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Hi, Everyone,
I am a 48-year-old female. The result of my first ultrasound in November: The "ill-defined irregular hypoechoic focus...measuring approximately 2.8 cm...probably corresponds to an area of heterogeneity as opposed to a discrete nodule...No well-defined nodules are delineated...." This sounded fine to me, but my doctor ordered a second ultrasound in a few months.
The second ultrasound prompted a call from my doctor that the area is still there, and it is now only a "smidge smaller" at 2.6 cm. Her concern is that "after six months" (it was actually four and a half months) the cyst has not shrunk enough. My doctor wants me to have a fine needle aspiration to rule out cancer. Walt, does this sound right to you? I have been under a lot of stress at work from December through March, and I am surprised it shrunk at all.
The cyst is both fluid and solid. Does this sound suspicious? It doesn't feel hard, but I understand that a malignant tumor on the thyroid cannot be differentiated based on touch.
I am afraid I'll have the fine needle aspiration, get an indeterminate result and be pressured to have a possibly unnecessary thyroidectomy. I understand that Tipper Gore got two indeterminate results from FNA and submitted to a thyroidectomy (not sure if it was total or not). The tissue biopsy done after surgery revealed that Tipper's thyroid was normal. I wonder how often this happens. I would be terribly upset if I were to give up a perfectly healthy thyroid because possibly unnecessary tests were done and were inconclusive.
I'm having trouble thinking clearly. I have read the archives and am more informed, but I still have a couple of questions. Would it be unwise to skip the fine needle aspiration and have another ultrasound in a few months to see if there is significant shrinkage? How much should a cyst shrink in four and a half months?
I don't want to repeat Tipper's experience. She of all people should have had access to excellent health care. Walt, if you or anyone else can educate me or help me sort this out, I would really appreciate it. Thank you for any advice.
In Reply to: Fine Needle Aspiration for Thyroid Cyst posted by Confused on April 06, 2002 at 16:23:12:
Hi, Confused -
I have had a thyroid nodule for at least a few years. It has not grown since the time I learned about it (my "doctor"
said he knew about it but didn't think it was important enough to tell me - then during a routine exam by an endocrinologist for my osteoporosis, I learned that I had it. When I got my records, there was an incidental note saying that I had the thyroid nodule and was euthyroid.
So, I asked him about it and he said it would be best to biopsy it even though he didn't think it was cancerous.
I'm glad it was biopsied (turned out negative). Now I remind them to check it each time I go for my yearly exam.
If your nodule has grown, in my opinion you should have it biopsied. The procedure is simple - even if you had to have another biopsy. I have had several friends who have had a thyroid lump removed and they didn't remove the entire thyroid. I also have a friend who has never had her 3 nodules biopsied because no one has mentioned it to her.
But, if your doctor recommends it and if you trust his judgment, then please do it. Otherwise, you should really find another doctor whom you can trust - difficult as it is.
Sorry this is so long. Raisa
In Reply to: Fine Needle Aspiration for Thyroid Cyst posted by Confused on April 06, 2002 at 16:23:12:
Hi, Confused.
The test that would do this for me is the RAI diagnostic tracer dye scan. IF the nodule is "cold" I would get the biopsy. If it is "hot" or normal I would not.
I am surprised that you did not mention this having been done.
Walt
In Reply to: Re: Fine Needle Aspiration for Thyroid Cyst posted by Walt Stoll on April 07, 2002 at 08:04:48:
Hi, Walt -
Neither ultrasound nor the RAI test you mention was given to me as an alternative to the needle biopsy for my thyroid nodule. Does this have to do with money or what? The endocrinologist himself did the biopsy, and I believe they own the laboratory which
analyzed it. Also, is having the needle biopsy dangerous?
i.e. does it cause the cancer to spread if it is malignant?
