# Thyroid nodule/goiter



## littlemars2001 (Aug 28, 2012)

Hi Everyone,

It has been a while since I posted the my thyroid saga continues. I have a multinodular goiter and my ultrasound report from about 18 months ago showed the Isthmus is 3mm thickness. Left Lobe is enlarged measuring 56X18X23mm (12.1 gram left lob). Mid pole nodule containing calcification measuring 31x10x20mm in diameter and has internal Doppler flow signal. Upper pole nodule (anechoic) 3mm in diameter and my right lob is enlarged with a small nodule on it too. I had an FNA of the dominant nodule which was negative for cancer. I started to have discomfort in the neck and had another ultrasound which did not show any significant changes about 7 months ago (the radiologist said he would biopsy again but that it was not really necessary). Now, I'm having difficulty getting food down my throat when I eat and it seems like I can only get all the food down all the way is when I wash it down with a drink. I'm going again for an ultrasound and possibly biopsy and my doctor is checking my blood work again (all blood work was normal about 18 months ago). He is also referring me to a surgeon and said that my thyroid could very well be causing the swallowing problems.

Should I request another biopsy even if the nodule/thyroid size has not changed much? The first biopsy produced a lot of blood mostly but they obviously had enough of a sample to say that there were no cancer cells seen. I just don't understand why I'm having such problems swallowing now. However, I don't want to have my thyroid removed unless the swallowing issues become unbearable or it turns out I have cancer.

Any advice would be welcomed at this point. Thank you.


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## ChrisP (Oct 29, 2013)

Hi mars; welcome.

It's an internal growing process in my opinion. Everyone has a different story, a different side effect, a different tale. Unfortunately, it will not go away on it's own, and chances are your difficulty in swallowing will eventually get worse. This is due to the fact that one of your nods are in your mid-pole of the THY. You could ask for another FNAB under ultrasound guidance to scoop out that area with calcification. You'd be surprised that a lot of the time the results of an FNAB are in-accurate because they take a sample from an area that doesn't contain any suspicious abnormality. Again, I would ask for another FNAB with ultrasound guidance.

Linking back to the beginning here, I would save the stress and relieve yourself with surgery if you're up for it, but that's just me; you'll have to decide with that on your own! We're here for you throughout the process and I hope you keep us posted. xx


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## littlemars2001 (Aug 28, 2012)

Thanks for the advice. I'm going to bring up your suggestion on the FNAB under ultrasound guidance to the radiologist I'm seeing. He is really great and would probably be willing to do it since he owns the practice. Deep down, I feel like I will have the surgery at some point....I'm just not ready yet.


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## Octavia (Aug 1, 2011)

If your nodule is growing "backwards" into your neck (as opposed to one like mine, which was protruding from the front of my neck), the ultrasound may not be getting an accurate picture, but it's worth a try to do another ultrasound and ultrasound-guided FNA so you could have a more informed discussion with your doctor about the possibility of (or need for) surgery.


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## Swimmer (Sep 12, 2013)

If you are unable to swallow well, then you won't want to drink very much water, and if you don't get enough water, you can become dehydrated which can shut down the kidneys, introduce all sorts of immediate problems - even death. If you were to get a sore throat/cold while you are already having trouble swallowing... You could possibly get into trouble... I want to encourage you that you write on your sheet when you go into the doc -- "DIFFICULT TO SWALLOW now for ______ DAYS" I'm so glad you are on your way to getting more help -- and after you see one surgeon, be sure and get a second opinion. Somebody on here said to make sure you get someone who does a few a week (something like that.)


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## littlemars2001 (Aug 28, 2012)

Octavia, you are correct about the way the nodule could be growing. I was told that it was growing inward and that is why my PCP never really picked up on it (originally it was found incidentally on a different test). I go for the ultrasound and biopsy this Wednesday so we will see what happens.

Swimmer, thanks for the advice as well. The surgeon my Endo was going to refer me to has performed roughly 9000 surgeries so I'm hoping this will be a good one but I know someone else who had her thyroid removed due to cancer so I may check out her surgeon for a second opinion if it looks like it has to be removed. Is there a point when a doctor will tell you it has to come out, even if it is not cancerous or causing low/high TSH levels? My Endo told me it is big enough to justify removal but it almost seemed like it would be up to me to decide--which I thought was a bit weird.


