# Sudden painful and swollen nodule - UPDATE



## grenalynn (Mar 27, 2013)

Last night the left side of my thyroid started to become slightly sore. Now this morning is slightly more painful to touch, even when I turn my head. the area also seems a bit swollen. What could cause this? Nothing else in my neck hurts. I had a cold a few days ago, but it's cleared out. I'm not really finding any info online. Any idea on an onset of pain?


----------



## joplin1975 (Jul 21, 2011)

Probably a flare up of antibodies...have you ever had tested?


----------



## grenalynn (Mar 27, 2013)

Tested as in a biopsy? Yes, I had one in April. Inconclusive after 11 passes.


----------



## grenalynn (Mar 27, 2013)

What is a flare up? I also read about hemorrhages? If it's still painful/swollen come Monday I think I may see the ENT this coming week.


----------



## Andros (Aug 26, 2009)

grenalynn said:


> Last night the left side of my thyroid started to become slightly sore. Now this morning is slightly more painful to touch, even when I turn my head. the area also seems a bit swollen. What could cause this? Nothing else in my neck hurts. I had a cold a few days ago, but it's cleared out. I'm not really finding any info online. Any idea on an onset of pain?





grenalynn said:


> Tested as in a biopsy? Yes, I had one in April. Inconclusive after 11 passes.


If you have had inconclusive FNA results, that is a red flag. It would be most wise to consider seeing an ENT about this situation.

Pain is also a warning sign.

What are your Thyroglobulin and Thyroglobulin Ab results?


----------



## grenalynn (Mar 27, 2013)

I had lab work done back in March. All was normal, but I'm not sure what Thyroglobulin and Thyroglobulin Ab are? I can try and find my lab results to see if that was included. I recently saw an ENT who is doing a left parotidectomy early Jan who said I should have a left thyroidectomy soon after, due to size (3 cm). He has seen the U/S images and is just waiting for the path report from my April thyroid biopsy. It has never hurt until now. I don't understand?


----------



## grenalynn (Mar 27, 2013)

I just found my lab work from back in March and they did not run labs for Tg or TgAb.


----------



## Andros (Aug 26, 2009)

grenalynn said:


> I just found my lab work from back in March and they did not run labs for Tg or TgAb.


Here is some information on the Thyroglobulins.

TPO and thyroglobulin
http://onlinelibrary.wiley.com/doi/10.1111/j.1699-0463.1994.tb04888.x/abstract
http://www.wikigenes.org/e/gene/e/7173.html

Understanding Thyroglobulin Ab.
http://www.labtestsonline.org/understanding/analytes/thyroglobulin/test.html

Thyroglobulin Ab and cancer
http://qjmed.oxfordjournals.org/content/59/2/429.full.pdf

Glad to hear that you have an ENT on board.


----------



## ChrisP (Oct 29, 2013)

I agree, pain is not a good sign. I would get another FNAB done, esp. since it came back inconclusive.


----------



## grenalynn (Mar 27, 2013)

Thank you! So should I just call and have the ENT order a test for those lab readings? I'm worried, I have no idea why it could be hurting so suddenly?


----------



## Endocrine_Surgeon (Oct 31, 2013)

I can understand why you would be scared by the sudden pain. But this isn't something to panic about. The most common cause of sudden pain in a nodule or cyst is hemorrhage. That is, some bleeding occurred into the nodule. This does not mean that it is cancer - this occurs in both malignant and benign nodules. It hurts because the bleeding suddenly stretches the surrounding thyroid.

From what you've said here, I wouldn't think that you need to have a thyroglobulin level checked at this time. It won't provide much information. We follow thyroglobulin and thyroglobulin antibody levels with people who have had thyroid cancer and have had a total thyroidectomy. It's not so important to have it checked now.

You do need to see a surgeon about this, though. I would call the ENT's office and let them know what happened, and ask when they can see you, if you don't already have an appointment. I would try to see him in the next few weeks.


----------



## grenalynn (Mar 27, 2013)

Thank you so much for you reply! I will be calling my ENT in the morning. I should see him this week. I hope that it is just a hemorrhage and nothing major. If it is that, I read there's not treatment necessary and the body will just absorb it, correct?


----------



## grenalynn (Mar 27, 2013)

Also, Endocrine_Surgeon, my ENT highly recommended that I have my left side (the side giving me problems now) removed due to a 3cm nodule there. I have normal labs as of this past March. I also have many nodules, in both the left and right side. Is 3cm a reason to remove? I'm worried that I will just be causing more harm than good.


----------



## ChrisP (Oct 29, 2013)

grenalynn said:


> Also, Endocrine_Surgeon, my ENT highly recommended that I have my left side (the side giving me problems now) removed due to a 3cm nodule there. I have normal labs as of this past March. I also have many nodules, in both the left and right side. Is 3cm a reason to remove? I'm worried that I will just be causing more harm than good.


