# Separate mass - thyroid tissue



## Rosario (Nov 3, 2013)

Hi. New to the board. Have had hypothyroid symptoms for a while. Had tests done a year ago. Came back normal. Complained of pressure in throat. Was told it was acid reflux. Sent on my way. A year later, I see a different doctor. Again tests are normal. She feels my throat. Says my thyroid is enlarged. Had an ultrasound, found several nodules on one side. A separate mass on the other. It looks like thyroid tissue on the ultrasound. Don't have more info. She called with this info when I was in the middle of something hectic. Tried to call back but they were closed for the weekend. She is ordering 2 more tests tomorrow.

Here's my question, anyone familiar with separate masses in the area but not attached? She didn't seem concerned. Tried to research this but found very little.

I'll have more info in a couple of days but I'm having a lot of anxiety today.

Thank you!


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## KeepOnGoing (Jan 2, 2013)

Hi, Rosario

I don't have any experience of separate masses, though I do know that thyroids are very strange things and capable of anything.

Just wanted to say how sorry I am that you are going through this period of anxious waiting. It's perfectly normal to feel anxious, but try not to let it eat you up (easier said than done, I know!). Let us know what they say.

Thinking of you


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## ChrisP (Oct 29, 2013)

Hi there Rosario,

When you go back to the office for those other tests, make sure to ask for a copy of the ultrasound report, and you can post it to us when you receive it. You might have to either call your ultrasound department (where you had it done), or ask for it from your GP's receptionist, most likely they'll give it to you there. Also, you have the right to obtain any report you want. In fact, you should not have to even schedule an appointment to see your doctor to get the report, just call the front desk and you should be able to get them.

I think you should ask your GP to recommend doing a followup on the nodules very soon, to get a bigger picture and more accurate one of the multiple nodules as well as the one adjacent to them.

Keep us posted, and know that even though the waiting really sucks (we've all done that!), you'll get through it. :hugs:

x


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## joplin1975 (Jul 21, 2011)

I agree that punky thyroids grow in all sorts of weird ways.

Also a possibility: if your nodules are cancerous, that mass may be a lymph node with cancerous thyroid cells. Thyroid cancer frequently travels to nearby lymph nodes. (And, so you don't worry, it pretty common to have lymph node involvement. While it might mean a slightly longer surgery and more vigilant monitoring, the prognosis remains excellent.)


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## Rosario (Nov 3, 2013)

thank you ALL for the replies. I will ask for the reports. I plan to look for an endo to follow up on what all this means. I think she said it looked like an adenoma. From what I read these are separate from the gland. Some places they are called solitary nodules. I could be mixing this all up though. Having a hard time focusing. I attribute it to my nerves. It's hard to relax because the pressure on my throat is a constant reminder. She also put me on something to help me relax but I am having more symptoms from that than relief. I will come back with results. Hopefully good news.


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## Rosario (Nov 3, 2013)

I'm back with a little more info. The tests she ordered were a blood test for PTH w/ Ca, PO4, Creat. This wasn't part of my initial blood tests. It's for my parathyroid since it was mentioned in the US report. She also ordered a thyroid scintigraphy.

US Report:
Right thyroid lobe 4.5x1.4x1.2cm
Left thyroid lobe 6x2.4x2.2

Thyroid isthmus not thickened at about .2cm AP

These measurements suggest a mildly enlarged gland with size asymmetry

There are several closely approximated circumscribed solid nodules at the mid to lower pole left thyroid lobe, about 4 nodules ranging in size from 1cm to 3.5cm. Left lobe modularity probably explains the asymmetric left lobe enlargement. Inferior to but appearing potentially separate from the lower pole right thyroid is a circumscribed solid mass measuring about 2.7x2.4x2.1cm, heterogenous in echogenicity with components that are more echogenic than the right thyroid lobe tissue and other components are similar to the right thyroid lobe echogenecity. If there were clinical evidence for hyperparathyroidism, a large lower right adenoma would be a possibility. It is conceivable that this could represent a thyroid origin nodule quite exophytic from the lower pole right lobe.

And now I wait for the results to come back. I could have stayed and grilled the doctor for more info but it seemed pointless. She can tell me what she thinks but I just have to wait for the results. I am dissecting each word to figure out the odds that this is nothing.

I was expecting an FNA and not a nuclear test. Does one come before the other?

