Thyroid Cancer Forum - Thyroid Nodules growth

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Q: Thyroid Nodules growth

asked by: mhc4165 on May 14th, 2009

New User

On April 30, I had my follow up thyroid ultrasound for 3 small thyroid nodules that had been found by accident in 2006. This is the first time I waited a whole year and it seems like 2 of my 3 nodules which are the smallest ones, did grow about 2mm . Even though the technician told me that the radiologist told her that everything was the same. And then I got my report in the mail that my endo mailed to me and I found that this isn't really true.

It says that the nodule on my right lobe( which is described as mixed cystic and solid as it was a year ago but at the same exact place by a different radiologist was desribed as predominately cystic in July 2007!)) a year ago was 5 x 7 x 7 mm and is now 6 x 7 x 9 mm. And the nodule on my isthmus was 3 x 6 x 6 mm and now is 4 x 8 x 8 mm.

In June 2008 I had an ultrasound guided needle biopsy of all 3 nodules and had the samples looked at by 2 pathologists including a top one at Upenn and they didn't see cancer. Now I'm wondering if I should have another FNA.

The last follow up I only waited 9 months and these 2 nodules had grown very slightly only my largest predominately solid nodule on my left lobe was exactly the same size last follow up and still is.

One of the 2 small nodules which is one my isthmus (which concerns me since it's not a common place for nodules to be, they are usually on either lobes) was described last time as mixed solid and cystic and hypoechoic, but this time it's described by the same radiologist as nearly entirely cystic and doesn't mention hypoechoic at all.

The last follow up described all 3 nodules as stable but it doesn't use this term now. And my thyroid, in 3 ultrasounds before 2 of which were done at University of Penn also had always desribed my thyroid echotexture as *homogeneous* and now this new one describes it as *heterogeneous* ! It also says my thyroid is slightly small which was never said before either.

I have always had normal thyroid blood tests with no thyroid conditions. Does anyone know how much nodule growth in a year is something to be concerned about? I would really appreciate any info.

Thank you.

Replies(11)

x0x011

replied on May 15th, 2009

Experienced User

One thing that you have to understand is that there will always be some technical differences between ultrasound exams due to different sonographer scanning abilities and machine quality.

"It says that the nodule on my right lobe( which is described as mixed cystic and solid as it was a year ago but at the same exact place by a different radiologist was desribed as predominately cystic in July 2007!)) a year ago was 5 x 7 x 7 mm and is now 6 x 7 x 9 mm. And the nodule on my isthmus was 3 x 6 x 6 mm and now is 4 x 8 x 8 mm."

Mixed cystic and solid and predominately cystic mean the same thing. 2-3mm is not a concern. The growth of those nodules is negligible. Once they get over 1cm then a FNA coule be considered. Keep in mind each technologist could have measured the nodules slightly different, give or take a couple mm.

"One of the 2 small nodules which is one my isthmus (which concerns me since it's not a common place for nodules to be, they are usually on either lobes) was described last time as mixed solid and cystic and hypoechoic, but this time it's described by the same radiologist as nearly entirely cystic and doesn't mention hypoechoic at all."

Nodules can occur anywhere on the thyroid. The only reason they occur less frequently on the isthmus is because there is the least amount of tissue here. Isthmus nodules are tricky to image technically. Entirely cystic is good. If a tech doesnt optimize the image quality echoes can make a nodule look hypoechoic as opposed to cystic.

"The last follow up described all 3 nodules as stable but it doesn't use this term now. And my thyroid, in 3 ultrasounds before 2 of which were done at University of Penn also had always desribed my thyroid echotexture as *homogeneous* and now this new one describes it as *heterogeneous* ! It also says my thyroid is slightly small which was never said before either."

Some radiologists say stable even if a few mm's growth has occured. Others will just mention the change and leave it to the discretion of the endo to decide whether or not the growth is a concern or if the nodule can still be considered stable. It is very possible that your thyroid has become more heterogenous over time, or again this may be a technical issue. Small size is not a problem as long as your hormones are okay.

mhc4165

replied on May 18th, 2009

New User

My Nodules Growth

Thank you for your response. But I do consider growth of my 2 nodules which is where the Hurthle cells were found, having increased 2mm to be of concern.

Why if they are truly not cancer did they grow at all in just a year and 2mm?

And this is being measured on the same exact machine! And why would these 2 nodules that are more cystic though not entirely, have grown but my largest predominately solid 1cm nodule stayed exactly the same a year later?

The University of Penn pathologist had said last year after reviewing my FNA samples, that he does recommend clinical follow up of my nodules and to repeat FNA if any grow, he didn't specify how much growth. Dr.Mark Lupo gave me the same advice on the excellent Medhelp board in December before my recent follow up.

It was the radiologist who made the assesment and wrote my report as they always do not the tech.

And predominately or almost entirely cystic is not the same as mixed cystic and solid, The Society Of Radilogists in Ultrasound Conference and The American Association of Clinical Endocrinologists Task Force On Thyroid Nodules which is online, and others describe mixed cystic and solid as having an average risk of cancer, and almost all cystic as having a lower risk.

MyrahU

replied on May 19th, 2009

Active User, very eHealthy

Hey, I had Hurthle cells, too! Weird.

