Thyroid nodule

[zak1993]

I'm a 21 year old male and I've had a 3 cm nodule on the left side of my thyroid for about a year now. I haven't experienced any pain or other side effects, but I decided to ask my GP about it just to be on the safe side. To cut a long story short, I had a needle biopsy, which came back negative, but the ultrasound looked "suspicious" according to the surgeon that I saw. He believes I should have the left half of my thyroid removed, but when I asked him to explain why all he really said is that it has a good, predominantly central blood flow, which is a bad sign. I don't want to have surgery so I just asked what are the chances of it being cancerous and he said 50/50. I have my doubts, and I think he's just being cautious. So I guess what I'm asking is, should I have the surgery or just wait and get another checkup in 6 months or so.

Thanks

[Spareribs]

Hi and welcome Zak

Did the fine needle aspiration come back negative or was it 'inconclusive'?

I too had a 'suspect' nodule, removed after an inconclusive FNA test - although I did wonder if it was necessary and perhaps thyroid hormone treatment may have helped - to be honest, a doc saying it could be cancerous was enough for me to want that lump in my neck gone asap.

I think there is less of a tendancy to opt for immediate surgery now, more of a wait & see approach - but I would take notice of the blood flow indicator and ask more questions of your doctor.

Jane

[zak1993 in reply to Spareribs]

Thanks for the reply. Did your nodule turn out to be benign?

[Spareribs in reply to zak1993]

Yes, thankfully. A scarey few months 'tho.

I hope they know more after 4½ years, and diagnoses increasing.

[Clutter]

Zak1993, Ask for another FNA in 3 months. It's not uncommon to have 3 separate FNAs before surgery when FNA results are inconclusive although I note your result was negative. I don't know how a central blood flow affects the odds of the nodule being malignant but a large nodule >2.5cm is suspicious and I don't think your surgeon is being overcautious.

Unfortunately FNA testing isn't always conclusive either way as the small sample makes analysis difficult and the only way to be sure if the tumour is benign or malignant is when the nodule is biopsied after removal. Most thyroid cancers are extremely slow growing so the delay shouldn't be critical. If you do have a hemilobectomy and the tumour is benign your remaining thyroid will usually pick up the slack and produce the required thyroid hormone. If the tumour is papillary cancer your age puts you at low risk of recurrence so the remaining lobe will probably be left intact and you won't need radioactive iodine ablatement (RAI).

[Spareribs in reply to Clutter]

"your remaining thyroid will usually pick up the slack and produce the required thyroid hormone". the jurys still out on that one!

[Clutter in reply to Spareribs]

Not gonna argue with you, Spare. It is expected to pick up the slack, and often, but not always, does for the majority of people for a while at least.

[zak1993 in reply to Spareribs]

Do you have to take medication after having half of your thyroid removed? The surgeon kept trying to reassure me that I won't have to take anything because people only need an 8th of their thyroid for normal function =S

[Spareribs in reply to zak1993]

I could tick all symptoms but it was only when my TSH levels eventually rose above 10 that I received a prescription for T4 hormone at Xmas (4 years after op).

I know many who suffer adverse symptoms esp since their partial op, like me (& Lyn Mynott founder of TUK I think) yet will never be diagnosed until the bloods say so. This is problem we have.

They may be presuming the 8th is working normally.

[zak1993 in reply to Clutter]

Thanks for the reply. The info you gave makes me a bit more relaxed about the whole thing =)

[Clutter in reply to zak1993]

Zak, I hope you're only relaxed about possible thyCa being slow growing. It's very important you continue to monitor the nodule with follow up FNAs. ThyCa confined within the thyroid gland is usually easily removed but if it spreads beyond to the lymph nodes and other organs and mestatasises surgery is a lot more complicated and follow up treatment more onerous and not always successful.

I think thyroid levels are usually checked 6-8 weeks after hemilobectomy and although they are usually fine on half a thyroid gland it isn't always the case and some Levothyroxine may be necessary.