Thank you for reading this!


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## joplin1975 (Jul 21, 2011)

I had the RAIU first and then the FNA, but if I had to do it all over again, I would have skipped to the FNA. It's not always conclusive, but when it is, you have your answer pretty quickly.

Interesting results...I'm not well-versed in issues with parathyroid glands...hopefully you can get some answers quickly!


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## Rosario (Nov 3, 2013)

I am interpreting the echogenicity of the mass to be a good thing. Components being more echogenic than the right thyroid tissue and compoents being similar. More (hypogenic) I read is better. As you can see I am reading into everything. In the report was also his impression which seemed pretty bland and not too worrisome. Again, I am inferring for a little bit of comfort.

Impression:

Solid mass at the lower right neck as described. This appears closely approximated to but potentially separate from the inferior most aspect of the right thyroid lobe. If there were clinical evidence for hyperparathyroidism, a large parathyroid adenoma would be a possibility. It is however conceivable that this could represent a thyroid origin nodule quite exophytic from the right lobe. Correlate clinically (e.g. serologic PTH, calcium evaluation).

Nonspecific nodular changes in the asymmetrically enlarged left thyroid lobe as described. Thyroid scintigraphy might be considered to assess nodule functionality. (If the aforementioned inferior right thyroid bed region mass were to be of thyroid origin it might also be characterizable with scintigraphy).

I am holding on to the word "might", as in its simply an option. I have no idea if all these nodules/masses are checked further passed US but it they aren't then this would be good.

I don't get the last sentence. Why wouldn't scintigraphy help characterize if it was the parathyroid? Need to look that up. And why "if" the thyroid bed region mass were to be thyroid origin? I thought the report said it looked the same as my thyroid. I guess parathyroid tissue looks the same in an US.

I will try to relax until I get the results back. It's not easy. I was given something for the anxiety but that has been more trouble than help. Thank you for replying to my posts. I get relief from writing this all out.


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## Andros (Aug 26, 2009)

Rosario said:


> I'm back with a little more info. The tests she ordered were a blood test for PTH w/ Ca, PO4, Creat. This wasn't part of my initial blood tests. It's for my parathyroid since it was mentioned in the US report. She also ordered a thyroid scintigraphy.
> 
> US Report:
> Right thyroid lobe 4.5x1.4x1.2cm
> ...


Welcome to the group


Well; I know one thing. Your poor little thyroid is struggling in a big way. Hope your other tests come back soon so you know where you stand.

Either way, I do believe the thyroid will have to be taken out.

The symptoms you describe lead me to think (definitely not a doctor) that this is the thyroid only. Thyroid tissue can be a rascal and is quite capable of growing anywhere. And, the thyroid tissue will always take the path of least resistance so for it to extend beyond where one expects the thyroid to be (a healthy one) is not unusual.


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## Rosario (Nov 3, 2013)

No real update. Had my uptake done yesterday and the tech said they would rush my results so I could have them for my Monday morning appointment.

Two things. After taking the iodine pill, I stopped feeling the pressure in my neck. Is that odd? Maybe something else is going on but I did notice that the pressure has almost disappeared. Secondly, is there a chance that if my uptake comes back ideal that I won't need any more tests? Do they always do an FNA on nodules as big as mine? Should I insist on it if they don't recommend it? Should I want them out even if everything points at benign since they are not small? Thanks for any advice you have!


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## Rosario (Nov 3, 2013)

Scintigraphy update:

Uptake is normal. 20% (normal range 10-30).

The mass which was noted on the right lobe could not be seen on the thyroid uptake scan. Internal medicine doctor who went over my results today thought it was odd since the ultrasound was very specific about a mass.

The report continues with "A large cold nodule is present in the inferior half of the left thyroid lobe. A tissue diagnosis will be necessary to exclude malignancy.

No definite nodularity at the inferior right lobe is seen, although in the left anterior oblique views, the possibility of a warm or functioning nodule is raised. This is compatible with a benign process.

Impression:

Solitary cold nodule at the inferior left thyroid lobe; a tissue diagnosis will be necessary to exclude malignancy."

