Thyroid Problems/Thyroid CT Scan & Bloodwork Results
Hi, I'm a 42 y/o female who had routine bloodwork 2.5 yrs ago indicating TSH as 0.4 & FT4 as 0.69; PCP called and stated she was referring me to an endocrinologist. Unfortunately, with the appt being 6 wks out and having no troubling symptoms, I forgot about the appt til the day before and cancelled it.
A month ago I had a severe sore throat w/pus pockets and went to an ER. Upon exam of my neck they ordered a CT scan, stating my lymph nodes felt "too enlarged." The contrast CT scan showed "right thyroid lobe calcification which may be within a nodule; a definite nodule is not visualized." The report also states "prominent right level 2A 1.8cm lymph node is identified. There is also a prominent left level 2A 1.6cm lymph node. There are also mildly prominent 1.7cm severe bilateral level 1B lymph nodes. All of these demonstrate a fatty hilum." (Internet research has taught me a fatty hilum is good.) Everything else visualized on the scan is described as "normal" and "unremarkable." However, the attending MD stated that there WAS in fact a "nontox uninodular goiter," aka thyroid nodule, and that "by the looks of it, it's been brewing for at least a few years." That's when I remembered my earlier test results that I neglected to follow up on and the doctor said, "Exactly; that was probably this at an early stage." He then said things that were unsettling, such as "it's a blessing you came in with strep throat so we could find this" and "young lady, I cannot over stress to you the urgency of this. You need to follow up with a specialist, sooner rather than later" and called my CT scan results "concerning." I did follow up, and I have an appt with an endocrinologist on July 11th.
My TSH level last week was .33, meaning it has obviously dropped in the last 2.5 yrs.
With the above in mind, my questions to you are:
1) My mother had the exact same thing, only it was smaller and she was 62 at the time. They removed her entire thyroid; hers was benign as most are. Is it likely, in your opinion, that given my family history the same will be done to me?
2) What would prompt the attending MD in the ER to stress the urgency of following up the way he did? Was he possibly trying to tell me something without coming out and directly telling me?
3) What would be so "concerning" about the CT scan report, based on the portions I quoted above verbatim? And if they're so "concerning," why is my appt so far out?
4) What is the difference between a "calcification" and a "nodule"?
5) Finally, those TSH levels: what do they mean?
Thank you so much for your time; I realize it's valuable!
Warm welcome to you !
1. We do not perform total thyroidectomy in all the cases. When you visit an endocrinologist we do some physical examination and FNA (Fine needle aspiration). If your FNA results say the nodules ar benign/inconclusive then you will need to follow up after 6 months. If FNA results say Malignant papillary thyroid cancer then we recommend total or partial thyroidectomy depending on the size, position and number of nodules. If FNA results say its Intermediate, then it could be either follicular neoplasm or horthle cell neoplasm. We then conduct radioactive iodine scan to consider thyroidectomy.
So I can give firm opininion after FNA. But now it seems to be in initial stage. There is only one nodule. I think you would not need total thyroidectomy right now.
*Always total thyroidectomy is a good choice over subtotal thyroidectomy because there are less chances of recurrence of nodules.
2. Since there is lymph node involvement, the attending ER might have stressed on visiting an expert and getting proper diagnosis. The ER specialists wont be knowing the criteria for grading and staging the thyroid nodules for thyroidectomy. So it was good of him to recommend you to visit an expert.
3. Your CT is not too concerning but definitely needs to be brought in to the consideration of an expert for future planning and management of the condition.
4. Thyroid calcification is deposition of calcium salts in the thyroid tissue due to hormonal abnormality/ impaired circulation. But calcification precedes nodules. This calcification may indicate a future nodule. These calcification are most of the time benign. But FNA is needed to confirm that there are no malignant changes in them.
5. The latest TSH level of 0.33 is within range but even then borderline. This range is suggested to consider FNA.
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