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Have swollen throat and brain fog. Test showed heterogeneous thyroid tissue and colloid cysts. Any ideas?

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Radiologist, Nuclear Medicine
Practicing since : 1991
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My daughter is almost 13 years old. She has had throat swelling since dec/11 but no dr can visibly see the problem. Reactine doesn't help. Since April she has had brain fog, visual floater, inability to focus to read or write, low blood pressure, fainy feeling, plugged ears, cold hands feet, inability to lose weight (for years), Head pressure, dry ncomfortable eyes that feel heavy in the eyelid, dizziness, tingling in hands feet that has lead to leg and arm weakness/numbness,limbs feel heavy, low body temperature, full feeling in neck, pressure and pain in neck, can't lay down due to choking feeling, difficulty swallowing. Shortness of breath with oressure in throat. Chest heaviness and pain. Tests done, bloodwork, cat scan of head, MRI of head and recently a thyroid ultrasound that revealed a heterogeneous thyroid tissue, two colloid cysts measuring 2 mm each on lower left lobe, 3mm colloid cyst lower pole of right lobe, 3x3x2 mm hypoechoic nodule at mid portion of right lobe and several tiny colloid cysts all over. Would these cysts cause symtpoms? I am awaiting further follow up instruction from drs but am curious as o what these results mean and if they are causing her health problems. Free t3 is 5.2, free t4 is 8.7 and tsh is it possible she is hypothyroid? How does a person treat these cysts if they are causing a problem? Does her hyoid have to be removed?
Posted Mon, 24 Dec 2012 in X-ray, Lab tests and Scans
Answered by Dr. Manoranjan Chowhan 10 hours later

Thanks for the query.

Though the symptoms that you mentioned may be due to thyroid disease, she will need a detailed clinical examination and further test to confirm and treat the condition.

It would have been better if you had specified the units of thyroid hormones measures (free T3, freeT4 and TSH) because if the TSH is in 'microIU/ml', the value 2.84 lies within normal range -that means she is not hypothyroid.

As you have mentioned, she has multinodular Goiter and USG says there are 2 hypoechoic nodules in mid portion of right lobe apart from several colloid cysts (these are benign), a FNAC is required from the thyroid nodule (FNAC guided) to rule out other possibility and accordingly a decision can be arrived at whether surgery is right option (As after surgery she has to be on replacement therapy with Thyroxine for rest of her life) besides the trauma of surgery or can be managed with a conservative management.

Large multinodular goiter (MNG) can give rise pressure symptoms and particularly if there is retrosternal extension. In case 'MNG of Thyroid' is responsible for pressure symptoms then surgery will be required to treat it irrespective of FNAC report. Otherwise the decision of surgery should be taken after doing FNAC of Thyroid nodule.

As far as the cysts are concerned, if these are benign and simple cysts the same can be treated by simple aspiration.

In brief, all her current symptoms may not be linked to the thyroid gland especially when they are hardly noticeable. However further testing as described above need to be performed in order to safely proceed with the next steps of management (if at all needed).

I hope I am clear to you. Please write back if you have any enquiries.

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