# Ultrasound Results - Nodule and Coarseness



## dantetila (Jul 24, 2010)

Hi all,

I just had an ultrasound of my neck/thyroid/armpits come back and the results were:
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Ultrasound of Neck & Thyroid
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Multiple lymph nodes are seen in the neck. In the right anterior triangle five lymph nodes are counted and the largest is 1.2cm x 0.6cm. In the left anterior triangle, seven lymph nodes are counted and the largest is 1.8cm x 0.6cm. All of these lymph nodes are showing fatty hilum.

Right thyroid lobe is 5.0cm x 1.4cm x 1.5cm, left lobe is 3.7cm x 1.6cm x 1.0cm and the isthmus is 0.3cm. The left lobe, in the middle portion, shows a 0.8cm x 0.5cm well defined slightly hypoechoic nodule and the echo suggests an adenoma. The parenchyma elsewhere is slightly coarse.

Summary: Multiple lymph nodes in right and left anterior triangles of the neck. Normal sized thyroid gland with slightly coarse echotexture and left lobe adenoma found.

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Ultrasound of Axillae
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Scans through the left and right axillae show multiple lymph nodes as well. There are five on the right side and six on the left. These lymph nodes show fatty hilum. The largest lymph node on the left is 2.4cm x 0.8cm and the largest on the right shows 2.5cm x 0.6cm.

Summary: Five lymph nodes found on the right axilla and six found on the left axilla.

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I know that they found what looks to be a tumor, but what does the coarse echotexture mean? I am awaiting my endo's phone call but he has not seen the results yet.

I know adenoma's can be common, but I am a 24 year old male, so that makes it less common due to my sex and age. Also I have Celiac Disease, another autoimmune disorder related to Thyroid issues. Also as you can see I have lymph nodes swollen in my neck/axillae, coarseness of the thyroid, one lobe is close to being enlarged and the nodule is single. The adenoma is small, but do the other risks I mentioned warrant a FNA biopsy to make sure that is isn't anything worse?

I'm sure everything is going to be ok. I have a pacemaker as well for heart issues, so I've become pretty good at not letting stuff get to me over the last two years. I've just come to learn you have to put your health into your own hands sometimes, as some doctors dismiss stuff quickly. Do you feel 0.8cm is too small to worry about and that the coarseness of the Thyroid is no big deal, or does coarseness show that the Thyroid is being damaged?

I know nobody here can give me doctor's advice, but any experience with coarse texture or nodules is appreciated as I'd like to know what to expect. I also have had what feels like a slight pressure on my throat for the last 2 months, but my GP said it is unrelated since the nodule is too small, but couldn't the coarseness cause this?

Thanks again!


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## Andros (Aug 26, 2009)

dantetila said:


> Hi all,
> 
> I just had an ultrasound of my neck/thyroid/armpits come back and the results were:
> ------------------------------------------------------------------------
> ...


Welcome to the board.

http://en.wikipedia.org/wiki/Fludeoxyglucose_(18F) (FDG)

Re fatty hilum http://jnumedmtg.snmjournals.org/cgi/content/meeting_abstract/49/MeetingAbstracts_1/251P-d and I had to look up FDG so the link above is a reference to that.

I definitely think that you should have FNA and also a radioactive uptake scan because ultra-sound can miss some things.

Coarse echotexture means the tissue is not echoing as it should. There is a density.

Here is info on that...........

http://www.ultrasound-images.com/thyroid.htm

It sounds to me like you are receiving excellent medical care here and you are very brave to have overcome such obstacles at such a young age. I admire your attitude and philosophy!!!

Clearly, your thyroid is not a healthy one; sad but true. But as I say, "It sounds like you are in very competent hands medically speaking and for that I am grateful."

We are here for you; any time, any way, any day.


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## dantetila (Jul 24, 2010)

Hi,

Thanks for your great response, it is very helpful. Although my TSH/T3/T4 were normal in January (retested on Friday, results soon)...based on what you showed me, it could be Hasmito's, but I will let the doctors decide that.

I just wanted to make sure this ultrasound showed me something I needed to look into, or was this normal findings. I guess it doesn't look healthy, so I will be waiting for my Endo's call. I hope my Endo will biopsy the nodule, but I hear 8mm is too small. Do you feel with the coarse texture, that I should push him to biopsy it?

Thanks a lot and I'm only brave because I have to be, I wasn't at first, but over time you learn. Thanks again!


