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Thyroid Diseases

Possible Likelihood Of Thyroid Cancer

03/06/2008

Question:

I had a CT done a few days ago that accidently found a Thyroid nodule that was slightly compressing on my esophagus. The radiologist suggested a Thyroid Sonography to rule out Neoplasm. The Thyroid Sono showed: "The Thyroid gland is enlarged with the right lobe measuring 4.7 cm in length 1.7 cm AP and 1.6 cm in width. The Isthmus measures 7mm AP. The left lobe measures 3.7 cm in lenth, 1.0 cm AP and 1.2 cm width. There are nodular foci extending posterior the the isthmus just above the sternum with punctate calcification and no associated mass in the lower pole of the right lobe. The nodular foci posterior to the isthmus are heterogenous in echotexture. Biopsy is recommended to exclude the possiblity of malignancy of at least the larger of the two posterior nodules inferior to the isthmus. Within the Isthmus, a hypoechoic focus measuring 1.3 x 1.1 x 0.8 cm hypoechoic focus has some internal blood flow that is smoothly circumscribed and w/o definite calcification. There is a 1.3 x 1.1 x 0.8 cm hypoechoic focus in the lower pole of the right lobe of the thyroid gland which is of heterogenous echotexture. No definite calcifications are noted. Follow up is recommended." In the impression it notes: "nodular foci along the posteroinferior aspect of the isthmus warrant biopsy to exclude the possibility of malignancy." And that the others "nodules can be biopsied at the descretion of the IR physician." I had the CT done because of a chronic cough & trouble breathing with some pain and discomfort swallowing. There is no known family history of thyroid cancer. I hope to be scheduled for a biopsy soon. What are the chances that two tests suggest Neoplasm that the biopsy will be positive and what is my outlook? I am fairly healthy with only Hypertension, RA, Gallstones without gallbladder disease, and fibromyalgia. The only type of growth I found through research that grows in or on the thyroid that commonly compresses the esophagus causing SOB is a very maglignant and fast growing type of cancer that gives a life expectency of 6 mo. to 5 yrs. Any suggestions or advice will be greatly appreciated to give me a better understanding of this situation. Thank You... LB

Answer:

Without seeing the CT, it is hard to know how these nodules relate to the Thyroid or if they are enlarged lymph nodes but from the description I agree with a needle biopsy as that should tell you what this is.  There are several benign and malignant things this could be and they have different treatments and prognosis.  One step at a time.  I know you are concerned from the internet, but let that concern just drive you to get the diagnosis first and not just ignore it altogether. 

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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