# Thyroid nodule



## suzan30 (Sep 26, 2011)

Newbie here. I'd appreciate your advice.

I have a thyroid nodule that measures 6 x 3 cm. It is underneath my collarbone so I don't notice it at all. I've had two needle biopsies 6 months apart, both of which have been inconclusive. My understanding is that they yielded blood but not many cells. My doctor has recommended removing the right half of the thyroid which has the big nodule. They'd also do a biopsy while I am under anesthesia and decide at that point whether to take the whole thing out. My doctor seems to think it "looks" worrisome on the ultrasound ("not well defined" "irregular borders").

I am wondering if this is the normal procedure. My other option, according to my doc, is continued to have it monitored by ultrasounding every 6 months. I have no particular symptoms of thyroid difficulties, as far as I can tell.


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## lainey (Aug 26, 2010)

If I had a single nodule of that size with indeterminate results--I would have it removed.

Soon.

In real numbers, these present the highest risk for cancer--especially if your doctor is saying that it looks "suspicious" on the ultrasound.

Do you have baseline thyroid blood work?

Most people generally can function with half a thyroid. Should they need to remove the whole thyroid, hormone replacement medication is taken. Most people recover and return to normal fairly quickly.


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## joplin1975 (Jul 21, 2011)

lainey said:


> If I had a single nodule of that size with indeterminate results--I would have it removed.
> 
> Soon.


This.

Mine was significantly smaller, I did not notice it until a regular exam, and I would have also said I was asymptomatic (althought looking back I'm not sure that was entirely the case). It turned out to be cancer that had gone into three lymph nodes...lymph nodes that all looked normal on two different ultrasounds.


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## webster2 (May 19, 2011)

lainey said:


> If I had a single nodule of that size with *indeterminate* results--I would have it removed.


My US report had "interdeterminate and ill-defined" on it. There were a few things that didn't show up on the US too.



lainey said:


> Most people generally can function with half a thyroid. Should they need to remove the whole thyroid, hormone replacement medication is taken. Most people recover and return to normal fairly quickly.


For 20 years, I had only half a thyroid and life was pretty good for the first 18.

Welcome, and it is not my intent to scare you at all. Many of us have been there recently with very good outcomes. It sounds like your doctor is on top of this. Best wishes with your decision.


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## suzan30 (Sep 26, 2011)

Thanks to everyone for responding--and so quickly too!

The second ultrasound showed some enlarged lymph glands and that the nodule had grown a bit. I guess I am questioning the thyroid specialist's recommendation because the doctor who did the 2nd needle biopsy was very dismissive of the idea that 1) needle biopsies should be performed every 6 months 2)all large nodules should be removed. He seemed to be implying that surgeons are too quick to remove harmless nodes that many people develop as "part of the aging process," in his words.

From my own perspective, I've had two knee surgeries (left and right) in the last 4 years, which took a while to recover from. I'd really like to avoid another long convalescence, if possible.


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## joplin1975 (Jul 21, 2011)

I think, respectfully, once you start seeing changes to lymph nodes, the wait-and-see approach becomes significantly less, um, reasonable.

Surgery itself isn't that bad and I don't think it is comparable to a knee surgery (my husband is in orthopedics and he's been amazed at the difference in my experience and his patients).

Where are you with regard to blood work?


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## webster2 (May 19, 2011)

I agree with Joplin. FWIW, I had spinal fusion last year, and this was a breeze, but then again, I have had a partial thyroidectomy done before, when I was a young 'un!


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## suzan30 (Sep 26, 2011)

Thanks again for the help. I had initial blood work done when this thing was first discovered last December. It was all fine. Last week, they took more and I get the results next week. So . .. this is easier than knee surgery? I've been on crutches twice for 6 weeks in Chicago in the middle of winter, while living in a 3rd floor walk up. I'm a single mom and "hellish" is the only way to describe it. My dr. suggested that it would 2-3 weeks of downtime--that would be hard just now.