I don't think my thyroid levels were checked after my hemilobectomy as my tumour was malignant and I had completion thyroidectomy 3 months later. I wasn't on thyroid medication and hyper and hypo symptoms continued unabated, probably due to autoimmune attacks (Hashimoto's) on the remaining thyroid. I certainly felt better after the thyroidectomy when I was prescribed Liothyronine but probably in part because the Hashi attacks stopped when there was no longer a thyroid target.

[zak1993 in reply to Clutter]

Just thought I'd let you all know that I asked the surgeon for a follow up in 3-6 months, and he said no, haha. I was told that if I start to experience any "odd symptoms" I should go see my GP. Looks like I'm back to square one.

[Clutter in reply to zak1993]

Zak, I think that is a poor response. The nodule needs monitoring as there may not be any symptoms although changes may be going on. I think you need to discuss this with your GP to see whether monitoring can be arranged.

[zak1993 in reply to Clutter]

I think refusing the surgery may have annoyed him. I'll make an appointment with my GP for next week and see if I can sort something out.

[Clutter in reply to zak1993]

Zak, sounds like it but not a response in the best interest of the patient or considering the patient's wishes is it? I hope your GP will arrange someone else to monitor you.

[clemspoetry]

I would really consider this. I had a very similar scenario to yourself four years ago. I actually was referred to the hospital with some raised lymph nodes on the back of my neck and following an ultrasound scan - the lymph nodes in questions turned out to be nothing (just remains after a throat infection or similar). However, a 1-2 nodule was detected on my Thyroid during examination> I went through needle aspiration and they very much told me the same as you. Follow up in six months or possible partial thyroidectomy. Knowing that my stress levels could not handle the wait and my Family, Friends and my Boss at the time (who was a retired Consultant) advised me to go ahead and have the Operation. I did. All was well for two years, scar healed nicely, regular checks - there were still minute nodules on my remaining thyroid but nothing to worry about.

Then I started getting very tired, piling on weight, aching muscles, constantly hungry. And I was diagnosed with a Underactive Thyroid. I take 125 mg Thyroxine every day and to this day not sure why it just stopped working. One Doctor said it can just happen or sometimes too much of your Thyroid could have been removed. We will never know.

I am healthy now but have never really lost the weight, really have to fight with exercise and diet and actually regret jumping feet first into an operation without taking more time to research my options. I think I just panicked and if I had the choice again. I would not have had the operation. I felt alone and thought I was doing the right thing because my brain had just told me it was cancer and it actually wasn't. I have Friends now through a Thyroid health board who said I should have found them first and they would have told me to take the time. I had a young family and had never really been ill before so I thought I was making the right choice. Don't get me wrong the tablets are fine. They are what they are. But its a life long decision which could have been avoided. I will never know.

Please just take your time before making the decision. You still have time on your side. My Best wishes xx

[zak1993 in reply to clemspoetry]

I think I'm just going to wait and ask for another FNA in 3 months or so. Thanks for replying, all the comments have been really helpful.

[Barnacle4bill]

Not sure if a goitre is the same as a nodule but most of my thyroids were removed about 10 year s ago. The lump was so big it blocked my airway to the lung if I had my right arm above my head. It must have been big because whilst recuperating nurses kept coming up and asking if I was the one who had THE goitre removed. I did not know I was famous. Anyway the surgeon described that he had left a small amount of thyroid behind has the lump was non malignant. I've had no troubles since the operation and have never taken any medication for it. Had a blood test out here in the UAE where I am working at present and TSH was 3.7 with a reference range .35 to 4.94, Free T4 was only just in range but T3 was fine. So with luck and wind in the right direction it may be fine.

[Chancery]

I would err on the side of caution, Zak. You are very young and that increases the body's chance of self-recovery. Once you start down the surgery route it tends to have a cascade effect and one surgery leads to another problem leads to another intervention leads to... And on it goes. Unless the docs are saying 'DO this, do it now,' I would err on the side of caution. In my experience, surgeons in particular are very cavalier about how well the body copes without bits and tell you how 'unnecessary' they are. It's not true. Once you take bits away it ALWAYS produces a knock-on effect. And you are never quite the same.

That said, don't get lax about it and shrug off check-ups. You need to keep an eye on that mother!