Question: I recently underwent an FNA for thyroid nodules measuring 2.6 x 1.8 x 1.9 cm and 2.7 x 1.6 x 1.5. One is hypoechoic solid, the other is hypoechoic complex. There was some growth (2mm, 1mm and 1mm) from the the utrasound on 10.25 to the FNA on 11.1. Both had microcalcifications and both had peripheral and intrnodular blood flow. The FNA came back benign and I was told no further intervention. I am experiencing pressure in my neck, there is a lymph node which measure 1.8 on the side of my neck which is visible. I regularly sleep through my alarm, have to nap after work, my voice deepens. My cholesterol and rbc count are higher and I have never had a problem before. I believe this may be due to the thyroid. Is this truly a case where a dr will not help me alleviate the symptoms as I am being told or are there measures I can take to alleviate the symptoms. It took 6 months to get to this point with no change in symptoms. i wake up choking sometimes. I need some sort of intervention

It was an ENT surgeon who told me no further intervention was needed. I originally was referred to a general surgeon who said the lymph node was too deep for him to handle. He referred me to the ENT. I originally sought care to due to a visible lump on the left side of my neck. I thought it was this lump causing the pressure in my neck. The Ct scan said it was a lymph node measuring 1.3 cm. It was the Ct scan that showed the thyroid. My TSH level was taken back in May when all this started was 1.17. The free T4 was not performed because the TSH level was normal.

US NECK

HISTORY
heteorogenous thyroid on CT

TECHNIQUE
Longitudinal and transverse scans were obtained through the region of the thyroid glands using real time
ultrasound.

COMPARISON
None

FINDINGS
The study showed the right thyroid lobe to measure 5.3 x 2.2 x 2.0 cm in overall diameter with a normal internal echotexture. No lymph nodes are identified. A single thyroid nodule is noted in the mid/inferior aspect of the lobe. The nodule is hypoechoic and measures 2.4 x 1.7 x 1.6 cm.

The left thyroid lobe measures 5.4 x 1.9 x 2.1 cm in overall diameter with a normal internal echotexture. No lymph nodes are noted. A single thyroid nodule is noted the mid lobe. The nodule is complex and measures 2.6 x 1.5 x 1.6 cm. The isthmus measured 2 mm and was unremarkable.

IMPRESSION
Bilateral thyroid nodules as described with the right thyroid nodule in the mid/inferior lobe appearing hypoechoic and solid measuring 2.4 x 1.7 x 1.6 cm. The left thyroid lobe is complex in the midpole measuring 2.6 x 1.5 x 1.6 cm. Clinical correlation is recommended.

FNA--The patient was identified by first name, last name, date of birth, and medical record number. Informed consent was obtained after explaining to the patient the risks, benefits, indications, and alternatives to the US guided thyroid FNA procedure. Afirma analysis for FLUS or Hurthle cell neoplasm on cytology was discussed. The patient agreed to proceed. Real-time thyroid ultrasound was performed by radiology technician, and I was present throughout the procedure.


A dominant nodule was again visualized within the right mid lobe. It measured 18 x 19 x 26 mm with a hypoechoic heterogeneous echotexture, microcalcifications, and mild peripheral and intranodular color Doppler
flow. A dominant complex cystic solid nodule was again visualized within the left mid lobe. It measured 15 x 16 x 27 mm with a hypoechoic heterogeneous echotexture, microcalcifications, and mild peripheral and intranodular color Doppler flow. A time out was performed. The patient was again identified by first name,last name, date of birth, and medical record number. It was determined to biopsy the dominant nodule within the right mid lobe and left mid lobe. The patient agreed to proceed. The skin was prepared by betadine swaband alcohol prep pad. Topical anesthetic was applied.

Under strict aseptic precautions, the right mid lobe nodule was again identified with high resolutionultrasonography. Using ultrasound guidance, a 25 gauge fine needle was inserted into the nodule and FNA (fine needle aspiration) was performed. Hemostasis was achieved with direct pressure. In a similar manner, 2 more passes were made for a total of 3 passes. Passes 1and 2 were sent for cytology. Pass 3 was kept to be sent for Afirma if necessary. The needle tip was visualized within the nodule on each pass with ultrasonography.

Under strict aseptic precautions, the left mid lobe nodule was again identified with high resolutionultrasonography. Using ultrasound guidance, a 25 gauge fine needle was inserted into the nodule and FNA (fineneedle aspiration) was performed. Hemostasis was achieved with direct pressure. In a similar manner, 2 morepasses were made for a total of 3 passes. Passes 1 and 2 were sent for cytology. Pass 3 was kept to be sent for Afirma if necessary. The needle tip was visualized within the nodule on each pass with ultrasonography.

Location: OSDENDO Collected Date: 11/17/2015 Accession #: C15-37644
Copy To: Accession Date: 11/17/2015 Client Case #:
Outside Client.: Reported Date: 11/18/2015 Report Type: Final Report
Submitting: - XXXXXXX C XXXXXXX DO
Diagnosis
Reviewed By: XXXXXXX XXXXXXX Dipippa,BS,CT(ASCP)
GWV Medical Center Lab
Electronically Signed Out: Cletus Baidoo, MD
GCMC Lab
A. Thyroid, right mid, fine needle aspiration:
Benign.
Benign follicular nodule.
Cell block: The cell block preparation contains blood only.
Adequacy: Adequately cellular specimen.
B. Thyroid, left mid, fine needle aspiration:
Benign.
Benign follicular nodule.
Cell block: The cell block preparation shows similar findings.
Adequacy: Adequately cellular specimen.
Clinical History
A) Right mid 1.8x1.9x2.6cm
B) Left mid 1.5x1.6x2.7cm.
Gross Description
A) 2Diff, 2Pap, 5ml bloody,1CB, Afirma collected
B) 2Diff, 2Pap,5ml bloody, 1CB, Afirma collected

Preliminary Assessment of Cellularity
A) Adequacy evaluation performed by XXXXXXX DiPippa, Cytotechnologist
Specimen is adequately cellular.
B) Adequacy evaluation performed by XXXXXXX DiPippa, Cytotechnologist
Specimen is adequately cellular.

Microscopic Findings
A to B: Microscopic examination is performed.
Reviewed slides show predominant clusters/sheets of macrofollicles with evenly-spaced, uniform follicular. Colloid is present.
Microfollicles are not predominant. Pseudonuclear inclusions, nuclear grooves, and papillary architecture are not present. Macrophages are noted in the background, with increased numbers in Part B.