Scan and Op advice for my 69yo Dad

[RachelP03]

My father (age 69yo) who has Hashimoto’s disease is about to have a Hemi-thyroidectomy as he has a 26mm nodule on his right thyroid butterfly. I have attached his scan letter which doesn’t mean much to me so any input gratefully received.

He himself wants to know if he would be better off having a full thyroidectomy to avoid having any surgery in the future should a new nodule appear on the remaining portion. Obviously he will need thyroid medication for the rest of his life but it would avoid two lots of surgery.

I’m not sure how to advise him on the scan letter or his questions. Your input would be great.

Thank you!

[apelila]

I would say NO to any surgery on the thyroid, unless a biopsy shows cancer. Nodules can come and go with nutrient deficiencies and changes. He will have hashimotos with or without a thyroid and he will still be hypothyroid with or with his organ. Have him google Izabella Wentz and make the nutritional changes she lists for nodules & goiters. It can shrink!

[Hedgeree]

Hi RachelP03,

Has your father just had the one FNA on his nodule?

I'm in a not dissimilar situation as I'm soon to have a partial thyroidectomy which came about as a bit of a 'surprise'. I'd had two FNA on a 3cm nodule and the second showed suspicious cells so was advised that it would have to be removed along with right side of my thyroid.

Obviously I can understand your father's concerns but I would personally be inclined to want to keep hold of as much of my thyroid as possible.

No one here on the forum can really suggest what your father should do as no one is medically trained so that decision would have to be discussed with the ENT surgeon.

When I had my scans I was told that many people develop nodules as they get older and don't even know that they have them. Originally I did think I could just continue to get mine monitored but wasn't expecting or hoping for it to become suspicious.

I'll alert another forum member who's replied to my posts about nodules; hope that's ok

PurpleNails

Hopefully other forum members that may have been in this situation will reply to your post.

Best wishes.

[PurpleNails Administrator]

I’ll explain some of the terms used in report -

“Borderline diagnosis of Hashimoto’s”. Scans can usually detect Hashimoto’s from the pattern visible. But they often prefer to rely on antibody testing.

“Persistent symptoms local and systemic”. This suggests not only are the thyroid levels causing ongoing symptoms there are specific throat issues such as breathing, swallowing voice or compression pain from thyroid. It that the case?

“Adenopathy” refers to lymph nodes and saliva glands. These look normal.

With Hashi also known as autoimmune thyroiditis the immune system is attacking the thyroid & causing literal destruction of the thyroid, this is what causes the shrinkage and less density to areas of the thyroid (heterogeneous - - less solid than expected)

The single nodule noted as rounded (taller> wider shape is more concerning)

Homogeneous / hyperechogenic - means denser more solid tissue.

Superior = upper & inferior = lower location of thyroid.

Avid central & peripheral vascularity means the blood to the the edge & within the nodule is great. Edge blood flow to nodules is common. Blood flow within nodule is more abnormal and what raises classification to U3 (intermediate)

U1 (normal) - no nodule

U2 (benign)

U3 (indeterminate)

solid nodule mixed or central vascularity

(No signs of lobular (taller than wider) no mention of micro calcification or lymph/gland involvement)

U4 (suspicious)

solid very hypoechoic / lobulated/

U5 (malignant)

irregular outline, microcalcification, associated lymphadenopathy.

(U1-2) should be regarded as reassuring. No need to perform an FNA UNLESS the patient has a statistically high risk

Has the FNA results come back? Often the samples do not obtain sufficient cells to test.

If the results are detecting abnormal cells then usually surgeons remove entire thyroid.

If the nodule is causing physical issues then the lobe with nodule is removed.

Does your father have confirmed diagnosis of Hashis. Have antibodies been tested? What is his currently taking replacement? If so what dose?

Full thyroid includes:

TSH, FT4, FT3. TPO & TG antibodies. Important to test folate, ferritin, B12 & Vitamin D.

Arrange private test if GP/specialist unable to test completely.

I would stress it is very important your father has a FULL thyroid for for 2 main reasons. Firstly for a baseline or benchmark to compare pre and post surgical levels.

Secondly as there is a underlying thyroid autoimmune issue it is important to ensure he is adequately medicated. Potentially - if under replacement, the thyroid and or nodule is swollen & correct treatment could reduce it. By the sound of it the thyroid is small so this might not be the case.

[RachelP03]

Thank you everyone, really helpful input and I have shared it with my Dad. Fingers crossed.