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Have nodules on thyroid. Getting hot flashes without sweat. Worried about medullary cancer?

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Practicing since : 2004
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I have three nodules on my thyroid. All are solid and 1-2 cm-ish. Here is the US report:
In the interpolar region of the right gland, there is a solid isoechoic 0.8 x 0.84 cm nodule. This is similar when compared to prior studies.

In the lower pole of the left gland, there is a heterogeneous solid lobular nodule that measures approximately 1.8 x1.4 x 1.6 cm. This is hypervascular and contains punctate echogenic foci compatible with microcalcifications. When compared to the prior study, the size is similar to slightly increased, and the echotexture is now more heterogeneous. In the interpolar region of the left gland, there is a solid, isoechoic 1.6 x 1.1 cm solid nodule, similar with compared to the prior study.


Bilateral solid thyroid nodules. The nodule in the lower pole of the left gland is more heterogeneous than the prior studies.

I had FNA and they said one was benign and I think they said the one with the most concerning characteristics was benign. One was inconclusive. One is atypical.

I also have lots of hot flashes without sweat so i am worried about medullary cancer. I know what hot flashes are, and these are different.

My doctor is not particularly helpful to me in understanding results. He wants repeat FNA. I suggested bloodwork and he agreed.

Thanks for any thoughts. I cannot believe I am writing to an online doctor, but the doctor I saw was so pathetic in his professionalism, I thought I may have better luck here. Thanks.
Posted Wed, 7 Nov 2012 in Cancer
Answered by Dr. Indranil Ghosh 6 hours later

Thanks for writing to us.

First of all, I am really sorry that you had a bad experience with your doctor so far.
Coming to your reports, I feel that at least one nodule, that on the left, is a bit suspicious. Though the FNA is benign, some of the USG characteristics like solid, hypervascularity and microcalcifications are suspicious for malignancy. I would certainly get another FNA and if that is negative may be excision biopsy or lobectomy (removal of the left lobe) to establish the diagnosis. The nodule with atypical characteristics may also need repeat FNA.

Flushing attacks may be a sign of medullary thyroid cancer but I am not sure whether you are actually having just hot flashes or flushing.

Hope I have answered your query. I will be available for further follow-up queries, if any.
Above answer was peer-reviewed by
Follow-up: Have nodules on thyroid. Getting hot flashes without sweat. Worried about medullary cancer? 7 hours later
Thank you for your medical impressions.

I, too, have read enough to understand that nodules in and of themselves are very common in adults (60%) of the population. And, as such, US images are used to predict----to whatever degree possible----the likelihood of malignancy. When I read articles it seems that the five characteristics most correlated with malignant findings on FNA and or exercision biopsy are:

irregular margins (do I have these?????? is that what "heterogeneous" refers to?)

echogenicity (I think my nodule does have this....please confirm?)

microcalcification (clearly stated)


hypervascularity (clearly stated).

How often (percentage) does a nodule have all or some of these characteristics (as mine does) end up being benign?

Also, please confirm (according to my report) which of the five characteristics I have.

And I really really thank you for this information. If this is too many "follow up queries", I apologize, and thank you in advance for your time.

Answered by Dr. Indranil Ghosh 4 hours later
Thanks for follow-up.

You do not have irregular margins according to this report. In fact there is no comment about margins, heterogeneous does not denote irregular margins. However, you have a hypoechoic nodule with punctate (dot-like) echogenicity. These increase the possibility of cancer.

Even if a nodule have all of these it can still be benign (20-40%).

Best wishes.
Above answer was peer-reviewed by
Follow-up: Have nodules on thyroid. Getting hot flashes without sweat. Worried about medullary cancer? 17 minutes later
Thank you.

It sounds like I have all of the characteristics except for the margins, which I assume I do not have, or it would have been stated.

And even in nodules with all 5 of these characteristics, 20-40% of them are benign.

So...if I have a repeat FNA on the most suspicious nodule and it is benign, would you suggest I leave things alone, or might you suggest taking out half my thyroid to biopsy it and confirm the diagnosis (due to the highly suspicious characteristics)?

Thank you again,
single mom of four daughters.......:-)
Answered by Dr. Indranil Ghosh 10 hours later
If the repeat FNA is benign then I may follow it up but if it is inconclusive or suspicious then I would recommend lobectomy.
If two consecutive FNA are definitely benign then chances of cancer are really low.
Above answer was peer-reviewed by
Follow-up: Have nodules on thyroid. Getting hot flashes without sweat. Worried about medullary cancer? 13 hours later
Last question:

In the 20-40% of benign nodules that have all five of the US characteristics which are most associated with malignancy, how many of these wind up being cancer down the road?

You are the first person to tell me that a nodule can look like cancer and NOT BE cancer in up to 40% of cases. This is amazingly good news.

Thanks so much.
Answered by Dr. Indranil Ghosh 37 minutes later
If a nodule is actually benign then chances of it turning into cancer in the future is very low.

Not only in thyroid but in all organs, not all which look like cancer are actually cancerous. That is why FNA or biopsy is so important!
Above answer was peer-reviewed by
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