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Thyroid Diseases

Enlarged Thyroid Treatment

04/12/2007

Question:

I am a 36 yr old female with an enlarged thyroid. I have a family history of thyroid disease. I have a 4yr old son born with congenital hypothyroidism, a paternal grandmother with thyroid disease, and a cousin which my family thinks had cancer. My doctor ordered a full blood test. My test were CA 9.0, ION CA 5.1, ESR 1, PTH 8 (Low), T3f 299, t4f 1.0, TPO 210 (High), TSH 3.1 He ordered a thyroid ultrasound Impression: 1. The left lobe reveals two nodules within the upper to mid pole laterally as described above. They are indeterminate from this study. Also, an indeterminate 1.6-cm nodule is noted lateral to the smaller nodules. A follow up thyroid ultrasound in 3-4 months to reassess is recommended. The ultimate need for an ultrasound guided fine needle aspiration procedure cannot be excluded at this time. 2. The isthmus reveals a 2-mm small nodule as well.

Should i be concerned?

Answer:

I normally would recommend going ahead with the fine needle aspiration biopsy of the dominant nodule, but follow-up to ensure stability is certainly reasonable. Neither approach in my view is wrong from what you have told me.  It's a balance between being medically aggressive, risks and health status otherwise and anxiety level.  It is likely that you have a benign multinodular goiter and may become hypothyroid over time. Your MD or an endocrinologist can give you more information regarding this and their reasoning for their recommendation.

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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