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## lainey (Aug 26, 2010)

Generally a thyroidectomy is an overnight hospital stay. As for time off from work, that varies from person to person, but the 2-3 weeks is about accurate.

If you need replacement medication, it can take a little bit of time to settle out the dosage--they do blood work and adjustments every 6-8 weeks until your levels settle out. The primary symptom at that point is tiredness.

If it were me, I would be seeking a third opinion.

The second doctor seems a very dismissive, honestly for a nodule that is growing, with enlarged lymph nodes nearby. Far too suspicious IMHO.


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## Andros (Aug 26, 2009)

suzan30 said:


> Newbie here. I'd appreciate your advice.
> 
> I have a thyroid nodule that measures 6 x 3 cm. It is underneath my collarbone so I don't notice it at all. I've had two needle biopsies 6 months apart, both of which have been inconclusive. My understanding is that they yielded blood but not many cells. My doctor has recommended removing the right half of the thyroid which has the big nodule. They'd also do a biopsy while I am under anesthesia and decide at that point whether to take the whole thing out. My doctor seems to think it "looks" worrisome on the ultrasound ("not well defined" "irregular borders").
> 
> I am wondering if this is the normal procedure. My other option, according to my doc, is continued to have it monitored by ultrasounding every 6 months. I have no particular symptoms of thyroid difficulties, as far as I can tell.


Welcome!

So, tell us.......................; what does your thyroid panel look like? TSH, FREE T4, FREE T3? If you could post the results and the ranges we could have a look.

Also, what antibodies' tests have you had run and if so,results and ranges please?

Anytime FNA is inconclusive, that leaves a lot to be desired and the protocul "usually" is ablation.

I happen to agree w/that.

However, this is a board that is supportive of any course you chose to take. We are here for you; not to enforce our opinions on others.

You have no symptoms other than the nodule on the clavicle that you can in fact feel?


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## suzan30 (Sep 26, 2011)

Sorry, I don't have the results of the latest tests including the antibody screening but I expect to get then next week. I didn't really think much about the initial blood tests that were done last year. I was told they were fine by my gp and just accepted that. I don't recall that I got specific numbers, or asked for them.

As for symptoms, I have had problems with insomnia, fatigue, anxiety in the last year, but I've always thought of them as related to work and family related stress not thyroid problems. My dr. noticed the goiter last year at my annual check up which started this whole thing. I wasn't aware of it. The nodule itself is under the collarbone, imperceptible to me, and I can't tell that have I swollen glands either.

If this needs to come out, should it be a priority? Or can I wait until my work situation settles down in the spring? I don't want to take a chance with my health, but I don't want to over-react either.

Thanks again for your help and advice.


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## Andros (Aug 26, 2009)

suzan30 said:


> Sorry, I don't have the results of the latest tests including the antibody screening but I expect to get then next week. I didn't really think much about the initial blood tests that were done last year. I was told they were fine by my gp and just accepted that. I don't recall that I got specific numbers, or asked for them.
> 
> As for symptoms, I have had problems with insomnia, fatigue, anxiety in the last year, but I've always thought of them as related to work and family related stress not thyroid problems. My dr. noticed the goiter last year at my annual check up which started this whole thing. I wasn't aware of it. The nodule itself is under the collarbone, imperceptible to me, and I can't tell that have I swollen glands either.
> 
> ...


When you can, we can help you further if we can see all recent lab results pertinant to the thyroid and ranges.

I am going to be upfront with you. Nodules on the clavicle do point to papillary cancer.

Papillary tumors are the most common of all thyroid cancers (>70%). Papillary carcinoma typically arises as an irregular, solid or cystic mass that arises from otherwise normal thyroid tissue. This cancer has a high cure rate with ten year survival rates for all patients with papillary thyroid cancer estimated at 80-90%. Cervical metastasis (spread to lymph nodes in the neck) are present in 50% of small tumors and in over 75% of the larger thyroid cancers. The presence of lymph node metastasis in these cervical areas causes a higher recurrence rate but not a higher mortality rate. Distant metastasis (spread) is uncommon, but lung and bone are the most common sites. Tumors that invade or extend beyond the thyroid capsule have a worsened prognosis because of a high local recurrence rate.

