Suspicious Thyroid nodule

[Laralou29]

Hi

9 months ago I had some sort of virus that caused a large swollen lymph node in my neck and it wouldn’t go down. I was referred for an ultrasound and when they scanned my neck they accidentally found a lump on my thyroid.

I had a fine needle biopsy and at the time they just told me nothing to worry about it’s not cancer but we want to check it again in 9 months to be safe.

9 months later I’m currently 26 weeks pregnant and I’ve just had my 2nd fine needle biopsy.

I went for an ent appointment and they said they aren’t sure if it’s cancer or not and that my two options are cut out half my thyroid and test it for cancer and just leave it alone and forget about it 🙄 not really what I need at the moment being pregnant.

Do I need to get a second opinion because I think it’s unfair being given only these two options.

[PurpleNails Administrator]

That’s really tough & not being given really guidance doesn’t help. 

I can’t given you a recommendation on which option to choose, but before you decide I’d make sure a few step are done. 

Firstly obtain the scan report & pathology report.  There are sometimes little details which aren’t explained - but can tell you more of what you need to know. 

When they say “not sure” I’d want to know exactly why.  Is there something abnormal detected or has the sample failed - for example. 

Also important to look a thyroid function. If you do go on to have surgery you’ll need a complete prior benchmark of levels.

Sounds silly but ENT look at physical problems with a “does this need surgery” viewpoint.  They don’t alway do any blood tests or assume that the GP will deal with this aspect & often it is incomplete.  

Do you have copies or online access to results? For full test you need:

TSH

FT4

FT3

Thyroid antibodies

TPO & TG

Plus important to test

Folate 

Ferritin 

Vitamin D

B12

Include any results & ranges (ranges vary between labs - so essential to interpret) 

Did doctors seem to be leaning toward surgery or monitoring?  

This likely won’t be much comfort but when thyroid cancer isn’t certain many are prepared to wait & watch.  This is on the basis nodules are “over diagnosed” (often by accidental scanning as in your case) and even when cancer is present it rarely breaches the confines of the thyroid.  

That said - I’d know I be highly concerned at even the remotest possibility and be asking for further FNA & investigations.  

[Laralou29 in reply to PurpleNails]

thanks for your reply, all I know is that the result was inconclusive and on the letter they sent it says I have a u4 thy3a thyroid nodule.

I’ve had full thyroid panel done recently and all is fine.

The consultant didn’t give me any indication what would be best that’s what makes it harder if they said we highly recommend removal id probably go with what they say.

Reassuring to know that thyroid cancer usually stays confined.

Such a confusing time

[Hedgeree]

Hi Laralou29,

PurpleNails has given you some good suggestions in their reply.

I've recently had a partial thyroidectomy due to an indeterminate nodule (though not pregnant too old!) The surgeon did say prior to me confirming that I would have the surgery that I could decide to not have the op done but she did say she would be contacting me again in a few months to see if I'd reconsider. She was worried about the unknown factor as my nodule was indeterminate. I asked about ablation but wasn't suitable for the procedure.

Ask as many questions of the ENT clinic as you need to!

Also you have your pregnancy to look after; have you asked if you could delay making a decision till after your baby arrives? With them giving you the option to delay maybe you could ask for another FNA after you've had your baby? Then make a decision what to do.

When I was deciding wether to go ahead I was also thinking of the symptoms that I was experiencing. Are you symptomatic with the nodule? Does it make you feel like there's a lump in your throat or does it affect your swallowing? When you lie down does it make you feel like your breathing is restricted?

Obviously no one on the forum can make the decision for you.

I realise you said your recent thyroid results are good but it may be useful to post them and members can make suggestions.

Best wishes.

[Laralou29 in reply to Hedgeree]

hi

thanks so much for your reply. How are you now having some of your thyroid removed?

I have no symptoms due to it. They can’t even feel it from the outside of my neck. No problems swallowing etc altho 9 months ago when I had the swollen lymph node along side it I did feel something when I swallowed but that went once the lymph node went down. My thyroid blood results are always fine.

They did say they will see me again end of January to let them know my decision. I asked about another fine needle biopsy because I feel as having a baby that would be the best option but they told me the only do 2 then make a decision. It hasn’t grown or changed in 9 months just the same inconclusive result I think.

I’ve sort of accepted I will probably have to have it removed but my husband wants me to get a second opinion. Such a worrying time

[Hedgeree in reply to Laralou29]

Hi Laralou,

I feel ok. It's only been three weeks but doing alright though taking things slowly and a day at a time. What is surprising is although now I'm 'properly hypothyroid' (they wouldn't treat me before for a below range FT4 possible central hypo) I am now going to be prescribed levothyroxine but do feel alright possibly better than before (so far!)

From the reading that I did prior to deciding to have surgery, the operation is classed as major surgery even if you're only having partial removal of a lobe. I was told it would take an hour and a half but it took almost three hours as it was more complicated than they anticipated. I did feel quite done in afterwards and stayed in overnight.

Obviously in the future they'll be able to do more diagnostic procedures while our thyroids are intact and no need for diagnostic partial thyroidectomies. From my reading I think this is available in USA but not here yet. As I said I also wasn't suitable for ablation which they do here at a few centres in the UK.

How far on in your pregnancy will you be in January? If they send you an appointment could you not delay it then and get it rebooked?

Keep asking them questions. I was lucky as my surgeon said I could ring her secretary which I did and she always returned my calls and answered all my questions. Try to find out how much they intend to remove, is it half of your thyroid or a smaller part? What % have they given for the chance of it being cancer?

As Purplenails said previously get a copy of your report and scan info if you can. I didn't try for a second opinion but you could try and see if that's possible. You certainly don't need all this stress whilst pregnant.

Best wishes.