# Help – I need your opinion



## Barton Bulldogs

Please - I need your opinion to help keep me in focus of realistic options.

Here is the situation:
•	50 year old male
•	Went to Endocrinologist for elevated hct hgb and rbc second to testosterone repayment. During the visit the endo discovered an enlarged thyroid gland
•	Without symptoms 
•	Went for TSH and free T4. Results are TSH 0.81 normal -and- Free T4 1.2 normal
•	Went for Ultrasound, Results are markedly enlarge thyroid gland left more than right
•	Ultrasound results part b: dominate nodule is the in the lower pole of left lobe measuring 3.6 x 1.6 cm contains calcification and does not seem to have significant vascularity.
•	Ultrasound result part c: dominate nodule in the lower pole of the right lobe measuring 1.5 x 1.3 cm - without calcifications - no significant vascularity however was identified.
•	Got these results today - waiting for my endo response - wife is a nurse with this endo

Help your thoughts:
•	What might be the next step-?
•	Is this a higher rate for cancer than other type of ultrasound findings-?
•	How bad is experience the Fine Needle Thyroid Biopsy-?
•	How bad is the experience of Thyroid surgery-?
Thank you for your input


----------



## Jaimee

I could be wrong, but I'm thinking a Fine Needle Aspiration (FNA) would definitely be in order. I had one and it was uncomfortable, but lots of people I know didn't think it was bad at all. There are definitely worse things. I'm not sure the answers to your others questions, but I bet some people here might.


----------



## lainey

Yes, an FNA will likely be in order based on the size of the nodules. An FNA uses a long needle to take cell samples. Usually they numb the area and there is mild discomfort from the needle and perhaps mild bruising afterward.

Keep in mind that 95% of thyroid nodules are benign. Cancer is less likely when there are multiple nodules. While there are certain characteristics of a nodule that make it more likely to be suspicious than others, you cannot tell the nature of a nodule from an ultrasound, a biopsy must be done.

They will likely take more than one sample from each nodule. Results from the FNA will either be positive, negative or indeterminate. Depending on those results you would either watch and wait or elect for surgery.

All surgery has its complications. Thyroid surgery usually requires an overnight hospital stay and a recovery period of several weeks. The patient must take thyroid hormone replacement medication for life afterward.


----------



## Andros

Barton Bulldogs said:


> Please - I need your opinion to help keep me in focus of realistic options.
> 
> Here is the situation:
> •	50 year old male
> •	Went to Endocrinologist for elevated hct hgb and rbc second to testosterone repayment. During the visit the endo discovered an enlarged thyroid gland
> •	Without symptoms
> •	Went for TSH and free T4. Results are TSH 0.81 normal -and- Free T4 1.2 normal
> •	Went for Ultrasound, Results are markedly enlarge thyroid gland left more than right
> •	Ultrasound results part b: dominate nodule is the in the lower pole of left lobe measuring 3.6 x 1.6 cm contains calcification and does not seem to have significant vascularity.
> •	Ultrasound result part c: dominate nodule in the lower pole of the right lobe measuring 1.5 x 1.3 cm - without calcifications - no significant vascularity however was identified.
> •	Got these results today - waiting for my endo response - wife is a nurse with this endo
> 
> Help your thoughts:
> •	What might be the next step-?
> •	Is this a higher rate for cancer than other type of ultrasound findings-?
> •	How bad is experience the Fine Needle Thyroid Biopsy-?
> •	How bad is the experience of Thyroid surgery-?
> Thank you for your input


Hi and welcome to the board!!

The low testosterone is a symptom. There are some studies out there on this.

Calcification is "suggestive" of cancer so an FNA is definitely in order. I prefer RAIU to sonograms myself but if you get the FNA, that will be a good thing.

Men are more prone to cancer of the thyroid; unfortunately.

In the future your lab ranges would be so appreciated as different labs use different ranges. I could not tell where your FREE T4 was at and that would be important and I wonder why the doc did not run FREE T3 which is your active hormone?

Did the doctor do any antibodies' tests?

I can't comment on FNA or thyroidectomy as I have not had either one. Others will be along for that.

Here is some info.

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

Here are some recommended tests.

TSI
Normally, there is no TSI in the blood. If TSI is found in the blood, this indicates that the thyroid stimulating immunoglobulin is the cause of the of a person's hyperthyroidism. 
http://www.medicineonline.com/topics/t/2/Thyroid-Stimulating-Immunoglobulin/TSI.html

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.

I am sure your wife knows all this stuff though but I posted it anyway.

Sorry this is happening to you but glad you came here for info and support.


----------



## SnoodMama

Hi, I just had a FNA biopsy and it wasn't bad at all. It was pretty much like having another ultrasound. They look around with the ultrasound first and then numb your neck with a little shot (didn't hurt). And then they put in another needle and pull out the stuff they need while following it on the ultrasound. It took about 45 minutes. I wasn't even sore afterward really. Maybe just a tiny bit? It was not bad at all.

