3a thyroid lump - advice on next steps please

[gcarrie]

Hello

After several trips over five months to the GP complaining about throat issues, (feeling like i had a swollen and sore throat) I was sent to an ENT who ordered an ultrasound. The radiologist found a 1cm lump on the left thyroid gland and two smaller lumps on the right lobe and then made two passes/attempts at FNA because of the larger one because of characteristics he observed including that it was hypoechoic. He also said that it was solid but had difficulty obtaining enough of a sample. The radiologist said i did not have a goiter and that he was sure the lumps/nodules were not autoimmune related. I have had thyroid antibodies but they were within the normal range. The result of the FNA cell analyais was a Thy 3a- --stating that it was a follicular legion of unknown significance.

The ENT doctor has suggested a repeat FNA cytology in a few weeks. Is the Afirma test available in the UK?

I have a nunber of symptoms such as a swollen tongue, difficulty swallowing and pain along my right jaw and sometimes the right inner ear. The radiologist said he thought the lump was too small to be causing my symptoms. I am a little worried as i have also recently been diagnosed as having an off the charts level of intraepithileal lymphocytes (IELs) in my small intestine but the cause for this has not been found despite many tests. The current diagnosis from my gastroenterologist is that i am a resistant celiac and the high the very high IELs means that it could turn into an agressive lymphoma of the small intestine so it has to be monitored with repeat endoscopy and colonoscopy . Although i was never diagnosed with celiac disease i stopped eating any gluten or dairy almost four years ago in an effort to improve my longstanding gastrointestinal issues/pain.

Any thoughts or advice would be much appreciated?

Thank you

[shaws Administrator]

Hi, I'm very sorry I am not able to answer your question but someone who has had similar symptoms/diagnosis to yourself will be along soon to help. It is a minefield at times.

[gcarrie in reply to shaws]

Thank you... It is so kovely of you to respond so quickly

[annie-7]

Hi gcarrie, hoping this might be helpful. I have a single thyroid nodule, also described as hypoechoic. I had the same pain as you describe in my jaw/ear. I'd had this pain for years before my diagnosis of Hypothyroidism.

I decided to do nothing and then have another scan 6 months later, as my nodule is just under 1cm. They scanned me again, it hadn't got any bigger, so then they discharged me.

I don't think that the Afirma test is available in UK, which is why I refused the FNA, I felt that one thing could easily lead to another and I would end up with no thyroid and no effective treatment. They were quite blasé about taking out my thyroid gland.

I will add that the pain has now gone with adequate T4 and especially T3. I am feeling a lot better now and I have also read a lot of info on here and other sites/books. I was also vitamin D deficient, I felt better after supplementing this.

Sorry I don't know anything about the second part of your post, I'm sure someone will comment soon.

[gcarrie in reply to annie-7]

Thank you for your reply. It was very helpful. If I understood correctly you are taking the T4 and T3 because of your hypothyroid diagnosis. Do you continue to have ultrasounds to monitor the size of the nodules? If so how often is sensible? I heard that the most common thyroid cancers are very slow growing. Or did you simply decide that your symptoms were all due to being hypothyroid? My TSH, T4 and T3 have all been well within the normal range although I feel very unwell. Thank you again.

[annie-7 in reply to gcarrie]

I think that the nodule had been there at least 20 years, with lots of (what I now know) Hypo symptoms before I received the diagnosis. I think that the (ENT) consultant was a bit taken aback at my decision to not launch straight into FNA/Surgery etc. I have history with this particular hospital, so there is not much trust there. I now question everything.

I have not been offered any more scans as there was no change in the size of nodule over 6 months. Obviously, if I start to get any odd symptoms I'll go back.

I did feel awful on T4 alone and it wasn't untill I added some T3 that I started to feel a bit better, and then the ear/neck/throat pain disappeared. Over time I have learned that for me to feel well my FT3 has to be at the top of the range, thus making my TSH almost suppressed. I also used to have a choking sensation, sore throat and choking on food/drink - this has also got better now.

I do hope you feel better soon and that you get some answers.

[gcarrie in reply to annie-7]

Thank you again very much for sharing... It has been extremely helpful. Wishing you the best.

[Clutter]

gcarrie, thy3 is an inconclusive result. Have the repeat FNA in 3 or 4 months. Some members have had 2 or 3 inconclusive results and then had hemilobectomy which proved to be benign in histopathology. I had hemilobectomy after an inconclusive result because the nodule was compressing my trachea. Histopathology was malignant and I had follow up completion thyroidectomy 3 months later.

I don't think the Affirma test is available in the UK.

[gcarrie]

Hi Clutter. Thank you so much for your reply. Its really unfortunate that the Affirma test is not available here yet. It sounds like a much more diagnostically accurate way of deciding whether or not to worry about and continue to monitor nodule (or worse yet take out a benign one). Did the ultrasound determine that your nodule was compressing your trachea or did the doctors undertake an MRI or CT scan or go by your symptoms? I think I read elsewhere that your nodule was 2 cm?

I constantly have a trouble swallowing, occasionally have food or drink go down the wrong way, and my throat feels swollen but I am told I do not have a goiter. The radiologist who undertook the US said that he thought the 3 nodules he saw only one of which was 1 cm were two small to be responsible for my symptoms.

Any opinions or suggestions for more reading would be very gratefully received.

[Clutter in reply to gcarrie]

Gcarrie, I had a sensation of something stuck in my throat going back 15+ years but there was no palpable lump detected then and it was suggested I had Globus sensation.

A lump appeared in my neck overnight and the ultrasound scan showed the nodule was 2.5 or 2.8cm and was compressing the trachea. I had no goitre. My symptoms were mostly hyper at first but thyroid levels were euthyroid with elevated thyroid peroxidase antibodies so I was told symptoms were non-thyroidal. I didn't believe it, and as symptoms resolved after thyroidectomy I'm convinced that Hashimoto's caused the symptoms.