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What Do Nodules On Thyroid Indicate?

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Posted on Mon, 23 Feb 2015
Question: Here is my story. I had a CT with contrast to evaluate my heart for upcoming Aortic Valve replacement. This past Sunday I was reviewing my medical records for the surgeon appointment and noticed they found nodules on my Thyroid. Never was I told by the cardiologist and the test was ran a month earlier. When I went into the surgeon he said that he would not perform the surgery until we know the thyroid concenrs because it can affect the functions of the heart. I then saw my internal medicine primary and had labs ran and for TSH T1 T2 T3 T4 and all were normal. He sent me to the hospital for an ultrasound. They found a nodule on my Ithsmus and on my left lobe. I saw an endocrinologist yesterday. She was referred to me but I found out she has only been in practice a year. She did an ultrasound and said the one on my Ithsmus is an Echoic Primarily solid nodule and it measured 2 cm. the one on my left lobe was also Echoic but not as solid. I asked her risk of cancer and she said the left was not a concern but the ithsmus was suspicious for cancer and she gave it double the odds that it was. She said it is very treatable but she also said that I had several other nodules under 1cm throughout my thyroid. She said either way she would recommend that I remove my thyroid due to future risks even if not cancer. I fought the hospital and she supported me in getting a stat biopsy knowing I have open heart surgery scheduled. They are getting me on Monday and I should have results by Wednesday afternoon. My questions...Should I do heart surgery first or the thyroid surgery if cancer? If not cancer I would think do heart surgery first. She did an ultrasound of my lymph nodes and said she didn't see anything which is good. I also have a second opinion Endocrinologist appointment on Monday so I need to know what to ask. What scares me is we would have never known I had them if my CT was not done. They said they are slow growing by 2cm is big which means they have been there for awhile right? What are odds if they are cancer that they spread to something else if there for awhile? Based on description of what I gave you - she said solid had a halo appearance around it would you suspect it is cancer? Next questions....can you have an aortic mechanical valve with no thyroid? What would the affects be on the heart especially if I have it removed after heart surgery and its newly functioning? Please let me know and also do you recommend removal of the thyroid even if benign? Also will idione radiation affect my heart valve either now or when I have it in the future and will idione attack the heart? ALso can you take Coumadin with Thyroid meds and what are the contradictions for long term use a it woud be 40 years if I lived a full life and what is full life expectency with both of these? Can you ask a specialist for Endo and Cardiologist? Thanks!
doctor
Answered by Dr. Binu Parameswaran Pillai (3 hours later)
Brief Answer:
THYROID SURGERY

Detailed Answer:
Good day,
Noted your concerns. There are several issues to discuss.

1. Post Aortic valve repair, you will be on blood thinners ( Warfarin/Coumadin) and it has to be stopped before any future surgeries, procedures. So that has to be considered.

2. To assess the chances of thyroid malignancy. This will need a needle test. Thyroid cancer risk assessment can only be done after a needle test.HALO around nodule is a good sign and malignant nodules usually will lack it.
However, as your endocriologist has pointed out , there are several nodules on both sides which will grow in future and it is impossible to do a needle test from each nodule. These nodules will eventually grow and hence the best option would be surgery.

If the needle test is negative, and if you choose to observe, then thyroid surgery can wait and a repeat scan after 6 months will be recommended. Even if the needle test is benign, if the nodules grow in future surgery will be indicated. So it is a tricky situation and if i were you, i would opt for surgery.


If the Aortic stenosis is severe, you will need an early surgery for that. If needle test is negative thyroid surgery can be done later. However, the other argument is that, you will be on blood thinners after valve repair and for any future surgeries, that will have to be stopped and you will need heparin during that time. So some surgeons will prefer to do a thyroid surgery first and do valve repair later. Thyroid surgery is not complex and is easier compared to valve repair.

There is no problem taking Coumadin and thyroxine together. If there is cancer in thyroid, you may ( based on type of cancer) need radio iodine later. This also will not affect heart valve.

