Possible FNA biopsy of thyroid needed

[Crzygirl]

HI, I had a thyroid ultrasound last year due to ALL bloodwork, including antibioties being completely normal. I just had another US done along with bloodwork which is ALL completely normal again.

This time my US says "the right lobe appears heterogeneous. There are numerous tiny sub centimeter nodules. The largest nodule is in the posterior mid region and contains multiple tiny foci. This nodule measures 11.4 x 7.5 x 3.0 mm. IMPRESSION: Dominant nodule containing microcalcifications is seen in the mid aspect of the right lobe. This lesion was NOT seen on the prior study and is ammenable to FNA if clinically warranted.

(Left lobe appears heterogeneous. There are numerous sub centimeter nodules).

My doctor was convinced I had Hashimotos, but I've had EVERY test run and it is all completely normal, BUT I do have symptoms of hypothyroid......From the exhaustion to hair loss, dry skin, exzema,muscle pain,headaches, canker sores, weight gain for no reason, depression. I've even tried antidepressants which do not work for me, only bad side effects. Honestly at this point I would not mind a cancer diagnosis, I am so sick of feeling sick with no answers. Any thoughts would be appreciated. All of my vitamins are also fine, I am supplementing and at a good range. This was also tested, along with all hormones. My neurologist who I see for my headaches has also run tests for inflammation etc. I don't have MS, Lupis, NOTHING. I've had every test immaginalbe done, Also celiac blood test is negative. I tried to go "gluten free" but many products are made in a facility that contain tree nuts, which I am highly allergic to :/

Could I still have a thyroid problem even if all blood work is completely normal?

[Nanaedake]

It is possible to have normal bloods and have a thyroid problem but I can't tell you what your results mean, too complicated for a non medical person like me. Will they do more investigations and what next? I had 3 FNA and then the consultant recommended a surgical biopsy so it took 10 months to get diagnosed. It can be a bit of a drawn out process.

[Nanaedake]

By the way, FNA is ok, I didn't find it painful, just a bit uncomfortable. It didn't cause me any problems.

[Crzygirl in reply to Nanaedake]

Did they find that you had a thyroid problem after the biopsy? I have heard the fine needle aspirate route can be inconclusive many times. And was your blood work also all normal? I see the new doctor about the thyroid in a few weeks, I'm just assuming they'll do a FNA. I'm just afraid it will be inconclusive also. At this point if I need a full biopsy I'm fine with that.

[Nanaedake in reply to Crzygirl]

My blood work was normal. They could not determine a diagnosis after 3 FNA which was why I needed a surgical biopsy.

I think it can be a bit hit and miss sometimes with FNA but maybe it was the lab? I guess it might depend on the experience of the people doing the FNA and then those doing the evaluation of results?

After the surgical biopsy they were able to diagnose.

[Crzygirl in reply to Nanaedake]

Thank you for responding. If they do schedule a fna & it's inconclusive I will push for a biopsy. I hope you are well after finally getting a diagnosis.

[Nanaedake in reply to Crzygirl]

You shouldn't need to push for a biopsy, if they can't determine the diagnosis with FNA they might repeat a month or so later but they should advise the next course of action. Many nodules are harmless and indolent so you'll have to take their advice. Ask for and keep a copy of all results to track investigations done. Then you can make sense of them and keep a record less likely to be lost.

I'm fine but it's taken 10 years to get to this point. I didn't have this forum at the start and then was too ill to follow the good advice. I'm sure you won't have the same trouble, you've got this forum to help and support you.

[Inaquandary]

Hi, I just wondered how things are now? Did you get any further? I am 2 weeks after having Total Thyroidectomy... My thyroid was the size of a tin can!!

[Crzygirl in reply to Inaquandary]

Have gotten nowhere! From my second ultrasound showing micro calcification the ENT agreed I should have a FNA. I went to schedule it & because the nodule is only 1cm the hospital won’t do it. And another radiologist read the ultrasound & didn’t see micro calcification. So now my doc wants me to see another endocrinologist. So my second ultrasound is completely useless since no one agrees on what they see.....back to nothing!

[Inaquandary in reply to Crzygirl]

The ENT guy I saw referred my to a surgeon rather than an endo. My thyroid tumour was 4.5cm across and I had 59 lymph nodes temoved, 22 of which were cancerous. The worrying thing was the 2 FNAs I had were inconclusive. The only thing that gave any definite results was an MRI scan. I ended up going private, so glad I did.

[Crzygirl in reply to Inaquandary]

Wow! That’s insane. Did your MRI show cancer? My doc won’t send me to a surgeon because the nodule is so small. And was all of your thyroid bloodwork normal? I’m glad you pushed. I know someone who had normal bloodwork also & her nodules we’re wrapped all around her trachea. They never did a FNA on her because the tumor was so large - straight to surgery.

[Inaquandary in reply to Crzygirl]

Hi.. Yes my blood tests showed nothing out of the ordinary except vitamin D deficiency and antibodies were 608. My thyroid was the size of a coke tin. It was expensive to go private but wirth every penny. NHS would still be drawing diagrams. If you look at my other posts you will see photos of my neck... Not pretty! X

[Crzygirl]

I’m seeing private docs. I’m in the US, I’ve had antibioties tested twice. That’s normal also. Just a bunch of hypo symptoms that can’t be explained :/

[vocalEK]

"Completely normal" is not the same thing as optimal. And you need to be optimal to be as free of symptoms as possible. I suggest you join the Thyroid UK community. This is a post from SlowDragon, an Admin of that community:

"For full Thyroid evaluation you need TSH, FT4, FT3 plus TPO and TG thyroid antibodies and also very important to test vitamin D, folate, ferritin and B12

Private testing recommended here tests ALL these

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers. £99 often reduced to £79

Ask GP to test vitamin levels

All thyroid tests should ideally be done as early as possible in morning and fasting. When on Levothyroxine, take last dose 24 hours prior to test, and take next dose straight after test. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's. Low vitamins are especially common with Hashimoto's.

Food intolerances are very common too, especially gluten.

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ideally ask GP for coeliac blood test first." healthunlocked.com/thyroidu...

[vocalEK in reply to vocalEK]

Most docs think that anywhere within range is "completely normal", but the free thyroid hormones, Free T4 and Free T3 need to be optimal. That is above the mid-point of your lab's standard range for FT4 and in the top quartile for FT3. restartmed.com/normal-thyro...