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## Andros (Aug 26, 2009)

dantetila said:


> Hi,
> 
> Thanks for your great response, it is very helpful. Although my TSH/T3/T4 were normal in January (retested on Friday, results soon)...based on what you showed me, it could be Hasmito's, but I will let the doctors decide that.
> 
> ...


Ditto on the bravery!!! Survival instinct. "When the going gets tough, the tough get going!"

It could be too small and that would be another good reason to get radioactive uptake scan so they can "better see" that nodule and if anything was missed by the sonogram. I always hate to use the "C" word but I would not be very helpful if I did not bring the subject up. We have to be sure about this one way or the other. Rule it in or rule it out.

The swollen lymphs have me concerned. So, first we rule out cancer and then we consider other things that might cause that.

God bless you. Hoping to hear from you very soon. We have lots of good info here and come Monday, you will get more replies, I am sure.


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## dantetila (Jul 24, 2010)

Yeah the C word has crossed my mind and my GP has mentioned it is always a possibility. I actually posted on a Thyroid Medical Export board and an Endo Doctor replied telling me he felt the signs pointed to Hashimoto and that the nodule needed no further investigating, just followup scans in a year. He also said that lymph nodes are common, so investigation is up to the doctor since my lymph nodes appear to be benign.

I feel this advice is not the best. I agree the nodule is small, but it is big enough to be biopsied. Also with the amount of lymph nodes I have that appeared over the last few months, plus the coarse texture of my thyroid and my medical history, I feel this nodule needs to be treated with more aggressiveness than if I found only an 8mm nodule with nothing else.

I don't think its going to be anything too bad, but I would be a liar if I didn't say I'm worried. I just really hope a Thyroid Uptake scan in done at the very least and go from there.

I just had a few question for you that maybe you might know or have experienced.

1. Do you know if Hashimoto is treated with medication or only if your levels are off? My levels were ok in January and I can't see how things would of changed much since then.

2. My one lobe is 5cm and my other 3.7cm. Isn't 5cm considered to be borderline large and 3.7 borderline small? Maybe I'm wrong, but it just seems weird that both are so far apart in size, but then again I don't know much about the subject.

I look forward to further responses and any great insight or advice. Thank you!!


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## dantetila (Jul 24, 2010)

Update

Just spoke to my Endo's office and they informed me that he feels the ultrasound looks good and nothing needs to be done so they are keeping my 1 year appointment. I am quite angry right now. Am I overreacting or should I try and find a new doctor?

Thanks.


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## Andros (Aug 26, 2009)

dantetila said:


> Yeah the C word has crossed my mind and my GP has mentioned it is always a possibility. I actually posted on a Thyroid Medical Export board and an Endo Doctor replied telling me he felt the signs pointed to Hashimoto and that the nodule needed no further investigating, just followup scans in a year. He also said that lymph nodes are common, so investigation is up to the doctor since my lymph nodes appear to be benign.
> 
> I feel this advice is not the best. I agree the nodule is small, but it is big enough to be biopsied. Also with the amount of lymph nodes I have that appeared over the last few months, plus the coarse texture of my thyroid and my medical history, I feel this nodule needs to be treated with more aggressiveness than if I found only an 8mm nodule with nothing else.
> 
> ...


#1. It is my humble opinion that the TSH should be suppressed in Hashimoto's to keep the antibodies quiet and also to prevent cancer. Hashi's and Graves' both have a tendency towards cancer.

#2. I do agree; it is weird and it also is not normal for a healthy thyroid. As to the symmetry or lack of thereof, I would not know what the normal parameters would be.

Anything w/ the lymph nodes "always" has to be investigated and thoroughly. If they are swollen, something "is" wrong. It could be minor such as a sinus infection or major such as Hodgkins, thyroid cancer etc.. I am sure you know the drill here on that.

I am worried w/you and we both will breathe a sigh of relief when the docs get to the bottom of this. To "know" is also to "know what to do."


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## dantetila (Jul 24, 2010)

Thanks again for the response Andros. I'm not sure if you saw the post I wrote before yours, but I called my Endocrinologist office and they informed me that the ultrasound was normal and Thyroid looks healthy. I am shell shocked really that they could even say that. I'm assuming you will agree with me that I need a new doctor.

Thanks.


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## Andros (Aug 26, 2009)

dantetila said:


> Update
> 
> Just spoke to my Endo's office and they informed me that he feels the ultrasound looks good and nothing needs to be done so they are keeping my 1 year appointment. I am quite angry right now. Am I overreacting or should I try and find a new doctor?
> 
> Thanks.


Absolutely!!! Your ultra-sound does not look good! Where is this guy coming from?