YOU WILL NEED TO SIT TOGETHER AND TALK TO ANAESTHESIST and HEART SURGEON and ENDOCRINOLOGIST ( after needle test) regarding all the above factors.

I realize that it is a complex situation. But this is the best advice i can give you with out examining you. Please feel free to ask further.

Regards
Binu



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai (14 minutes later)
I do have severe aortic stenosis and was scheduled for surgery on march 9. Surgeon post poned until we got answers. My biggest question if cancer would you recommend thyroid removal before surgery and get levels in line and then do heart ? I hate thought of cancer in body. What are risks of cancer if solid and echoic and 2m? Do you think they have been there for awhile and is it normal to not even know they are there? If on Coumadin first and take our thyroid hey bridge with lovanox and out me back on Coumadin but doesn't Coumadin before thyroid medicine affect absorption? If there are several would you recommend suegery either way? Is there anythjng we can do naturally or through medicine to reduce size of them or how they are attacking my thyroid like with diet? Thanks!!
doctor
Answered by Dr. Binu Parameswaran Pillai (2 hours later)
Brief Answer:
Please wait for needle test report

Detailed Answer:
Solid and hypoechoic lesions can rarely harbour cancer. If you have a tight aortic stenosis, that has to be repaired anyway. Your thyroid nodule must have been there for a while which was incidentally noted in a CT scan. This is called as an incidentaloma. There is only around 1 to 5% chance of malignancy. Even if it is malignant, most thyroid cancers are very slow growing. It can take several years for them to grow unlike cancers in other parts if the body.

There is no issues taking coumadin and thyroxine together.
There is minimal or no chance that the thyroid nodules can spontaneously reduce in size. There are no drugs which can reduce the growth of nodules. However if you have hypothyroidism( TSH high and Free T4 low ) then thyroxine treatment can occasionally shrink the nodules. But a 2 cm module is very unlikely to regress even with thyroxine.

At this stage I feel that you should wait for the thyroid nodule needle test. Decisions can change based on this and please be patient for few days.
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. Chakravarthy Mazumdar
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Answered by
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Dr. Binu Parameswaran Pillai

Endocrinologist

Practicing since :2003

Answered : 1439 Questions

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What Do Nodules On Thyroid Indicate?

Brief Answer: THYROID SURGERY Detailed Answer: Good day, Noted your concerns. There are several issues to discuss. 1. Post Aortic valve repair, you will be on blood thinners ( Warfarin/Coumadin) and it has to be stopped before any future surgeries, procedures. So that has to be considered. 2. To assess the chances of thyroid malignancy. This will need a needle test. Thyroid cancer risk assessment can only be done after a needle test.HALO around nodule is a good sign and malignant nodules usually will lack it. However, as your endocriologist has pointed out , there are several nodules on both sides which will grow in future and it is impossible to do a needle test from each nodule. These nodules will eventually grow and hence the best option would be surgery. If the needle test is negative, and if you choose to observe, then thyroid surgery can wait and a repeat scan after 6 months will be recommended. Even if the needle test is benign, if the nodules grow in future surgery will be indicated. So it is a tricky situation and if i were you, i would opt for surgery. If the Aortic stenosis is severe, you will need an early surgery for that. If needle test is negative thyroid surgery can be done later. However, the other argument is that, you will be on blood thinners after valve repair and for any future surgeries, that will have to be stopped and you will need heparin during that time. So some surgeons will prefer to do a thyroid surgery first and do valve repair later. Thyroid surgery is not complex and is easier compared to valve repair. There is no problem taking Coumadin and thyroxine together. If there is cancer in thyroid, you may ( based on type of cancer) need radio iodine later. This also will not affect heart valve. YOU WILL NEED TO SIT TOGETHER AND TALK TO ANAESTHESIST and HEART SURGEON and ENDOCRINOLOGIST ( after needle test) regarding all the above factors. I realize that it is a complex situation. But this is the best advice i can give you with out examining you. Please feel free to ask further. Regards Binu