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    Have nodular goiter. Tested for thyroid hormones. Which specialist should I consult?

Posted on Sat, 23 Feb 2013 in Thyroid Problem and Hormonal Problems
Question: I have a goiter starting growing with nodules 15 years ago - that was when I noticed it. The lobes have been bigger about 5 cm and the other the left on 7 cm. Several nodules in both - The left lobe is diffusely heterogeneous and enlarged. The dominant nodule is up to 4.4 x 2.7 x 3.5 cm. that specific nodule has grown bigger from 2 cm 8 months ago - On the ultrasound in March 2012 it was about 2 cm and the last in Nov. the measurements above. This measured nodule is the major issue between the ultrasounds. The nodule was biopsied in May and the biopsy showed: FNA left lower pole: Adequacy: Limited by scant/borderline epitehlial cell component - 4 to 6 groups of folliculare cells present with scant colloid.
General category: Benign thyrod nodule - negative for malignant cells or neoplasm.
Interpretation: Cystic lesion favor cystic change in an adenomatoid nodule., exact classification is limited due to lack of sufficient epithelial cells - no malignant cells identified.

2. Left lower pole FNA:
Adequasy - Non-diagnostic due to lack of sufficient epithelial cells - less than 6 groups of follicular cells present - the specimen consists primarily of peripheral blood elements.
General category: Non- diagnostic
Interpretation: The thin prep smear and the cell block section reveals hemosiderin laden macrophages, RBC's as well as admixed inflammatory cells.
This biopsy is from May - and I was never contacted about the content - only set up for another doppler imaging in Nov. At that time going to the MD to find out about the new scan done I was sick and had to wait until middle of XXXXXXX and then to find out that the nodule complex one was so large.
I was advised to remove the lobe but asked for another biopsy and that oneis set up for Febr 1.

I understand that the thyroid should most likely be removed and also looking for the best surgeons on the east coast of FL - I am 2 hours + north of Fort Lauderdale.
I have fibromyalgia and lately a sore throat and feel thatsomething is there on the left side. To me the nodule looks outside about the same for some years now.

Greatful for an answer - the MD I have now general surgeon and does only about 2 - 3 operations per month of thyrodectomies.

Also like to continue - the impression from the last doppler: Heterogenous appearance of the thyroid with interval enlargement of the left thyrod lobe compard to the prior exam and multiple nodules. Dominant nodlue measuring up to 1.7 cm in the mid right thyroid lobe likely representing the previously noted dominant nodule on the prior exam likely not significantly changed. Heterogeneous nodule in theleft thyroid lobe measuring up to 4.4 cm - increased in size since the prior exam.
Also - on the report from November on the finding noted is - that in the upper right thyroid lobe a complex 7 x 6 x 6 predominately hypoechoic nodule noticed.

Other wordings are: isoechoic 1.7 x 1.2 x 1.8 cm round nocule in themid right thyroid lobe representing dominnant nodule on prior exam in March.

In the left mentioned are heterogeneous nodule noted and there is a large echogenic focus with posterior shadowing in the uppe pole of the left thyroid 6mm.

The left thyroid lobe is diffusely heterogeneous and enlarged. And there is where the dominant nodule is up to 4.4 x 2.7 x 3.5 cm.
Answered by Dr. P.V Pradeep 2 hours later

Thanks for sharing your concern here. I have gone through all the details that you have mentioned.

You have a multinodular goiter which has grown in size. Even though you have not mentioned about the levels of thyroid hormones (ie. values of T3/T4/TSH) I understand that it may be normal. In view of the age of the patient and repeated non diagnostic aspirates, please find an endocrine surgeon in your area and get a Total thyroidectomy performed.

Surgical expertise is most important, since if performed by a surgeon who does occasional thyroid surgery, then you may land up with complications like voice change, breathing difficulty, and permanent decrease in levels of calcium due to the damage to parathyroids. Hence get yourself operated by a high volume surgeon that is somebody who operates atleast 100 thyroid per year (10-12 cases per month). In my center, we have the expertise but you have to travel long distance.