3cm is quite large, your ENT sounds about right. Seems like he's skipping the past biopsy you've had that came back inconclusive and going straight to surgery. If you're up for it, I would do it, if not; I recommend you get another biopsy first and wait it off a bit. Up to you!


----------



## grenalynn (Mar 27, 2013)

Thank you, ChrisP!


----------



## Endocrine_Surgeon (Oct 31, 2013)

grenalynn, about the operation: the answer is that it depends. My practice is to recommend an operation for nodules greater than 4cm. 3cm is large, but we see 3cm benign nodules all the time. In your case, if the nodule is now causing problems and we have an inconclusive biopsy, I would probably recommend surgery. (The type of "inconclusive" also matters - was it an insufficient sample or was it something like "atypia of undetermined significance"?) If you have nodules on both sides, I would consider doing a total thyroidectomy if any of those nodules on the right side were suspicious - like over 1cm, with microcalcifications, etc. But again, as a surgeon I would want to review everything before saying for sure what operation you need.

Your ENT should be able to review everything and help you decide what is best.


----------



## grenalynn (Mar 27, 2013)

My path report stated: (There were 11 passes done here)

*Specimen A, Thyroid, Left, FNA
Microscopic Diagnosis:
Diagnostic Category: OTHER
Final Diagnosis: Cyst fluid only. See Comment.
Adequacy: Less than optimal due to lack of satisfactory follicular epithelium. The cell block contains hemosiderin laden macrophages with no evidence of malignancy.
Immediate Evaluation for Adequacy: Insufficient for adequate interpretation.

Gross Decription: Recieved is 30 cc of red fluid... (blah, blah)

Comments:
The specimen consists almost exclusively of histiocytes and red blood cells. While technically it is insufficient, in the proper clinical and radiographic setting these findings are consistent with a benign cyst. Correlation with radiographic findings (complexity, size, etc.) are suggested for guidance in further clinical management.*

My recent ultrasound stated:

*RIGHT LOBE*

*0.8 x 0.4 x 0.6 cm hypoechoic solid (upper)*

*0.2 cm complex (mid)*

*0.2 cm (lower, new since March)*

*LEFT LOBE*

*0.4 x 0.2 x 0.4 cm hypoechoic (upper)*

*3.0 x 2.2 x 1.9 complex (lower)*


----------



## ChrisP (Oct 29, 2013)

grenalynn said:


> My path report stated: (There were 11 passes done here)
> 
> *Specimen A, Thyroid, Left, FNA
> Microscopic Diagnosis:
> ...


In my opinion, it seems as if the 'inconclusive' side of the diagnosis occurred because there seemed to be a lack of tissue sampling acquired during your biopsy. They extracted tissue from your large nodule (The 3cm complex one), and looks as if they only acquired the cystic components of it. I really recommend for you to get it done again under ultrasound guidance so they can get a more concerning area of the nodule (It looks like they missed!). It also states: "correlation with radiographic findings (complexity, size, etc.) are suggested for guidance in further clinical management.", meaning; they suggest another FNAB to be done under guidance to extract the area with the most concern.

My nodule was complex like yours about a year ago, and now it's completely solid, which is part of the reason why you should definitely get that biopsy done again soon.

Talk to your ENT about it when you get to see him/her. xx


----------



## grenalynn (Mar 27, 2013)

It was ultrasound guided. I'm unsure why with so many passes it was inconclusive.


----------



## Andros (Aug 26, 2009)

grenalynn said:


> Thank you! So should I just call and have the ENT order a test for those lab readings? I'm worried, I have no idea why it could be hurting so suddenly?


I sure would and definitely mention the pain as well. Keeping you in my thoughts and please do keep us in the loop re all of this.

We want you to be well and we know you want that for yourself as well.


----------



## brejim (Jun 7, 2013)

I am having a Total Thyroidectomy December 9th due to nodules. 2 FNA have been non-diagnostic (complex cyst). Has been drained twice and has come back bigger each time. I also am experiencing a good deal of pressure and pain. I am multiple nodules on each lobe. The pain is concerning to me. I'm nervous about surgery but I can barely sleep because when I lay down I feel like I'm choking. Good Luck and I hope you get answers soon.


----------



## Endocrine_Surgeon (Oct 31, 2013)

grenalynn, it was inconclusive because they only got cyst fluid. There may not be a lot of "solid" component in there. In the comments (where you often get the best impression of what the pathologist thinks is going on), they say that it is likely a benign cyst. So it may just be a benign cyst, but could also have a solid component that was not biopsied - which is why it was inconclusive.

Your other nodules are small, <1cm, and if they don't have other suspicious findings (these aren't mentioned in the report), you can probably just watch them.


----------



## grenalynn (Mar 27, 2013)

Thank y'all very much! I will be making an appointment with my ENT this morning to check out this new pain and swelling.