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

http://www.cancer.gov/cancertopics/pdq/treatment/thyroid/Patient/page1

I sincerely hope this is not the case but I personally would not mess around putting off ablation.


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## Octavia (Aug 1, 2011)

The size of your nodule, as well as the potential spread to lymph nodes, seems very suspicious for cancer to me. 6 cm is large. Very large. Tumor size is an important factor for long-term prognosis.

If it were me, I'd be scheduling a thyroidectomy asap. Even faster if you are over 40.

It is not nearly as bad as knee surgery. True "down time" is under a week. 2-3 weeks is a cushion. If you HAD to go back to work a week later, you probably could do at least part-time, assuming you're not doing physical labor.


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## suzan30 (Sep 26, 2011)

Oh, my . . . now I am worried. I am going to call and see what the antibody tests showed. It seems strange that I can have such a large mass and not feel anything at all.


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## webster2 (May 19, 2011)

That sounds like a good plan. Some people have no symptoms at all. Sometimes the symptoms are so vague that they are often attributed to something else, or just getting older. Please don't let it go until spring.


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## joplin1975 (Jul 21, 2011)

Agreed, it sounds like a good plan. I can certainly appreciate your desire to wait, but thyroid cancer is -- relative to other cancers -- so easy to treat that I'd hate to see any additional waiting cause problems if it is indeed cancer.

I was roofing my house 10 days post-op. I certainly do NOT recommend that, but I say it just to underscore that while this is surgery and there will be a recovery time, it's nothing like knee surgery.

Good luck!


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## suzan30 (Sep 26, 2011)

So, I called my doctor first thing about the antibody tests. I managed to get the nurse who told me that everything is in the normal range. Forgive my ignorance, but is this an indication that my node is not cancer?

Thanks again!


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## lainey (Aug 26, 2010)

You really cannot determine if the nodule is cancerous from blood work results.

It's done in pathology.

Seek a referral to an endocrine surgeon or doctor that specializes in needle biopsies--a doctor that specializes in breast cancer or endocrine cancer would have good experience here. Have them review the results of your ultrasound and needle biopsies and get their opinion as to what direction you should go.


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## Andros (Aug 26, 2009)

suzan30 said:


> So, I called my doctor first thing about the antibody tests. I managed to get the nurse who told me that everything is in the normal range. Forgive my ignorance, but is this an indication that my node is not cancer?
> 
> Thanks again!


There are some antibodies that you should not have at all. I hate to say this but you are going to have to go get copies of your labs. The nurse is not the doctor.

Your doctor feels surgery is wise; I happen to agree with that. A second opinion won't hurt anything. You might go see an ENT. They usually do a lot of thyroid surgery.


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## suzan30 (Sep 26, 2011)

Thanks, again. The nurse is going to send me the results and I have follow up appointments with both the surgeon and the endocrinologist, but not for a couple of weeks. Everyone is on staff at a major university hospital (University of Chicago) that is very highly regarded, so I don't lack confidence in them. I 've just become very anxious after reading the responses here, since I had been pretty blase based upon the fact that nodules seem to be so common, cancer relatively rare---and of course, I don't feel sick at all and can't discern the any bodily changes either.


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## webster2 (May 19, 2011)

Which ever doctor you decide to see, just make sure they do quite a lot of thyroid surgeries. You don't want a beginner!


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## suzan30 (Sep 26, 2011)

I called my doctor and spoke with her nurse again. It turns out that in addition to my big nodule in the left part of my thyroid, I have two more in the right side. One is 7 x 4 x3 ml. and the other 10 x 7 x 7 ml. Does the presence of more nodules increase or decrease the chance that this is cancer?

