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Thyroid Diseases

Multiple Thyroid Nodules and Goiter

04/06/2007

Question:

I received the results of my thryroid ultrasound and thyroid uptake scan today. I have multiple nodules on both left and right sides of my thyroid gland, plus a nodule at the isthmus. I also have a goiter. My internist said we will wait 6 months and then do another ultrasound to compare. The nodules are 5mm-1.3 cm in size.; less than 5mm cyst on the left with a 5mm solid nodule near the isthmus, but the uptake scan results didn`t display "hot" or "cold". Is my internist right to wait 6 months for another ultrasound, or is a 2nd opinion, now, needed. I have had a hysterectomy due to displaysia (sp), since then precancerous growth removed from the vaginal area, and also precancerous colon polyps removed. My sister has had breast cancer, and my dad had prostate cancer. Any suggestions?

Answer:

You likely have a benign multinodular goiter and waiting to look for changes over time is reasonable. My approach would be to look for risk factors that might suggest higher risk for your thyroid haboring a cancer such as:

Also I would evaluate you, as your physician likely did, for symptoms (for example, pressure or swallowing issues related to the thyroid size) and check your blood for thyroid function activity.  These issues along with your level of anxiety and desire to be aggressive would lead me to consider needle biopsy of all lesions greater than 1 cm or just remove the thyroid after counseling as to the risks of these procedures.  Alternatively, if you have multiple medical problems, do not want to be aggressive or do not have any of the above issues, then 6 month follow-up is reasonable. 

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Response by:

Jeffrey J Sussman, MD Jeffrey J Sussman, MD
Associate Professor of Surgery, Chief, Division of Surgical Oncology
College of Medicine
University of Cincinnati