my thyroid. I have Hashi's and am NOT hypo (yet). Doc says he suspects by April I'll have to be on meds for my hypo. Just really high antibodies. 
Hope you get in quickly~:hugs:


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## macklulu

I got a copy of the ultrasound, I am so confused. Four days after they confirmed my nodule grew, the hospital is saying they do not see it. Here is the report:

Thyroid ultrasound.

Gland is normal in size and echogenicity. No focal nodule. Slightly prominent 
lymph nodes within the neck measuring up to 22 x 21 x 9 mm in the right 
submandibular region and 23 x 15 by 0.8 on the left. Lymph nodes are 
increased from prior outside report of November 2010.

IMPRESSION:

No evidence for suspicious thyroid nodule.

Slightly prominent nodes within the neck mildly increased from prior. Unclear 
if these are reactive. Follow-up is recommended. 

My lymph nodes were 1.8 x 0.7 in the right side and 1.6 x 0.6 in the left side in November. How is this just a slight enlargement?? Anyways, I bet my doctor will not care about the 2 x 2 lymph nodes, she never seems to show much concern lol I wish the report would of said do they have hilum or not. Must look normal or they would of said I need a biopsy. Anyways, just needed to talk to somebody about it. THanks!!


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## Andros

macklulu said:


> I got a copy of the ultrasound, I am so confused. Four days after they confirmed my nodule grew, the hospital is saying they do not see it. Here is the report:
> 
> Thyroid ultrasound.
> 
> Gland is normal in size and echogenicity. No focal nodule. Slightly prominent
> lymph nodes within the neck measuring up to 22 x 21 x 9 mm in the right
> submandibular region and 23 x 15 by 0.8 on the left. Lymph nodes are
> increased from prior outside report of November 2010.
> 
> IMPRESSION:
> 
> No evidence for suspicious thyroid nodule.
> 
> Slightly prominent nodes within the neck mildly increased from prior. Unclear
> if these are reactive. Follow-up is recommended.
> 
> My lymph nodes were 1.8 x 0.7 in the right side and 1.6 x 0.6 in the left side in November. How is this just a slight enlargement?? Anyways, I bet my doctor will not care about the 2 x 2 lymph nodes, she never seems to show much concern lol I wish the report would of said do they have hilum or not. Must look normal or they would of said I need a biopsy. Anyways, just needed to talk to somebody about it. THanks!!


This is why ultrasound has it's limitations. They do not pick up everything and in a big part, that is due to the experience or inexperience of the operator.

Listen to me. Lymph nodes are not good. You need RAIU. Truly!! If your doc does not care about you, please find one that does!

The above could save your life! I am extremely worried for you.


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## macklulu

Thanks for the response Andros, it's funny how people you just met can care so much, but your doctor can care so little 

I just spoke to my Endo's office, apparently he signed off my U/S as OK and is not addressing the lymph nodes. I asked about an uptake scan and they told me he doesn't feel any tests are needed and will see me in October of this year.

I am going to go back to my family doctor and see what she thinks. It looks like I'm in store for some work to get to the bottom of this.

I know it is likely nothing and 2cm x 2xm x 0.9cm is not that big in the submandibular area, but I would think a doctor would check it out. I just wish the radiologist gave more detail on the nodes instead of just saying unclear if reactive, not sure what that really says.

Anyways, thanks for caring Andros!!!


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## Andros

macklulu said:


> Thanks for the response Andros, it's funny how people you just met can care so much, but your doctor can care so little
> 
> I just spoke to my Endo's office, apparently he signed off my U/S as OK and is not addressing the lymph nodes. I asked about an uptake scan and they told me he doesn't feel any tests are needed and will see me in October of this year.
> 
> I am going to go back to my family doctor and see what she thinks. It looks like I'm in store for some work to get to the bottom of this.
> 
> I know it is likely nothing and 2cm x 2xm x 0.9cm is not that big in the submandibular area, but I would think a doctor would check it out. I just wish the radiologist gave more detail on the nodes instead of just saying unclear if reactive, not sure what that really says.
> 
> Anyways, thanks for caring Andros!!!