Regarding the surgery itself, I was told that I would most probably spend one night in the hospital and go home. I am a single mom with a teenage daughter and no family in the area. I was wondering whether I'd be able to manage with just my daughter's help when I get home. I could ask my sister to come but that presents its own set of difficulties. Friends are mainly my colleagues or parents of my daughter's friends--in both cases, I'd really not have them around when I am tired, disheveled, and in pain. (I'm just a really private person.) Can anyone offer guidance about post-op recovery and how bad it is?

Thank you!


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## webster2 (May 19, 2011)

suzan30 said:


> I called my doctor and spoke with her nurse again. It turns out that in addition to my big nodule in the left part of my thyroid, I have two more in the right side. One is 7 x 4 x3 ml. and the other 10 x 7 x 7 ml. Does the presence of more nodules increase or decrease the chance that this is cancer?
> 
> Regarding the surgery itself, I was told that I would most probably spend one night in the hospital and go home. I am a single mom with a teenage daughter and no family in the area. I was wondering whether I'd be able to manage with just my daughter's help when I get home. I could ask my sister to come but that presents its own set of difficulties. Friends are mainly my colleagues or parents of my daughter's friends--in both cases, I'd really not have them around when I am tired, disheveled, and in pain. (I'm just a really private person.) Can anyone offer guidance about post-op recovery and how bad it is?
> 
> Thank you!


Oh, goodness...sorry to hear you have more. I really don't know if the quantity increases the chances or not. I am sure someone with more knowledge will chime in. I re-read my path report this morning, and was surprised that it was the little ones, and not the big one that was up to no good! Certainly knocks out the old adage, good things come in small packages!

I think if you let your daughter know that you would need her to be around for a few days, that would be great. Most likely, you won't be out of it, just a little sore, tired, and needing to lay low for a bit. it might be nice for her to have the opportunity to help you out.

Best wishes!


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## Andros (Aug 26, 2009)

suzan30 said:


> I called my doctor and spoke with her nurse again. It turns out that in addition to my big nodule in the left part of my thyroid, I have two more in the right side. One is 7 x 4 x3 ml. and the other 10 x 7 x 7 ml. Does the presence of more nodules increase or decrease the chance that this is cancer?
> 
> Regarding the surgery itself, I was told that I would most probably spend one night in the hospital and go home. I am a single mom with a teenage daughter and no family in the area. I was wondering whether I'd be able to manage with just my daughter's help when I get home. I could ask my sister to come but that presents its own set of difficulties. Friends are mainly my colleagues or parents of my daughter's friends--in both cases, I'd really not have them around when I am tired, disheveled, and in pain. (I'm just a really private person.) Can anyone offer guidance about post-op recovery and how bad it is?
> 
> Thank you!


When is your surgery scheduled? It just depends; I and others hope you don't have cancer at all but it sure sounds like that "bad girl" has to come out.


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## joplin1975 (Jul 21, 2011)

webster2 said:


> I think if you let your daughter know that you would need her to be around for a few days, that would be great. Most likely, you won't be out of it, just a little sore, tired, and needing to lay low for a bit. it might be nice for her to have the opportunity to help you out.


Well, dang. I'm sorry. I agree with webster. There isn't a ton of after care help you'll need. Mostly, you'll need lots of rest and soft foods to eat. I'm sure you daughter can handle most if not all of it. The most difficult thing for me was that I was not permitted to drive home (obviously) the day after the surgery and was not driving until I could move my neck freely. That took about a week and a half. Is your daughter driving yet? If yes, you'll be fine. If not, I'd just have someone around who could help you with transportation (and I absolutely understand not wanting to have non-family members seeing you at your not-best).


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## suzan30 (Sep 26, 2011)

Thank you all for your support and advice. My daughter doesn't drive, but we live in a city neighborhood and actually don't have a car. We just take public transportation and taxis once in a while. I can certainly get someone to give me a lift home, and we can groceries delivered and the like. I think with the help of my daughter I should be able to help.