Thanks. Raisa
In Reply to: Fine Needle Aspiration for Thyroid Cyst posted by Confused on April 06, 2002 at 16:23:12:
Hi Confused:
I had about 7 nodules on my thyroid, discovered by a vascular surgeon while he was examining me for something else. He sent me to a general surgeon who, though he could not palpate anything, sent me for an ultrasound-guided biopsy. When the results of the biopsy came back indeterminate, he recommended surgical removal of one lobe.
I read through Dr. Stoll's posts here on the effect of stress on the thyroid and elected to try to consistently practice at least an hour of relaxation a day for 6 months and see what happened.
6 months later, I went to see an endocrinologist (NOT the general surgeon!) who checked me again and found absolutely nothing.
Dr. Stoll says over and over of surgeons, "To a hammer, everything looks like a nail" and though your situation might be different from mine, NOT taking the advice of the surgeon was a very fine decision for me. He was a very nice man who was doing what he thought was best for me in his opinion and experience. But I believe I knew more about myself and my ability to heal than he did.
Are you seeing a surgeon or an endocrinologist, BTW?
Good luck,
Laura
In Reply to: Re: Fine Needle Aspiration for Thyroid Cyst posted by Laura S. on April 07, 2002 at 18:06:49:
Hi, Laura,
Thank you for responding and for your inspiring words. I have been a fan of Dr. Stoll and this bulletin board for a couple years now. There are wonderful people here!
I have been doing skilled relaxation, but on most days I did not make the two sessions. How were you able to be consistent at an hour a day, every day?
I am with an HMO, and my primary doctor (an internist) is referring me to an endo.
I admire what you have done for your health! Did you also follow the aerobics and whole foods diet recommendations?
I am impressed that you "knew" the proper path in the face of the "experts" telling you that you might have cancer and that you should have the surgery soon. I think I would freak out if I heard that, and I am afraid the pressure to have surgery to arrest a possible cancer would get to me. But perhaps I would stand firm, too, if my instincts said to. You are so much better off. You have saved your thyroid! I hope my story will turn out like yours. Thank you.
In Reply to: Re: Fine Needle Aspiration for Thyroid Cyst posted by Confused on April 07, 2002 at 18:47:27:
Hi:
Because I am a singer and voice teacher, I was extremely concerned about having surgery so near the recurrent laryngeal nerve so I read a lot about thyroid cancer and thyroidectomy. Once I saw how low the chances were of my actually having thyroid cancer with the indeterminate results I had as opposed to how high a risk I ran of having unnecessary surgey and thyroid replacement drugs for life, I felt comfortable waiting 6 months.
I managed the relaxation by scheduling it in. I went to the gym at 5:30 in the morning, came back and "relaxed" for an hour before I started my day. My husband kept the kids upstairs until I was through. It helped that it was summer for half of it and I didn't have to worry about getting the kids ready for school.
No, I did not go cold turkey on a whole foods diet, but have been practicing a modified version for years.
Thank you for your kind words! I'm afraid I'm not so disciplined now that my "crisis" has passed. You remind me that I need to renew my commitment to good health.
Take care,
Laura
In Reply to: Fine Needle Aspiration for Thyroid Cyst posted by Confused on April 06, 2002 at 16:23:12:
I've had a thyroid nodule for at least 18 years. Two FNAs during that time (not horrible experiences) told me that it was not cancerous. Surgeon told me that I could have it removed (don't know if he meant just the nodule or the whole thyroid) if it bothered me, but that I didn't have to do that. Synthroid for 11 years seemed to cause more problems than it was supposed to have solved, so I don't take that anymore. Just a complete nutritional supplement and that's seemed to do more good than anything else I've ever tried. The nodule has shrunk considerably, I sleep at night and my energy has returned to normal. I'm glad you're not rushing into surgery. You can't undo that damage.
In Reply to: Fine Needle Aspiration for Thyroid Cyst posted by Confused on April 06, 2002 at 16:23:12:
Thank you, everyone!
In Reply to: Re: Fine Needle Aspiration for Thyroid Cyst posted by Raisa on April 07, 2002 at 12:31:52:
Hi, Raisa.