----------



## Andros (Aug 26, 2009)

grenalynn said:


> Thank y'all very much! I will be making an appointment with my ENT this morning to check out this new pain and swelling.


I am very relieved to hear that you are staying on top of this and I hope the ENT does the same. Please let us know.


----------



## grenalynn (Mar 27, 2013)

So, I was diagnosed with "Subacute Thyroiditis". He ordered labs for T4, T3, TSH, Thyroglobulin & Antithyroid Antibodies. He requested to receive results too but is referring me to an Endocrinologist with suspected Hashimoto's (thyroiditis)? I am supposed to be having a left partial thyroidectomy next year at some point due to nodule size, so why would I need to see an Endo for something I'm having removed anyway?


----------



## Andros (Aug 26, 2009)

grenalynn said:


> So, I was diagnosed with "Subacute Thyroiditis". He ordered labs for T4, T3, TSH, Thyroglobulin & Antithyroid Antibodies. He requested to receive results too but is referring me to an Endocrinologist with suspected Hashimoto's (thyroiditis)? I am supposed to be having a left partial thyroidectomy next year at some point due to nodule size, so why would I need to see an Endo for something I'm having removed anyway?


I do hope the doc ran Thyroglobulin and Thyroglobulin Ab. It might be smart just to wait and see what the results are of those "2" tests (sounds like he only ran one) and we can better advise you at that time.


----------



## grenalynn (Mar 27, 2013)

OK, thanks! So I'm looking for Thyroglobulin, Thyroglobulin Ab and Antithyroid antibodies? May be a silly question but could I just request to have the other that to be run as well? One line says "Thyroglobulin" and the next says "Antithyroid antibodies".


----------



## Andros (Aug 26, 2009)

grenalynn said:


> OK, thanks! So I'm looking for Thyroglobulin, Thyroglobulin Ab and Antithyroid antibodies? May be a silly question but could I just request to have the other that to be run as well? One line says "Thyroglobulin" and the next says "Antithyroid antibodies".


I am always one for being specific. The Antithyroid Antibodies could be any number of tests. If you have the lab sheet, maybe you could call the lab and ask them?


----------



## grenalynn (Mar 27, 2013)

I wasn't able to get in touch with the lab today, but I was able to find the test list online: https://www.labcorp.com/wps/portal/!ut/p/c1/hYzLCoJAFEC_KO511HFcapgZOr5ldCOSElZqDzGYr8_2RZzl4RyoYGVslv7UzP00NlcQUNE6ZpTHhBNkAdkhUamN-tZR0KWrL397xD81309DByVURp07Wqp4poqhmxL00gAJPaiFHiNkIFCr0zM-QskULp0lkUeZ-bk2-08jkGYY-dvLPWtF1BZJblv2pi079v2rhhonnFL2-ZY23AbxUhhab9N8SBQ!/dl2/d1/L0lDU0dLYVkhL0lCU0FDSXdrREFRcUpBd0lKb29HL1lBNDV5b1EhLzdfVUU0UzFJOTMwT0dTMjBJUzNPNE4yTjY2ODA!/

Maybe I could specify which I want?

Thanks so much for your help!


----------



## Andros (Aug 26, 2009)

grenalynn said:


> I wasn't able to get in touch with the lab today, but I was able to find the test list online: https://www.labcorp.com/wps/portal/!ut/p/c1/hYzLCoJAFEC_KO511HFcapgZOr5ldCOSElZqDzGYr8_2RZzl4RyoYGVslv7UzP00NlcQUNE6ZpTHhBNkAdkhUamN-tZR0KWrL397xD81309DByVURp07Wqp4poqhmxL00gAJPaiFHiNkIFCr0zM-QskULp0lkUeZ-bk2-08jkGYY-dvLPWtF1BZJblv2pi079v2rhhonnFL2-ZY23AbxUhhab9N8SBQ!/dl2/d1/L0lDU0dLYVkhL0lCU0FDSXdrREFRcUpBd0lKb29HL1lBNDV5b1EhLzdfVUU0UzFJOTMwT0dTMjBJUzNPNE4yTjY2ODA!/
> 
> Maybe I could specify which I want?
> 
> Thanks so much for your help!


The link would not work for me BUT...................you need to mark Thyroglobulin and Thyroglobulin Ab. If not on the list; call the lab and specify.

Tell them why; they should be happy to assist you!

How are things going today; feeling any more pain?


----------



## grenalynn (Mar 27, 2013)

I was prescribed 800 mg of Motrin 3x a day. I took 800 mg when I returned from my appointment Monday and the pain subsided. I didn't have to take any yesterday (2400 mg is a lot, and I am still breastfeeding, so I'm trying to minimize.) but I woke up hurting a bit this morning so I took another dose.

Adros, here is a screen shot of all the "thyro" tests available. I called and they were very unclear on what tests would be run.


----------

