HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

How Can A Nodule In The Thyroid Gland Be Treated?

Posted on Wed, 28 Jun 2017

Question: I have a large growth on left lobe of my thyroid. Multi needle bx, results non-diagnostic. Could cyberknife surgery be used to destroy this growth ?

Answered by Dr. Mirjeta Guni (1 hour later)

Brief Answer:
About thyroid nodules;

Detailed Answer:
Hello and thank you for asking!
I have gone carefully through your concern.
If the FNA is inconclusive, to decide the treatment of choice the ultrasound characteristics are very important.
If there are suspicious characteristics in ultrasound, surgery is recommended.
Otherwise, if ultrasound shows typical benign nodule, probably cyber knife would be recommended.
Hope the information will help.
Kind regards,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Mirjeta Guni (3 hours later)

Ultra sound does not say benign nodule.
10/25/2016 "Large complex heterogenous nodule in the left thyroid lobe measuring 4.9cm. demonstrating internal color flow. Few echogenic foci are seen within this nodule."
4/25/2107 "Large inhomogeneous complex-appearing nodular area occupying the middle portion of the left lobe measuring 5.6x2.5 x 3.2 cm. This includes a 1.5 x .09 cm cystic area at one end of nodular area.
There is a benign appearing section 2 lymph node in the rt. neck. There is a benign appearing section 6 lymph node in the left neck."
Is surgery the only treatment or continue to ultra sound and biopsy frequently? I am not symptomatic.

Answered by Dr. Mirjeta Guni (1 hour later)

Brief Answer:
About thyroid nodules:

Detailed Answer:
Welcome back!

At this point, scintiscan of the thyroid gland would be of help.

If the nodules are not cold in scintiscan, the chances of malignancy are very low and there is no need to repeat the ultrasound as long as you do not have compressive symptoms (cough, difficulty in breathing).

If in the future the nodules increase, radioactive iodine may be suggested to shrink them.

Otherwise, if the nodules are cold (chances for malignancy are higher) I would recommend surgery as the nodules are too big and have had a tendency to increase in dimensions.

In big nodules, FNA is not very sensitive.
Hope the information will help.

Kind regards,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Mirjeta Guni (2 hours later)

What other tests would be helpful before deciding surgical intervention ?
Are there any "natural" options to shrink the nodules? Your comment about "in big nodules, FNA is not very sensitive", does that mean the tissue aspirated is not helpful in diagnosing ? Does core bx give better results than FNA?

Answered by Dr. Mirjeta Guni (6 hours later)

Brief Answer:
About thyroid nodules:

Detailed Answer:
Hi again,
The next examination before deciding for surgery would thyroid scintiscan.
In big nodules FNA is not very sensitive because the material is taken in a very limited area ( does not examine the whole nodule).
Core biopsy is not recommended in thyroid nodules.
Regards,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Mirjeta Guni (8 hours later)

I am 80 y/o.. I would prefer not to have thyroid surgery. So far evidence does not indicate cancer but increasing size is my concern. Again I have no symptoms. I have narrowed my decision to 1. trying to slow down the growing size with natural medicines. What would that entail? 2. shrinking the tumor with Iodine 3. shrinking or destroying tumor with cyber knife . Could you comment on these options ?

Answered by Dr. Mirjeta Guni (6 hours later)

Brief Answer:
About thyroid nodules treatment;

Detailed Answer:
Hi again,
The natural medicines are not efficient in treating thyroid nodules.

Radioactive iodine has been used successfully for many years in shrinking nodular goiter.

It is a very common treatment of benign thyroid nodules, without side effect.

It will help to prevent a further increase of nodule dimensions, preventing possible compressive symptoms in the future.

Cyber knife is indicated in inoperable malignant tumors.
It is very rarely used in thyroid malignant tumors.

What is your concern regarding radioactive iodine? Why do you consider cyber knife for the treatment of benign nodules?

Please let me know in details so that I can guide you accordingly..

Awaiting....

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Mirjeta Guni (3 hours later)

You are very kind and I appreciate the follow up. I have no objection to Radioactive Iodine. I thought perhaps Cyber knife was newer therapy. I have no confirmation of benign or malignant from 2 recent FNA. The growth of the nodule 2014 = 4.1cm; May 2015 = 5.1cm;Oct. 2016 =4.9cm; April 2017= 5.6cm. I feel I need to do something but surgery is not my first choice unless it is the only choice. Should I continue repeated FNA to try to get definite cytology to rule out malignancy? therefore surgery. I will request an appointment with my endocrinologist for further clarification, but needed to talk to someone for better understanding of situation.How can i ask the right questions?

Answered by Dr. Mirjeta Guni (16 hours later)

Brief Answer:
6onths follow up suggested:

Detailed Answer:
Hello,
I think your endocrinologist will suggest the scintiscan and propose radioactive iodine. I can not understand your hesitation for the radioactive iodine,but anyway if the dimensions increase during the 6 months follow up, you may repeat the FNA.
This remains the only alternative, as long as surgery and radioactive iodine are not preferred.
Best wishes,
Dr.Mirjeta

Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Prasad