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## joplin1975 (Jul 21, 2011)

Oh, then I think you'll do fine! As I've said multiple times on this board, my husband is an orthopedic PA with over a decade of surgical experience. He keeps telling folks how astounded he is that I had very little pain, recovered so quickly, and was really able to care for myself (minus the driving thing) so quickly after surgery. [Disclaimer: I did not have any issues with calicum or post-surgical vomitting etc.]

I would just stock up on easy to swallow foods (I pre-made soups and chilis), tylenol, and make sure you have access to ice and you'll be fine.

Thinking of you!


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## webster2 (May 19, 2011)

I think you will do just fine too! Your daughter will be a big help to you!  I've been through it twice, and was able to take care of myself. I just wasn't quite up to par for a bit. I didn't put a roof on like Joplin  but I did go camping two weeks after. Best to you!


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## Octavia (Aug 1, 2011)

Having normal lab results means just about nothing when it comes to thyroid cancer. My labs were all normal.

Regarding multiple nodules...I'm not sure if that increase the odds that it's cancer. I'm more concerned about the size of that "main" nodule.

I agree with the others - your daughter will be able to take great care of you. At my house, it's just me and my husband. He had wonder plans to take care of me after my first surgery, but then he ended up in the hospital the day after my surgery. He had pneumonia! So much for the ol' "for better or for worse"!  Anyway, I was able to take care of myself. You'll be sore, but perfectly capable and mobile.

I try to say this as often as I can: if you are prone to motion sickness, you MUST mention this to the anesthesiologist!!!!! They can put a little something different in your "cocktail" that will prevent you from vomiting for 2 days after the surgery (like I did).


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## suzan30 (Sep 26, 2011)

Dear all,

I got the test results today. Here's what it says:
Thyroglobulin AB Negative
Thyroid Peroxidase Ab Negative
Thyrotopin 1.27
Triiodothyronine 122
Thyroxine 8.9

Here's what it says about my big nodule:

Solid large, heterogeneous nodule in the inferior and midportion of the left lobe measures 6.2 x 3.3 x 3.1 cm. A smaller solid nodule in the superior pole measures 7 x 8 x 6 mm.

Any thoughts on my numbers?

Thanks as always.


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## Andros (Aug 26, 2009)

suzan30 said:


> Dear all,
> 
> I got the test results today. Here's what it says:
> Thyroglobulin AB Negative
> ...


Well, it would be nice to see the numbers for the Thryoglobulin Ab and TPO. Also, and I sure hate to put you to any trouble but we always need the ranges for all lab results as different labs use different ranges.

Yeah; that solid is iffy and very suggestive of cancer!! Is surgery scheduled yet? You know you are in our thoughts and prayers for all of this. Definitely!


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## webster2 (May 19, 2011)

I am so glad you are following up on this.


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## suzan30 (Sep 26, 2011)

Thank you both for responding. I didn't realize that the ranges were important. Here's what I got: (2nd column is the reference range)

Thyroglobulin AB Titer Negative
Thyroid Peroxidase  Titer Negative
Thyrotropin 0.30-4.00 mcU/ml 1.27
Triiodothyronine 80-195 ng/dl 122
Thyroxine 5.0-11.6 mcg/dl 8.9

Now, I'd really like to get my nodule out ASAP, but I don't see the doctor for a month and then still have to get on the schedule!


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## Andros (Aug 26, 2009)

suzan30 said:


> Thank you both for responding. I didn't realize that the ranges were important. Here's what I got: (2nd column is the reference range)
> 
> Thyroglobulin AB Titer Negative
> Thyroid Peroxidase Titer Negative
> ...


Yeah; wow! Triiodothyronine is below the mid-range of the range provided by your lab and Thyroxine is not much better but is a little above the mid-range.

I think your thyroid is struggling and you along with it. I know you will be glad to have it out.

Thank you so very much for re-posting with the ranges. This is so so helpful!


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