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Multinodular goiter with multiple cold nodules in left lobe. Explain

Age: 68 years old woman Wt. 57 kg Ht. 5 feet 2 inches Medication: BP: Telmikind AM 40/5 0-0- ½ Diabetes: Glycomet 500mg 1-0-1 Cholesterol: Zyrova 5 mg 0-0-1 Symptoms: No pain, no swelling, no weight loss , only feels body becoming hot more in lying down position, tired feeling, but works throughout the day. Lab report: TSH 0.06 mcIU/ml Total T3 109 ng/dl Total T4 7.7 mcg/dl USG thyroid report: Both lobes of thyroid and isthmus diffusely enlarged, shows multiple hypoechoic nodules, honey combing, cystic change and peripheral vascularity and rim calcification . One nodule measuring 1.4 x 0.4 cms in left lobe shows both central and peripheral vascularity. Rt lobe:1.8x2.0x3.8 cms Lt lobe:2.0x1.8x3.6 Isthmus:0.8 Bilateral parotid and submandibular glands normal No focal lesion/ calcification Few bilateral level IB lymph nodes with maintained fatty hilum largest 13x 6 mm on right Carotid and jugular vessels normal Impression: Enlarged thyroid with colloid nodules Hypoechoic nodule in left lobe showing central and peripheral vascularity. Thyroid scan Tec-99 pertechnetate 5 mCi Rt lobe normal in size patchy radiotracer concentration Lt lobe and isthmus enlarged show patchy radiotracer concentration with areas of decreased uptake B/L salivary glands well visualized Impression: Multinodular goiter with multiple cold nodules in left lobe Please tell if FNAC is required, Tablet Methimez 5 mg 0-0-1 is advisable. Please guide and help. I do not have credit card how do i pay your fees?
Asked On : Sat, 29 Dec 2012
Answers:  2 Views:  95
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Pathologist and Microbiologist 's  Response
hi there, from your blood reports its evident that you are htperthyroid and from your scan report it is indicative of diffusely enlarged goiter with an active nodule which is showing high vascularity. The rest of the gland is suppressed due to the hyper activity of the active nodule. The presence of lymph node enlargement and the presence of cold nodule on radionuclide scan is an indication for you to get a FNAC done preferably an ultrasound guided one from the cold nodule to rule out any malignancy. So I would suggest an FNAC to be done as soon as possible. Continue your medication as prescribed till then ,take care.
Answered: Mon, 31 Dec 2012
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General & Family Physician Dr. Mamun Kabir's  Response
you are suffering from subclinical thyrotoxicosis & drug is prescribed have multiple cold nudule which is not a indication of just observe if any rapidly enlarging growth,weight loss,any other physical problem.if any then you may consult a endocrinologist.
Answered: Mon, 31 Dec 2012
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