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What does detection of thyroid nodule on a MRI indicate?

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Posted on Mon, 15 Sep 2014
Question: I have a 2.3 cm nodule on my thyroid which was incidentally found on MRI ordered for c-spine (migraine) 2 yrs ago but was never told this by Neurologist. The report said I needed to be seen by clinician as the MRI couldn't tell whether this nodule was benign, malignant AND is at risk for carcinoma. (I just happened to come across my copy of this report - from 2012 last week and immediately called my MD).

TSH results came back-Doctor called and said my TSH was low! I have a "regular" ultrasound scheduled for next week to look at nodule. I have most EVERY symptom of hyperthyroidism. Doctor did not discuss T3 & T4 results.

My questions are: Is a "regular" ultrasound good enough? Is this more than likely Hyper vs Hypo since my TSH is low and should I be treated by my MD or request a specialist?

Symptoms: Tired, VERY tired, my joints ache, I can't stand the least bit of heat, perspire for no reason, depressed, extremely moody, my legs are so swollen it hurts to walk, I have both red and brown spots on my arms and legs, my skin is dry and flaky from my head to my toes, food often gets stuck in my throat, I'm seldom hungry but have gained a lot of weight and suffer from daily migraines. I now have what appears to be a rash in my groin area (swollen, red, itchy & painful)-which is probably from sweating. The list goes on and on...I'm desperately searching for answers. Please, please, tell me what your opinion is.

I'm literally tired of being TIRED and extremely nervous about this life altering event.
doctor
Answered by Dr. Binu Parameswaran Pillai (23 minutes later)
Brief Answer:
Please do not worry

Detailed Answer:
Good day,
Noted your concern.
You had an incidentally detected thyroid nodule on a MRI. This is called incidentaloma. The next step is to do a thyroid function test. If the TSH is normal or high, we go for an ultrasound. If the TSH is low, then we do a nuclear scan ( Technicium or Iodine uptake scintigraphy).

Hence in your case, you need a Technicium ( Tc) uptake scan. If the Tc uptae scan shows, a cold nodule , the we also need an ultrasound. ( now a days, most doctors do an ultrasound as well, for nodules of this size).

Could you tell me how low is the TSH ? Please request yor doctor for a the T4 as well.

I realize that you are disturbed and anxious of this discovery of a thyroid nodule. Please relax. Majority of thyroid nodules ( > 90%) are benign. However, we need further evaluation. Some of your mentioned symptoms could bbe due to hyperthyroidism, but not all. Anxiety surely will add on to these symptoms.

If the TSH was low, i would certainly advice my patiets to uundergo a nulcear scan. Keep ultrasound in the pipeline, but we need a nuclear scan. Most MDs will be aware of this. But if you have a chance to see an Endocriologist, that would be fantastic.

Kind Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Binu Parameswaran Pillai (8 minutes later)
Hi. I do not know what my T3 or T4 levels are. I was only told (by phone), that my TSH level was low?

I was told by my MD that I would go for an "everday" ultrasound and if the radiologist felt there was an issue with the nodule he would then place a needle in the nodule for biopsy.

I am extremely confused and feel my doctor has been very vague about this entire situation. I don't mean tgis in an ugly manner, but she is just a PA and I need to know what is going on with me?

Let me put it this way, if I were your child, what would you tell me to do? Do you think this is likely hyperthyroidism?

Thanks so much for listening to me.
doctor
Answered by Dr. Binu Parameswaran Pillai (11 minutes later)
Brief Answer:
Hello

Detailed Answer:
Thank you for the reply.
If you were my child, i would go ahead with the same way i explaiined earlier.
Since your TSH is low, i would request for a Nuclear scan ( Technicium uptake scan). That is the first choice.

An ultrasound is a very good thought. But i would place Nuclear scan as the first order in your case since the TSH is low. I wouldnt place a needle n your nodule until i get the nuclear scan report.

Please relax. As i mentioned earlier, majority of these nodules are benign.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Binu Parameswaran Pillai (24 minutes later)
I'm not so much concerned with it being cancerous as I am with realizing that a neurologist, PA, AND a pain specialist either never took the time to read the entire results or simply didn't take the time to inform me. This was 2 years ago for heaven's sake.

As a patient who pays a dear amount in insurance, and suffered quite a bit in the last 2 years with bronchitis, pneumonia, pleurisy and broken ribs (supposedly from coughing too hard), I just want correct diagnosis AND someone who will treat me genuinely. Not say "uh huh, uh huh and pass me a multitude of prescriptions.

How do I go about requesting for this nuclear exam and exactly what does it do?

Again, thank you for your honesty and kindness.
doctor
Answered by Dr. Binu Parameswaran Pillai (12 minutes later)
Brief Answer:
Hi

Detailed Answer:
I feel sorry as a doctor that they failed to mention about this finding in your MRI scan. It is a busy world. But that is not an excuse.

For nuclear scan, you may need a request filled by your MD or endocrinologist. I would recommend to meet a endocrinologist first. Apart from reading the MRI report, he will get a chance to examine you.

Nuclear scan will detect if the nodule is hot or cold. Hot nodules are usually not malignant. They can be treated by radio iodine ( as a tablet or liquid).

If it is a cold nodule, you will need an ultrasound scan and a needle test ( FNAC). Nuclear scan is done by nuclear physicians. It detects the activity ( functional status) of the nodule. Since you have low TSH and a single nodule in MRI, you are most likely to have a hot nodule.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai (13 minutes later)
I cannot thank you enough. You've certainly made me feel better "mentally!" Bless you for caring. I'll say (on my behalf), that is one of the main things a patient appreciates and looks for in a doctor.

After I have ultrasound and meet with my Dr. to find out exactly what is going on, I will surely be requesting an endocrinologist. I never knew how much the thyroid can affect you until now.

It is good hearted, kind doctors such as yourself who help people like me deal with disease in a positive manner. Again, I sincerely thank you from the bottom of my heart!
doctor
Answered by Dr. Binu Parameswaran Pillai (43 minutes later)
Brief Answer:
Thank you

Detailed Answer:
Thank you very much. A doctor feels very happy and satisfied when they hear such good words.

I would be more than happy to answer your questions if you have any. If you feel that there is no more questions to ask, may I request you to close the query.
Wish you good health

Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Binu Parameswaran Pillai

Endocrinologist

Practicing since :2003

Answered : 1435 Questions

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What does detection of thyroid nodule on a MRI indicate?

Brief Answer: Please do not worry Detailed Answer: Good day, Noted your concern. You had an incidentally detected thyroid nodule on a MRI. This is called incidentaloma. The next step is to do a thyroid function test. If the TSH is normal or high, we go for an ultrasound. If the TSH is low, then we do a nuclear scan ( Technicium or Iodine uptake scintigraphy). Hence in your case, you need a Technicium ( Tc) uptake scan. If the Tc uptae scan shows, a cold nodule , the we also need an ultrasound. ( now a days, most doctors do an ultrasound as well, for nodules of this size). Could you tell me how low is the TSH ? Please request yor doctor for a the T4 as well. I realize that you are disturbed and anxious of this discovery of a thyroid nodule. Please relax. Majority of thyroid nodules ( > 90%) are benign. However, we need further evaluation. Some of your mentioned symptoms could bbe due to hyperthyroidism, but not all. Anxiety surely will add on to these symptoms. If the TSH was low, i would certainly advice my patiets to uundergo a nulcear scan. Keep ultrasound in the pipeline, but we need a nuclear scan. Most MDs will be aware of this. But if you have a chance to see an Endocriologist, that would be fantastic. Kind Regards Binu