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Suggest treatment for thyroid nodule

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Posted on Mon, 19 Jan 2015
Question: I was recently diagnosed with PMR and my rheumatologist was also checking into RA. Because my CRP levels were at 36 and 59 I was put on prednisone which is slowly being reduced starting on Dec 24th. My platelet level was also 523. RA factor and Anit CCP were below 20. ESR was 23. I first went to the doctor for slightly enlarged lymph nodes on Oct 10 2014. When my doctor ordered the blood tests he also ordered a chest xray which reviled a fat pad. This prompted my doctor to order a CT scan and the Fat Pad came back fine but a a thyroid nodule was discovered. I was in an extreme amount of pain prior to being put on Prednisone. It is at least now bearable. Not seeing rheumatologist or GP until the 12th of XXXXXXX and feeling very stressed. Worried with regard to Thyroid Cancer. Please comment.
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Answered by Dr. Naval Mendiratta (1 hour later)
Brief Answer:
polymyagia rheumatica

Detailed Answer:
Good evening

Thank you for writing on health care magic

Well your diagnosis of polymyalgia rheumatica looks more or less confirmed and you have had a good response to steroids.

As for the thyroid nodule, yes I agree you need to get it evaluated. It can be an autoimmune condition considering the autoimmune nature of polymyalgia rheumatica. But I would recommend you getting an ultrasound of the thyroid along with fnac of it. The fnac will.give us a brief clue on if it is something beningn or malignant. Also you can examine yourself for any lymph nodes arising in the neck or axilla region. You can tell it to the doctor concerned too. So he shouldn't miss out on anything

Don't be worried about it. But yeah I won't suggest delaying it any further.

Feel free to ask me for more queries

I would be happy to help out

Regards.
Dr naval
Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Naval Mendiratta (8 hours later)
Prior to bring dianosed with pmr and put on prednisone i had complained of 2 swollen lymph noded one on each side of my neck. Would the prednisone reduce this swelling. Also the pain i was having is in the shoulders hips buttocks backs of thighs wrists and thumbs. Could the pain be symtoms of the thyroid nodule and swollen lymph node. Ultrasound scan scheduled dec 27 and blood tests showed normal thyroid levels
doctor
Answered by Dr. Naval Mendiratta (2 hours later)
Brief Answer:
Cause of thyroid nodule

Detailed Answer:
Good evening

The lymph nodes are a bit unlikely to happen due to PMR. Yes they can subside with prednisolone as well, as steroids suppress anything inflammatory or reactionary lymph nodes. The pain you are describing along with raised ESR could be very well attributed to PMR and less likely due to thyroid nodule.

But yes, i would want to rule out anything suspicious related to thyroid especially if they come with lymph nodes. Try and arrange FNAC the same day of ultrasound,so you can proceed with the next step without getting much time wasted. Also do ask for a Radio iodine uptake. The thyroid levels can be normal as they get affected only when the gland gets affected.

Dont worry, it will all work out. For all we know it is just a benign thing.But yes, as doctors we do keep the highest suspicion which will benefit you.

Do let me know for more queries

Regards
Dr Naval
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Naval Mendiratta (6 hours later)
So if the diagnosis is pmr and i am just starting to reduce the dosage of prednisone what kind of results would the rheumatoligist be looking for. More pain less pain?
Wpuld the reduction results be any different with rheumatoid athritis.
Both my doctors are away until XXXXXXX 8
doctor
Answered by Dr. Naval Mendiratta (11 hours later)
Brief Answer:
Monitoring of PMR

Detailed Answer:
Good evening

Sorry for the late reply.

For PMR, we need to look at your symptoms: 1. Increased pain over the shoulders, thighs
2. Duration of Early morning stiffness 3. Your ESR levels.

If the pain and stiffness begins to increase or the ESR remains persistently high on tapering the steroids, we may need to continue it on the same dose at which the effect was good. But yes on long term basis, we will have to add a steroid sparing agent. But that is only after 6 months to 1 year of treatment.

In Rheumatoid Arthritis, at our place we normally don't use steroids for long as patients get dependent. We prefer the other Drugs over steroids.

Hope the information has been useful

Do let me know for more queries. Would be happy to answer it

Regards
Dr Naval
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
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Dr. Naval Mendiratta

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Practicing since :2007

Answered : 754 Questions

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Suggest treatment for thyroid nodule

Brief Answer: polymyagia rheumatica Detailed Answer: Good evening Thank you for writing on health care magic Well your diagnosis of polymyalgia rheumatica looks more or less confirmed and you have had a good response to steroids. As for the thyroid nodule, yes I agree you need to get it evaluated. It can be an autoimmune condition considering the autoimmune nature of polymyalgia rheumatica. But I would recommend you getting an ultrasound of the thyroid along with fnac of it. The fnac will.give us a brief clue on if it is something beningn or malignant. Also you can examine yourself for any lymph nodes arising in the neck or axilla region. You can tell it to the doctor concerned too. So he shouldn't miss out on anything Don't be worried about it. But yeah I won't suggest delaying it any further. Feel free to ask me for more queries I would be happy to help out Regards. Dr naval