Are we sure he looked at your ultra-sound? Good grief.

You should be angry. I am angry and I don't even know you.

Hope others concur with my humble opinion.


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## dantetila (Jul 24, 2010)

Than Andros, I feel better knowing it is not just me. I called his office and asked if he looked at the right copy, they read the report to me line for line so it was definitely the right one. The secretary was actually rude as well when I asked how could it be considered normal, she responded, "Dr. Sigalas is the doctor, if there was something abnormal he would have you in his office sooner.". It is frustrating as finding a new doctor means I will have no help for a longer period of time. Oh well, that is how life goes sometimes. I just feel angry, I know they are human, but this is just silly.

Thanks again for listening to me.


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## McKenna (Jun 23, 2010)

Is your endo a surgeon? If not, then he shouldn't be making a call on a surgical issue, IMHO.

I had a situation with a large, cold nodule, I had a FNA which came back inconclusive and "rare fibrous substance". The ENT who did the biopsy said he was comfortable watching it for a year so I went to a new ENT who is doing a TT in Sept.

You can call an ENT surgeon on your own, make an appointment and tell him you want a FNA on at least one of those nodules.

My endo had nothing to do with my FNA or decision for surgery. The only thing he did tell me was that if I was having any discomfort in the throat that it was good to get it out.


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## dantetila (Jul 24, 2010)

Thanks for the response Mckenna.

No my Endo is not a surgeon. He is my primary Endo who has worked with me to make sure my Thyroid and Pancreas stays ok because I have Celiac Disease and those problems are related.

My family doctor said last Friday she is going to set me up with a surgeon to get a biopsy done on one of the lymph nodes, that is, if the surgeon agrees it is necessary (with my luck he probably wont). She asked me to work with my Endo to deal with the thyroid because he is the specialist there. I live in Canada and cannot get a surgeon without a referral from a doctor. I will let my family doctor know that my Endo is not going to help and likely she will try to set me up with something else (I hope anyways). I am just frustrated because I've asked other doctors online, board members with thyroid issues online and everyone agrees is it concerning and points to Hashimoto's or the "C" word. Then the one guy who is the specialist tells me I am fine, it just makes me wonder if I am just overreacting to the results. Although honestly I feel like he is wrong in this case.

I only have one nodule on my thyroid, which is 8mm. I know it is small, but based on the fact that it is solitary, I'm male, I'm young (24), I have Celiac Disease, have uneven thyroid glands, and have swollen lymph nodes, I would think my Endo would want to do a Thyroid Scan at the very least, but he wants to do nothing.

On the lymph node front, I have multiple lymph nodes and even though they have benign characteristics, my family doctor feels they are too big and are too many of them not to biopsy one.

Sorry I am rambling, just extremely frustrated. Thanks for your advice Andros and McKenna, I will let you know what my family doctor says Friday.


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## dantetila (Jul 24, 2010)

Hi,

I called back my Endo's office and expressed my concern that this was not just something to be brushed under the rug. She left a note for him and they just got back to me now. The secretary just called telling me that Dr. Sigalas said to see my family doctor about my thyroid. And that if I wanted to see him about the thyroid, I would need another referral because my original referral was for diabetes/pancreas testing. I wonder if this mean that he did think it was something to be looked at, but he just didn't mention anything because he wasn't my doctor for that.

His secretary said they can get me in next week. I wonder if that is a sign that they consider it something worth looking at since my original referral took 2 months to get in.

This does make me feel a little less like a hypochondriac.

Thanks for the help.

Adam Levoy


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## Andros (Aug 26, 2009)

dantetila said:


> Thanks for the response Mckenna.
> 
> No my Endo is not a surgeon. He is my primary Endo who has worked with me to make sure my Thyroid and Pancreas stays ok because I have Celiac Disease and those problems are related.
> 
> ...


We care very much what is going on with you so please keep us in the loop and of course we are most anxious to help if we can.


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## dantetila (Jul 24, 2010)

Hi Andros,

I appreciate that comment, it is very nice to have a place to talk. Even if my thyroid ends up being ok (which is unlikely based on the US), I am glad to have met such nice people here.

I'm not sure if you saw my post before yours, but I got a call from my Endo's office. The Doctor left a message for me saying for me to see my GP about my thyroid and if she wants me to see him, I'll need a new referral form since my old one wasn't for this problem. I think that is a little strange, but at least I know why. They never said he feels it is an urgent problem or anything like that, but they told me they can see me next week if the referral is in fast enough. That is a quick appointment, so I am assuming this means he agrees I need some followup.

Thanks again!


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