You are welcome. Caring comes free!! And I really do care. So do others on this board.

Swollen lymphs could be a sign of papillary cancer. Please read this...........

http://www.cumc.columbia.edu/dept/thyroid/papillary.html


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## macklulu

Thanks for the info!

The only thing is, it doesn't look like it is a thyroid issue. The last ultrasound said 1.1cm hypoechoic solid ill-defined area is very subtle. Maybe it was just a fluke. The hospital took lots of time looking at it and still found nothing. I have had 4-5 U/S's in the past 1.5 years which have all showed nodules and this is the first to say nothing...seems odd...but they spent 30 minutes looking at my thyroid and I just think they would of seen it. Now I'm starting to even believe them...I have to snap out of it haha  Either way the nodes are there and are large, so I'm still going to push!

thanks


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## Andros

macklulu said:


> Thanks for the info!
> 
> The only thing is, it doesn't look like it is a thyroid issue. The last ultrasound said 1.1cm hypoechoic solid ill-defined area is very subtle. Maybe it was just a fluke. The hospital took lots of time looking at it and still found nothing. I have had 4-5 U/S's in the past 1.5 years which have all showed nodules and this is the first to say nothing...seems odd...but they spent 30 minutes looking at my thyroid and I just think they would of seen it. Now I'm starting to even believe them...I have to snap out of it haha  Either way the nodes are there and are large, so I'm still going to push!
> 
> thanks


Please let me know how the pushing goes! You may have to start "screaming" cancer. You know? "If I have cancer and it goes undiagnosed, someone is going to pay!" Stuff like that.

You are in my thoughts and prayers.


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## nikimcn

macklulu said:


> I got a copy of the ultrasound, I am so confused. Four days after they confirmed my nodule grew, the hospital is saying they do not see it. Here is the report:
> 
> Thyroid ultrasound.
> 
> Gland is normal in size and echogenicity. No focal nodule. Slightly prominent
> lymph nodes within the neck measuring up to 22 x 21 x 9 mm in the right
> submandibular region and 23 x 15 by 0.8 on the left. Lymph nodes are
> increased from prior outside report of November 2010.
> 
> IMPRESSION:
> 
> No evidence for suspicious thyroid nodule.
> 
> Slightly prominent nodes within the neck mildly increased from prior. Unclear
> if these are reactive. Follow-up is recommended.
> 
> My lymph nodes were 1.8 x 0.7 in the right side and 1.6 x 0.6 in the left side in November. How is this just a slight enlargement?? Anyways, I bet my doctor will not care about the 2 x 2 lymph nodes, she never seems to show much concern lol I wish the report would of said do they have hilum or not. Must look normal or they would of said I need a biopsy. Anyways, just needed to talk to somebody about it. THanks!!


personally, i would try to find another doctor that cares about your health and works with you. that is what i'm doing~my general doc now is horrible. I'm switching, and have to wait til Apr 6 for a first appt, but I'm going to wait, and see. I need doctors who care! this is all so frustrating. :hugs:


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## macklulu

nikimcn...thanks for the tip, I agree.

I'm sorry to hear you had the same experience. I hope your appointment goes well in April, what is your medical situation if you don't mind me asking.

Thanks!


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## Andros

nikimcn said:


> personally, i would try to find another doctor that cares about your health and works with you. that is what i'm doing~my general doc now is horrible. I'm switching, and have to wait til Apr 6 for a first appt, but I'm going to wait, and see. I need doctors who care! this is all so frustrating. :hugs:


It sure is and I can identify! It took 20 years for me to get a diagnosis and medical intervention and that was only because I had a thyroid storm and almost died.

You would not believe how the doctors treated me all those years! I will "never" forget............................ever!


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