Now the waiting 1 week for the results, is the worst part. My results came back benign.

Good luck to you.

Lynn


----------



## katbid23

Hello and sorry to have to say "Welcome". My case has been what the Endo calls "unusual" from the bignning. But I will try to give you information that was given to me during the biginning of my journey. First, I'm surprised at how "rare" they say thyroid cancer is. Since I was diagnosed in Jan, I have met at least 4 other people that have or had thyroid cancer. So whatever you do be aggressive with your health care. I almost opted to not have a thyroidectomy because I was told that cancer was so rare. I did not even know that I had a thyroid problem until I went to the DR for female problems. I have graves disease. Based on that diagnosis alone, I was sent for an ultra sound and found that I had multiple nodules. The largest nodule being 2cm. I thought for sure that I would have an FNA. But I didn't. The Endo sent me for the uptake scan. This scan is the one that will tell the DR what the nodule is doing and what it truely looks like. This is when they found that one of my nodules was a "cold nodule", which is more of a chance of being cancer. Again, I thought I was going to have an FNA. But I did not. My Endo explained to me that the FNA is not always realiable. He said if you have a 2cm nodule and they do an FNA, they could stick that nodule several times and come back with negative or inconclusive resluts. However, that does not mean that it doesn't contain cancer. It "could" simply mean that out of all those sticks, they did not hit the one area that actually contain cancer cells. Then I thought maybe they would just give me the RAI to kill the thyroid and keep the nodules from growing. But this was not an option either. The endo explained that if you have the RAI to kill the thyroid, it not only kills the thyroid but it makes a mess of it. He said most surgeons will not want to touch it if it has been ablaited (not sure of spelling here so forgive me). Therefore, if there are cancer cells in there, the situation would get a lot worse. So my only option was to have the thyroid removed. My Endo and my Surgeon did not think I had cancer. They were very sure that I did not have cancer. Well I had my thyroidectomy on New Year Eve and found out on the 5th of Jan that I actually had Papillary and Follicular variant of papillary. The thyroidectomy, I feel was the easiest part. It was a little painful but the meds helped with that. I had my RAI in Feb and go back for more labs in a week. I guess I'm telling you all of this because you need to know that each case is different. Listen to your body and do research when you get test results. I did a lot of research and it helped me deal with the diagnosis. There are great people on this board with a lot of information. This is actually the first time I have posted a comment to a question. I was usually the one that was asking all the questions. 
Good luck and keep the faith.


----------



## Andros

katbid23 said:


> Hello and sorry to have to say "Welcome". My case has been what the Endo calls "unusual" from the bignning. But I will try to give you information that was given to me during the biginning of my journey. First, I'm surprised at how "rare" they say thyroid cancer is. Since I was diagnosed in Jan, I have met at least 4 other people that have or had thyroid cancer. So whatever you do be aggressive with your health care. I almost opted to not have a thyroidectomy because I was told that cancer was so rare. I did not even know that I had a thyroid problem until I went to the DR for female problems. I have graves disease. Based on that diagnosis alone, I was sent for an ultra sound and found that I had multiple nodules. The largest nodule being 2cm. I thought for sure that I would have an FNA. But I didn't. The Endo sent me for the uptake scan. This scan is the one that will tell the DR what the nodule is doing and what it truely looks like. This is when they found that one of my nodules was a "cold nodule", which is more of a chance of being cancer. Again, I thought I was going to have an FNA. But I did not. My Endo explained to me that the FNA is not always realiable. He said if you have a 2cm nodule and they do an FNA, they could stick that nodule several times and come back with negative or inconclusive resluts. However, that does not mean that it doesn't contain cancer. It "could" simply mean that out of all those sticks, they did not hit the one area that actually contain cancer cells. Then I thought maybe they would just give me the RAI to kill the thyroid and keep the nodules from growing. But this was not an option either. The endo explained that if you have the RAI to kill the thyroid, it not only kills the thyroid but it makes a mess of it. He said most surgeons will not want to touch it if it has been ablaited (not sure of spelling here so forgive me). Therefore, if there are cancer cells in there, the situation would get a lot worse. So my only option was to have the thyroid removed. My Endo and my Surgeon did not think I had cancer. They were very sure that I did not have cancer. Well I had my thyroidectomy on New Year Eve and found out on the 5th of Jan that I actually had Papillary and Follicular variant of papillary. The thyroidectomy, I feel was the easiest part. It was a little painful but the meds helped with that. I had my RAI in Feb and go back for more labs in a week. I guess I'm telling you all of this because you need to know that each case is different. Listen to your body and do research when you get test results. I did a lot of research and it helped me deal with the diagnosis. There are great people on this board with a lot of information. This is actually the first time I have posted a comment to a question. I was usually the one that was asking all the questions.
> Good luck and keep the faith.


Passing it forward. You are a total doll! Very informative post that will help many here.


----------