Personally, I would not consider a needle biopsy prior to an RAI uptake scan showing a cold nodule.
Remember the old adage: "To a hammer, everything looks like a nail." Docs tend to do what they feel competent to do, not necessarily what is best for the patient.
Walt
In Reply to: Re: Fine Needle Aspiration for Thyroid Cyst posted by Laura S. on April 07, 2002 at 18:06:49:
Thanks, Laura S.
Now, be sure to take to heart the "awarening" confused has inadvertantly given you.
Namaste`
Walt
In Reply to: Re: Fine Needle Aspiration for Thyroid Cyst posted by Walt Stoll on April 08, 2002 at 11:26:50:
Walt,
Why specifically would you be reluctant to have a needle biopsy, favoring instead the RAI uptake scan?
Thank you.
In Reply to: Re: Fine Needle Aspiration for Thyroid Cyst posted by Much Less Confused on April 08, 2002 at 15:19:26:
Hi, Much.
First you need to understand what a "cold nodule" is.
Has your docs not explained that to you?
Get them to explain "cold nodules" and why; "hot nodules" and why; "euthyroid nodules" and why. RAI uptake makes these determinations.
THEN, if you still have questions, write again.
Walt
In Reply to: Re: Fine Needle Aspiration for Thyroid Cyst posted by Walt Stoll on April 09, 2002 at 09:46:32:
Walt,
I called my doctor and asked her to explain hot, cold, and euthryroid nodules at your suggestion. She was helpful, but I felt that I knew more than she did just from searching the internet. She said she does not know why I thought perhaps I should have the radio iodine uptake scan instead of, or before, having a needle biopsy. She said the needle biopsy is definitive. I suspect cost-cutting is a factor in this course of diagnosis; I am with an HMO.
Can you run down for me the disadvantages of needle biopsy. I am a bit reluctant to have this done, as my sister had a needle biopsy that yielded a negative result while she had breast cancer! I understand that false negatives are 1-4% and false positives are 1% (maybe this is only for thyroid cancer). Are there other concerns I should be aware of?
I can make an extra appointment with an endo before the biopsy, but I think that may be a waste of time, since needle biopsy is the standard treatment method at my HMO and in general, I understand; it was the endo who told my doctor to order a needle biopsy for me. The reasons as I understand it, are because I had a 2.8 cm cyst that was partly solid that had not decreased significantly in size.
What I need is information about the pros and cons of radio iodine uptake scans versus fine needle aspiration biopsies. I haven't found much in my research, and I ask specifically because Walt, you seemed to strongly prefer the uptake scan, and I'm not sure why.
My HMO said the risks for needle biopsy are minimal: In one in 6-7,000 cases, there is a possibility of hematoma. Well, I can deal with hematoma. Is there more to it than that?
I wonder if the radio iodine uptake scan is dangerous. I know there is controversy surrounding the RAI procedure for destroying the thyroid (my sister just had that done on Friday for her hot nodules).
I need to make some decisions soon, and I would really appreciate any input I can receive on this board. Thanks very much!
In Reply to: Re: Fine Needle Aspiration for Thyroid Cyst posted by Cystic Thyroid on April 11, 2002 at 12:08:25:
Hi, Cystic.
Your doc is right, a needle biopsy MAY be definitive anthough they are not infallible either since such a small piece is taken.
My rational is that only a cold nodule needs a biopsy. All the rest can easily be reversed by wellness. See the testimonials in the archives OR even just those within the past 2 months that have not been archived yet.
This is the piece of the puzzle your doc doesn't know yet! NOn cancerous thyroid nodules ARE reversable within a few months by doing a wellness program.
A needle biopsy IS surgery and all surgeries have complications. A nedle biopsy is pretty safe but I would not have one if it was not needed. Be sure to get those complications from your doc. I will bet that she has not said anything about them to you.
Walt
In Reply to: Re: Fine Needle Aspiration for Thyroid Cyst (Archive in thyroid.) posted by Walt Stoll on April 12, 2002 at 18:03:28:
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