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## jade (Aug 6, 2013)

littlemars2001 said:


> Octavia, you are correct about the way the nodule could be growing. I was told that it was growing inward and that is why my PCP never really picked up on it (originally it was found incidentally on a different test). I go for the ultrasound and biopsy this Wednesday so we will see what happens.
> 
> Swimmer, thanks for the advice as well. The surgeon my Endo was going to refer me to has performed roughly 9000 surgeries so I'm hoping this will be a good one but I know someone else who had her thyroid removed due to cancer so I may check out her surgeon for a second opinion if it looks like it has to be removed. Is there a point when a doctor will tell you it has to come out, even if it is not cancerous or causing low/high TSH levels? My Endo told me it is big enough to justify removal but it almost seemed like it would be up to me to decide--which I thought was a bit weird.


If it's causing compression symptoms or the swallowing issues get worse, they might recommend surgery even if it's not cancer or causing TSH problems. Even if they recommend surgery, most doctors will leave it up to you to decide.


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## jenny v (May 6, 2012)

littlemars, I recently had my thyroid removed due to compression issues similar to yours. I had one semi-suspicious nodule that wasn't big enough to biopsy, but I was having more and more trouble swallowing in recent months. Couple that with labs that wouldn't stay stable and out it came! Come to find out, my right lobe was swelling backwards into my throat causing a kink in my esophagus, hence the swallowing issues. Funnily enough, the ultrasounds never picked up on it. I didn't have cancer (yay!), but my surgeon said it took him some work to get my thyroid out due to the years of damage and inflammation and the fact that the right side was growing backwards.

Talk to your doctor, weigh your options and go with what's most comfortable for you. But unfortunately once it gets to the stage where your swallowing is an issue, it usually doesn't just go away. It was actually more work for my surgeon to remove it now than it might have been even a few months earlier when I first felt the compression issues.


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## ChrisP (Oct 29, 2013)

I agree with Jade and Jenny,

My nodule also is growing internally/backwards and it does take a huge toll on compression. In fact, you can't even see it that well because the usual nodule grows outwards and protrudes out of the neck, whereas an inward nodule is the opposite, and instead of being palpable or visual to the naked eye, it rather compresses on your esophagus or trachea - which leads to the dysphagia you are experiencing. Like stated before, once you've met that surgeon, he will most likely recommend for you to remove it, but like jenny said, do what's comfortable for you. Thyroids are weird, they can grow upwards, inwards, outwards, downwards and even grow seperately from the gland itself. <_< x


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## littlemars2001 (Aug 28, 2012)

Thanks again to everyone for sharing your experiences.

Jenny, did you have any tests, like a barium swallow to assess the compression on your esophagus? My Endo said he could refer me to GI and they would probably order a barium swallow and/or endoscopy to see if my ability to swallow correctly is impaired. I guess my thought was that if I'm not too impaired by the goiter/nodules I would try to stick it out for as long as I can and avoid surgery. At the same time, I don't want to waste time and money on GI tests when I pretty much know what is causing me problems. My appt. tomorrow should help give me more insight and of course talking to a surgeon will do the same.


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## jenny v (May 6, 2012)

I didn't have any tests on my compressions issues except for one ENT looking at the upper part of my throat and saying it looked like I had acid reflux. Funnily enough, the left side of my thyroid was swelling outwards and making my neck look "puffy" (which the ultrasound showed), but it was the right side of my thyroid swelling backwards that caused the compression issues. My surgeon and I were sure that it was the left side causing the swallowing issues since that showed up in the ultrasound but it wasn't until I was open on the table that he realized it was the right side swelling backwards (that the ultrasound didn't pick up on) that caused it. And the left side swelling in general didn't help matters any.

I never had any problems with breathing, just with swallowing food (I would randomly choke on things) and feeling pressure in my neck. And after 10 years of dealing with Hashimoto's disease, I was ready for it to come out, so we didn't do a ton of tests before surgery.


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## joplin1975 (Jul 21, 2011)

Just wanted to pop in and say when I had my initial ultrasound, there was a comment (the wording of which I cannot remember) from the radiologist that said something about possible compression issues. I was under the impression it could be "seen" via simple u/s. That all said, I'm not sure I'd agree to lots of tests when it seens relatively straight forward what the issue is....


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