Thyroid nodule removal or not?

[Julesboz]

Hi all, I have a large single thyroid nodule (3.8cm). I’ve had an ultrasound scan which, although saying the nodule was low risk, recommended ENT referral. Apparently it’s unusual because it’s a single nodule and normally when they’re this large they are a part of a multinodule goitre and there’s thyroid inflammation and I don’t have that, it’s just a large single nodule.

So I saw a very good ENT specialist this morning who told me that the only way of knowing for certain if a nodule is cancerous is to remove it, and anyway once they get to about 4cm most get removed regardless of whether they are benign or not because they become obstructive. However he said he could do a needle biopsy and another US in a couple of months to see if it’s changed. He asked me if I wanted it removed regardless or whether to do the biopsy and US. I wasn’t sure so he said let’s go for the tests. He took a needle biopsy and said if anything was suspicious they’d call me back in, otherwise he’d see me in December.

However, now I’ve left the consultation and had a chance to think, I’m kind of thinking, well if it’s going to need removing anyway, why not have it done sooner rather than later before it does become a real problem? And what if it is cancerous but the biopsy proves inconclusive, wouldn’t it potentially cause more problems if it’s sat there being allowed to spread in the next couple of months? Obviously if the biopsy proves suspicious that makes the decision easier but what to do if not?

I’m wondering if anyone else here has been through similar and what you decided and how it worked out?

Thanks in advance!

[Hidden]

Any operation on the neck is dangerous and it is unlikely that any surgeon would automatically recommend it unless it was completely necessary. BUT, the longer you leave it, the more dangerous it will become to get it removed. I had no option to have my thyroid removed, in 2 stages, initially because it was strangling me as a benign goitre and causing me regular bouts of pneumonia, then the rest of it which was going berserk as a multinodular goitre causing me to feel very strange indeed, hardly able to move or even think straight.

With one like yours it is out of my personal experience but suggest you follow the advice of your ent specialist. Whereas I no longer have any faith whatsoever in what any non-ENT medic may tell me, I have the utmost faith in others, especially surgeons, who have, genuinely, saved my life 3 times and I have the scars to prove it.

Do not agree to have all of the thyroid gland removed initially if intervention is required. This will probably ensure you of some, hopefully many, years of normal life as the remainder of the thyroid should continue to work fully. When all of the gland is removed, you will be offered ONLY levothyroxine which is virtually guaranteed to leave you with unresolved hypothyroid symptoms for the rest of your life whatever dose you may take.

[Julesboz in reply to Hidden]

Thanks panda321, I’ve emailed the surgeon’s secretary and asked if it would be partial or whole removal as I’d rather not have the whole thyroid removed. I feel inclined to trust the ENT surgeon as I know someone who works with him and he’s one of the top guys locally so, as he gave me the option to have it removed sooner rather than later, I’m guessing he thinks it’s a good idea. It’s a tough decision! I think I’ll wait till I get the results of the FNA and get his answers and make a decision then.

[cjrsquared]

I initially had a large nodule with normal thyroid function. I opted for fna which was negative and then yearly ultrasound for monitoring. The nodule did indeed get larger and I developed others, it became multinodular and after 5 years it was causing problems with swallowing and breathing when lying flat. It was at this point I had surgery which turned out to be sensible as one of the newer nodules did indeed turn out to be malignant along with one lymph node. I also had one cycle of radioactive iodine to kill off any remaining thyroid tissue. I am now 5 years on and cancer free.

I do not regret waiting for surgery as my thyroid function remained normal all the way through until surgery, and trying to get thyroid replacement therapy correctly balanced has been quite challenging. It has however been very helpful to have had 5 years worth of ‘normal’ thyroid function to identify the optimum levels of ft3 and ft4 which work for me.

It is not easy to weigh up the risks but I think waiting for the results of the fna before making any decisions would give you more information. I wish you well at this worrying time.

[Julesboz in reply to cjrsquared]

Thanks cjrsquared, I’ve emailed the surgeon’s secretary asking a few more questions about surgery. But yes I think I’ll wait till I get the results of the FNA before making a final decision. Thanks again! It’s good to hear that you’re now cancer free