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Over weight. Phentermine helped. Reports said non-functioning adenoma, colloid cyst or malignancy. Help?

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Practicing since : 1994
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I am a 32 year old white female, 5'4", 152lbs. For years I have had a very hard time keeping my weight down. It didn't matter if I ate completely healthy and worked out 3-4 times a week, my weight would never go down. I had my thyroid checked multiple times but my doctor always said all of my levels were fine. It wasn't until a doctor prescribed me phentermine that I was able to bring my weight down and keep it between 145 and 155. However, now I wonder if my thyroid really did have issues...

I went in for a routine physical and my doctor felt a nodule. After an ultrasound was done diagnoses stated: R. Thyroid nodule null.
Under orders it ordered a thyroid nuclear scan and an endocrinology referral Indications under "orders" states - Right lobe 2 x 1.5 cm nodule and Solidary right lobe thyroid nodule
The sonogram results state: right thyroid at 5.8 X 1.7 X 1.6 cm with an inferiorly located heterogenous 2 X 1.5 X 1.4 cm nodule with some increased vascularity. Left thyroid at 3.8 X 1.1 X 1.4 cm with no nodules. Isthmus at 3mm.

I went to have a nuclear scan and those results stated:

25 uCi of I-234 in capsule for was administered to the patient orally and a 24 hour RAIU scan was performed. The 24 hours RAIU = 25% - Multiple images of the thyroid gland were obtained.....

Images demonstrated normal thyroid size, configuration, and position. There is a photopenic defect within the lateral aspect of the lower pole of the right thyroid lobe. Tracer distribution remainder of the right thyroid lobe and entirety of the left thyroid lobe is normal. No hyper-functioning thyroid nodules are identified.

Normal 24 hours RAIU of 25%
Hypofunctioning defect within the lateral aspect of the lower pole of the right thyroid lobe. Differential diagnosis includes nonfunctioning adenoma, colloid cyst or malignancy.

I went to see an Endocrinologist and he didn't explain anything to me. He just had me schedule a biopsy. I am having the biopsy done next Tuesday. I went to my regular physician and all he could tell me was that solid individual nodules my size is not as normal as multiple small nodules or goiters. He said because of this it puts me at a higher risk of being in the 5-10% of having a malignant nodule. Is this true? I am really nervous about the biopsy and I am even more nervous that it may be malignant. Is there any advice or answers you could give me?

Thank you.

Worried Patient
Posted Wed, 23 May 2012 in Thyroid Problem and Hormonal Problems
Answered by Dr. P.V Pradeep 1 hour later


Thanks for the query.

I have noted your history, all the tests and investigations done. Accordingly you have a solitary thyroid nodule which has been correctly investigated so far.
- Ultrasound examination revealed the 2.5 cm nodule.
- Multiple thyroid hormone tests results are normal.
- Nuclear scan was unnecessary since your thyroid hormones were normal and you do not have hyperthyroidism.

Solitary nodule or multiple nodules all have equal chances of malignancy i.e. 5%. Fine needle aspiration cytology will reveal the nature of the nodule and rule out malignancy.

I understand your apprehension which usually happens with most of my patients. At this point, I can only tell you are in the right track towards treatment. Go ahead and get the biopsy done. Once the test results come I would be able to comment more about what can be done; whether or not it needs to be removed or is it something benign.

Hope this helps. Let me know if you need any more help.

Wish you good health.

Best wishes
Above answer was peer-reviewed by
Follow-up: Over weight. Phentermine helped. Reports said non-functioning adenoma, colloid cyst or malignancy. Help? 18 hours later
Because its 2.5 cm is there a chance, even if it's benign, that they will still remove it?
Answered by Dr. P.V Pradeep 4 hours later
Hi and thanks again,

Fine Needle Aspiration Cytology (FNAC) is important here.

Based on the data provided, your ultrasound (USG) does not reveal features like microcalcification, homogenously hypoechoeic nodule with loss of peripheral halo. If these features are found, removal needs to be considered.

If USG does not show these features, Fine Needle Aspiration (FNA) biopsy is benign too, then no surgery is needed and you need 6 monthly follow up to reassess the nodule size.

Hope this answers your query. Let me know if you have any more queries.

Wish you good health.

With warm regards
Above answer was peer-reviewed by
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