I asked my doctor if she thinks they were referring to the one which was 3.5cm and she said yes. I called to make an appointment with a surgeon she recommended for my consult in order to get a FNA and the soonest appointment they have is December 2nd. I honestly can't wait that long so I am going to see if I can see someone else. I asked what about the discrepancy with the mass and she said the surgeon would discuss that with me. That was my biggest concern so to wait 3 weeks will be torture. Any advice? Should I set my mind to have this nodule removed no matter what the FNA says since it is big and cold? It would give them a chance to check the right side.

Thank you for reading this.


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## Andros (Aug 26, 2009)

Rosario said:


> Scintigraphy update:
> 
> Uptake is normal. 20% (normal range 10-30).
> 
> ...


Well..................here's the thing and I sincerely hope it is benign; this is going to worry you and you will have to have frequent check-ups throughout your whole life. My vote would be OUT! Plus, it is sizable and may continue to grow.

But.................we are jumping the gun here. Best to wait and see what the surgeon has to say about all of this. You could also try to get on a cancellation list w/the surgeon you have an appt. w/; perhaps?


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## Rosario (Nov 3, 2013)

Hi Andros. Thank you for your reply. I did ask about a cancellation list. I even called back made it clear I could be there with little notice.

I'm completely ok getting it out and going on medication. I know that's strong to say this early on but what they didn't discuss in the report is that I have 2 other nodules on the left which the US said were atleast 1.5 and bigger. Both solid. Plus the right side mass just disappearing is odd. I can't get this FNA quick enough even if its terrible. I called another recommended Surgeon but they are scheduling in December too. I suppose this is normal but it's only for the initial consult, not even for the FNA. The Thanksgiving Holiday isn't helping with scheduling.

Thanks for listening to me. It feels better when I let it out.


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## Andros (Aug 26, 2009)

Rosario said:


> Hi Andros. Thank you for your reply. I did ask about a cancellation list. I even called back made it clear I could be there with little notice.
> 
> I'm completely ok getting it out and going on medication. I know that's strong to say this early on but what they didn't discuss in the report is that I have 2 other nodules on the left which the US said were atleast 1.5 and bigger. Both solid. Plus the right side mass just disappearing is odd. I can't get this FNA quick enough even if its terrible. I called another recommended Surgeon but they are scheduling in December too. I suppose this is normal but it's only for the initial consult, not even for the FNA. The Thanksgiving Holiday isn't helping with scheduling.
> 
> Thanks for listening to me. It feels better when I let it out.


Believe me; we are all ears here!!! With the solid situation on the left; getting that cantankerous thyroid out is probably the best way to go. Like I say; "Why worry for the rest of your life?"


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## thumper54 (Sep 2, 2013)

Just a thought - I wonder if the mass is cold and that is why it's not showing up on the scan. If it's outside the thyroid it should only show up if it's warm or hot, shouldn't it? I have only one large nodule and it freaked me out due to the symptoms, so I'm so sorry that you have so many to deal with. I too wanted action immediately, but after four months I'm now more patient. (Having anti thyroid meds and beta blocker working has really helped me with the symptoms, but I'm hyper). My one nodule is also cold and it looked like I only had one lobe on the scan. I sure hope you can get into the surgeon soon. Knowing what's going on really helps the stress level.....


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## Rosario (Nov 3, 2013)

thumper54 said:


> Just a thought - I wonder if the mass is cold and that is why it's not showing up on the scan. If it's outside the thyroid it should only show up if it's warm or hot, shouldn't it? I have only one large nodule and it freaked me out due to the symptoms, so I'm so sorry that you have so many to deal with. I too wanted action immediately, but after four months I'm now more patient. (Having anti thyroid meds and beta blocker working has really helped me with the symptoms, but I'm hyper). My one nodule is also cold and it looked like I only had one lobe on the scan. I sure hope you can get into the surgeon soon. Knowing what's going on really helps the stress level.....


Or worse, it isn't thyroid tissue so it didn't absorb any iodine and therefore can't be seen. That's my concern right now. The unknown and of course having to wait. Based on other posts 3 weeks doesn't seem long when you consider Thanksgiving is in there too. Thanks for reading and your input.


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## Rosario (Nov 3, 2013)

My consult has been moved up to next week (yes!) and I've been researching a bit more so I can be prepared with questions.

While searching around this site, I have seen a few blood tests that I haven't had. I'll post the ones I have had. Is it odd that considering my large nodules and swelling that I haven't Tg Antibodies tested? I did the most conservative estimation of all my known nodules/masses added up and it comes to 3.5 inches of solid mass. That's a lot. I have a small neck so I can't imagine was is being displaced!