Hope I have been able to guide you. Let me know if you need any further clarifications.

With warm regards
Above answer was peer-reviewed by : Dr. Mohammed Kappan
Follow up: Dr. P.V Pradeep 8 hours later
Dear Dr!

As we are new in the Florida area do you have any suggestions for surgery thyroid doctors - I have done some research on the internet and found a Doctor in Boynton Beach XXXXXXX Goldhaber and on the list from XXXXXXX Shomon. Would you have any other suggestions.?

And due to the size and growth I am very concerned and now when I have a sore throat and then feeling the problem more. What are the odds for malignancy? with something like this? Surely as I have not been feeling good from migraine and fibromyalgia for the whole year - this makes me nervous on top of all this. Values of bloodwork normal - hope you got my follow up question
Thank you,XXXXXXX
Answered by Dr. P.V Pradeep 2 hours later

Please try

Memorial Center for Integrative Endocrine Surgery
Contact Information
Memorial Medical Office Centre
1150 North 35 Avenue, Suite 200
Hollywood, Florida 0000

It looks "non malignant" for now. Histopathological studies done following removal of the thyroid will confirm the status of thyroid.

Above answer was peer-reviewed by : Dr. Prasad
Follow up: Dr. P.V Pradeep 3 hours later

Thank you so much for your prompt answer and I will call the referral - I am such a freak when it comes to sedation - having only had one after miscarrige 25 years ago - and that is all! It is safe now isn't it!!!???

Just beside the point two of my girls are veterinarians and one in Surgery living in Hollywood, and they think I am pretty crazy sometimes......

Thank you again for your rapid answer.

Answered by Dr. P.V Pradeep 7 hours later

Thanks for asking me.

Hope you have an uneventful surgery and quick recovery.

Please let me know if you have any other queries related to the same. Otherwise please close and review this query. Thanks.

Take care
Above answer was peer-reviewed by : Dr. Mohammed Kappan
Follow up: Dr. P.V Pradeep 4 days later
Hi again!

do you have additional hospitals for specialist thyroid surgeries also? Can a thyroid give hot flashes and more frequent headaches and nervous symtoms also - I get anxiety and panic and my thinking puts obstacles in my way.
At onetime in the beginning of the thyroid problem I was given synthroid and did not tolerate that at all got heart palpitations - but my understanding after surgery when no hormones are produced this should not happen - or? Are there also other hormone meds?
I go back for the biopsy next week for the larger nodule as the other report reflected the May biopsy - but I know this Doctor is not doing enough of thyrodectomies for me to be comfortable.
Thank you,
Also panic anxiety and depression and tiredness can that be part of this thyroid issue? The bloodwork by the way was: FT4 result 1.1 rANGE 0.8-1.9, t3 1.0 range 0.8 - 1.8 and uTSH 0.596 range 0.4000 - 4.000
Answered by Dr. P.V Pradeep 15 hours later

There are many centers and surgeons in USA known for their dedicated work in thyroids. I mean surgery of thyroid

They include:

Dr XXXXXXX Perrier, The University of XXXXXXX MD XXXXXXX Cancer Center
Department of Surgical Oncology, Unit 1484
Houston, TX 0000-1402

Massachusetts General Hospital
15 Parkman Street, WACC 460
Boston, MA 0000

2920D Taubman Center
1500 E. Medical Center Drive XXXXXXX Arbor, MI 0000-5331

Thyroid disease generally will not give those symptoms which you mentioned. It can happen in thyroid disease if you have high levels of thyroid hormones in circulation like hyperthyroidism. We can also see these symptoms in a condition called "Medullary Thyroid cancer" wherein the affected individual will also have associated adrenal gland tumor called pheochromocytoma. But your FNAC results are always non malignant.

I dont think you need any more biposies since it will not add much to the information we have and more or less the thyroid surgery which you have to undergo will be the same that is a "Total Thyroidectomy"

Warm regards

Take care
Above answer was peer-reviewed by : Dr. Mohammed Kappan
Answered by
Dr. P.V Pradeep


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