Here are the blood tests:


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## ChrisP (Oct 29, 2013)

This is really odd. I know the waiting is going to really stink. I've been waiting for about 4 weeks now to see my ENT, the wait definitely is a killer, especially when things are so in the blue and results never fail to come back as nothing but odd.

I agree with Andros, I think it needs to come out. Your thyroid is struggling and buffering in weird ways. It will most likely continue to grow, and eventually could be risky. I think surgery is becoming very necessary. But again, wait and talk to your ENT. Keep us posted. xx


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## Andros (Aug 26, 2009)

thumper54 said:


> Just a thought - I wonder if the mass is cold and that is why it's not showing up on the scan. If it's outside the thyroid it should only show up if it's warm or hot, shouldn't it? I have only one large nodule and it freaked me out due to the symptoms, so I'm so sorry that you have so many to deal with. I too wanted action immediately, but after four months I'm now more patient. (Having anti thyroid meds and beta blocker working has really helped me with the symptoms, but I'm hyper). My one nodule is also cold and it looked like I only had one lobe on the scan. I sure hope you can get into the surgeon soon. Knowing what's going on really helps the stress level.....


That is a thought that I share w/you. Cancer does not uptake; unfortunately.


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## Rosario (Nov 3, 2013)

Had my consult today. Waiting for call to schedule biopsy. As soon as I make that appointment, I have been ok'ed to make my surgery appointment. Doctor feels that no matter the results, atleast one side should come out. My left side has 4 nodules and they are pressing against my throat. Never discussed any wait and see if the results come back benign because it's visible on my neck. Not too bad but I haven't read that a solid nodule shrinks. How does this sound? Anyone think I am jumping the gun and electing surgery just because of size and number? I ask because I now realize that I never asked if I could avoid it. Thank you for your opinion!


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## joplin1975 (Jul 21, 2011)

No, I do not think you are jumping the gun. Rather, I think the sooner if comes out, the better.


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## Rosario (Nov 3, 2013)

I think so too. I just never argued the other side which is not like me. I don't want to be driven by fear of the unknown. It is a lot of solid nodules though. That I can't be exaggerating. Thank you for your confirmation.


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## Rosario (Nov 3, 2013)

Back with the same question. Sorry. Had my biopsy yesterday. The radiologist did the largest nodules on each side. A few things that the radiologist said are confusing me on what to do. He confirmed that the largest on the left is 3.5cm but he said that the second largest was almost as big. Around 3cm (I think) and it's right next to it. This says "do it" to me. He did say that normally they wait until its 4cm to operate no matter what the results are because the biopsy can miss cancer cells on something that big. But mine is 3.5, isn't that close enough? He didn't say anything. Should I be waiting if it's benign in case it doesn't grow and it's really just extra scans each year? My thyroid is working perfectly. This is telling me to hold off. My biopsy is going to Afirma. He made it sound like it's very good at predicting benign but not great at cancer. Fair enough. So if Afirma says benign and I am not at 4cm, am I being too hasty?

Why should I remove atleast the left? Size? Cold? I tried to make my case to my husband and felt that I didn't have enough concrete reasons.

Of course all these ifs will be filled in next week but I am concerned with getting a benign result and then having to make a difficult decision. Inconclusive and cancer will be slam dunks. Thanks again for your time and advice!


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## joplin1975 (Jul 21, 2011)

I personally think 3.5 cms is plenty big. I know my u/s underestimated the size of my largest nodule (they said it was 2.5cm and post-op path had it a 3.2cm), so its very likely you meet the criteria.

I know you said your bloodwork was normal...if you have the results, post them. If you are having symptoms of hypo with pressure in your throat, I have a feeling your labs might be "normal,' but just barely. Also, have you had your antibodies tested. If you are positive for antobodies, then blood tests are less than helpful and I wouldn't hesitate to remove the whole thing (better quality of life). And, again, if you have antibodies and leave in the left side, it will likely be more difficult to stablize on meds because you will have 1/2 of an unhealthy thryoid mucking things up.

Finally, were I in your shoes and know what I know now (that the surgery was not difficult and that my life has improve exponentially since), I would opt for surgery if only just to find out what that separate mass thing is!


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## Rosario (Nov 3, 2013)

Thank you!

3.5 is big but if it doesn't grow, I'm ok with it there. I think. The pressure I had been feeling is gone oddly enough. I think it was anxiety. But big as in risky? That would be different to me.

Regarding blood tests, I'll post what was sent to me. I need to find the ones for the parathyroid but I think those are irrelevant. I have no symptoms at the moment. Quality of life is pretty good aside from my worry. Oddly, all previous symptoms went away when I started taking something for the anxiety this process was/is causing me. No longer tired, no knee joint pain, no pressure in throat. Odd right?

The separate mass seems like just part of my thyroid. Wish I could change the title of this thread. The radiologist said he's 99% sure its just my thyroid. the tech also said it looked like it was thyroid. The biopsy will confirm if it's thyroid tissue.

Besides getting 100% assurance, why else do it if Afirma says benign? I made the argument that these nodules are most likely going to continue to grow and I will be revisiting this later after having to monitor and being even slightly worried in the back of my head for months. But is that enough reason?

--need a little time to post results. my file is too big.


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## joplin1975 (Jul 21, 2011)

Rosario said:


> Regarding blood tests, I'll post what was sent to me. I need to find the ones for the parathyroid but I think those are irrelevant. I have no symptoms at the moment. Quality of life is pretty good aside from my worry. Oddly, all previous symptoms went away when I started taking something for the anxiety this process was/is causing me. No longer tired, no knee joint pain, no pressure in throat. Odd right?


Hee. I said the same thing when I first posted here. I couldn't be better, I said! Well, two years later, I can say that I did not fully appreciate how ill I was. Those antibodies are horrible, awful things. If you have them and have a surgeon willing to consider a TT, go for it, I say!


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## Rosario (Nov 3, 2013)

I hear your case. It's hard for me to say if I'm really feeling bad and just convincing myself otherwise. I really do think I'm fine. Here is the main page from my blood work. I just need someone to say that my nodules will definitely get too big and will definitely need to come out and no one so far has said that. Not my internist, surgeon or radiologist. I'm kind of hoping for inconclusive as crazy as it sounds to feel better about this surgery which might be elective.


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## Andros (Aug 26, 2009)

Why nothing having to do with the thyroid except for the FT4? What's up with that? This is sooooooooooooooo discouraging.


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## Rosario (Nov 3, 2013)

Should I call have those tests done before surgery? What if they are normal? And what if they are not?


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## Rosario (Nov 3, 2013)

Could I have something like Hashimoto and it not be detected with the few tests I have had? I don't think it will make a difference on the surgery but I did read that you can have normal blood tests with hashimoto. Thanks!


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## joplin1975 (Jul 21, 2011)

Rosario - If I were in your shoes, I would very much want the additional tests Andros mentions. It's difficult (but certainly not impossible) to stabilize on medications if you have autoimmune issues. That may or may not sway you/your husband/your doctors opinions about your options, but at least you can choose a treatment plan knowing you have as much information as possible.


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## Rosario (Nov 3, 2013)

Thank you Joplin and Andros. I wrote the surgeon an email for her to review and call me back on Monday. Unfortunately she is gone for the Thanksgiving holiday. I asked about the blood tests. I think she might say she didn't consider them because her recommendation to operate is due to size and since they are cold, they are not likely to shrink. I am guessing here. I have no idea how the antibodies would figure into my case. I also asked what other factors she considered in recommending surgery. I am guessing again that it was mostly based on 4 nodules on one side and their sizes. Perhaps she has experience with solid nodules and their growth. I will update with her response and hopefully the Afirma results early next week. Thank you both for your advice!


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## Rosario (Nov 3, 2013)

Part of my biopsy results are in. The right side which was the potentially separate mass on the ultrasound is in fact thyroid and it is benign. That's a relief. The left side was inconclusive so they are doing molecular testing on it which isn't complete. Doctor at this point recommends the left side to come out due to size and discomfort it is causing. Per doctor, the nodules are not shrinking. They are cold so not going to respond to meds and solid so injecting them won't help either. Anyone have an opinion on that? I cannot find anything that explicitly says that cold solid nodules shrink. At this point, I am taking everything she says as fact and going through with the surgery even if the second part of the biopsy comes back benign. Thank you for your opinion!


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