Although mine turned out to be cancer, I know what you are going through. The multiple ultrasounds, the FNAs, all that. Not fun.

Yes, it is possible to have something grow that isn't cancer. Benign tumors and nodules can grow, but not be cancerous. When my FNA results came back, they were "inconclusive" (but showed Hurthle cells) and the three ultrasounds over time showed the single nodule I had to be growing. After a year of this, my doctor advised me to have the right lobe removed (where the nodule was) and have it tested.

I asked my ENT if it is possible for a benign nodule to grow. He said yes. I asked if it is possible for a benign nodule to become cancerous. He said yes. I asked if Hurthle cells made it more likely to be cancerous. He said yes. After much research and consideration, I decided to have the surgery and the nodule turned out to be cancerous.

I think what your doctor is telling you is good advice. Your only two options are to keep testing it to make sure everything is okay or to have it surgically removed (which is probably premature in this case).

Unfortunately, you may never have a clear-cut test result that tells you it's time to have it removed. I didn't. These tests have false-positives and false-negatives. I'm glad you are doing research into the topic. That made me feel better and I felt like I could more fully participate in making decisions about my care.

The main thing to remember is that if it does end up being cancerous, the prognosis is very good. The treatment isn't nearly as bad as it is for other cancers and the tests to detect it after treatment are very effective.

I hope everything turns out well. It seems like you are receiving excellent care from experts. As long as you continue to do your follow-ups, you should be fine.

mhc4165

replied on May 21st, 2009

New User

Thank you for your reply.

But the a top thyroid pathologist at university of Penn told me that he didn't think it was likely my nodules could turn cancerous.

I asked if benign nodules can turn cancerous to my former endo at university of Penn and he said no. They say that about 67% of people mostly women have thyroid nodules and 90-95% are benign, if that many were turning cancerous than thyroid cancer even though it has increased would be much more common than it is.

Also a top thyroid pathologist in Canada Dr.Sylvia Asa told Rita Banach the director of the Canadian Thyroid Cancer Survivors group, that there isn't evidence that me having some hurthle cells increases the chance of my nodules if they are truly benign now, to turn cancerous.The university of Penn pathologist told me I don't have that many Hurthle cells and that only when there is a lot of them is it a problem.

My nodules are very small though so the FNA needle may not have gotten all of the cells and there may be more Hurthle cells there.

What type of thyroid cancer did you have? The National Cancer Institute and others report that even the most common type of thyroid cancer papillary is more treatable under age 45 and that after this the prognoses isn't as good. I will be 45 next April and The American Thyroid Association says on their website that the prognoses isn't as good after age 40.I'm pettrified of having the surgery though!

MyrahU

replied on May 21st, 2009

Active User, very eHealthy

I had Hurthle Cell Carcinoma, which some experts classify as Follicular thyroid cancer, but others argue that it is a type in it's own right. I was 24, which is really really young for this type of thyroid cancer (most people who get it are over 40).

I was just passing on the information that my doctor told me. I don't know how often benign nodules turn cancerous, or if it's just the fact that the FNA missed the cancerous cells early on and then they became numerous enough to catch. All I know is that my cancer was difficult to diagnose. After taking out half my thyroid with the nodule, they sent it to Los Angles, to one of the top pathologists in the state. Finally, he figured out it was cancer.

Why are you having surgery if they aren't cancerous? Are they blocking your airway or causing some other problem?

Don't worry about the surgery. It's surprisingly not that bad. Having my wisdom teeth out was way worse--much more painful for much longer.

Users who thank MyrahU for this post: mhc4165

mhc4165

replied on May 24th, 2009

New User

Thank You For Your Response I Sent You A Private Messa

Thank you for your response. I'm sorry you had thyroid cancer especially Hurthle cell! You must have a lot of Hurthle cells for it to be Hurthle cell cancer.

And it's strange that your FNA would still be inconclusive. How big was your cancerous nodule?

The only surgery I ever had was my 4 wisdom teeth when I was 17, but I didn't have to have my neck cut open, a breathing tube,and especially general anaesthesia and I'm older now with a premature heart beat and I'm totally petrified of thyroid surgery!

I see myself going into a panic last minute in the hospital and saying get me the h*ll out of here you are *not* going to cut my neck open,give me general anaesthesia, and a breathing tube!

MyrahU

replied on May 25th, 2009

Active User, very eHealthy

I don't think the amount of Hurthle cells matter, it's what they're doing. The nodule was not that big (I could feel it, but not see it), but it was growing slowly (like millimeters over the course of a year and a half). It hadn't spread --dr said it was like stage zero, maybe one.

My wisdom teeth were impacted, but I didn't have to have my neck cut or anything (does anyone have to have that done?). The pain after was much worse than thyroid surgery. My thyroid incision is about three inches and wasn't really painful. More sore. I had this done twice (once for each half) about a month apart. I didn't even need to finish my pain meds.

Don't worry. You won't panic at the last minute. They give you calming medication while you are waiting. If you are worried that you won't sleep the night(s) before, ask the doctor for anxiety medication.

You'll wake up feeling gross (from the general anesthesia) and with a sore throat from the breathing tube, but that goes away after an hour or so. The ice cream they'll probable give you will help, once you feel like eating it.

You still didn't say why you need surgery if it isn't cancer?

mhc4165

replied on May 26th, 2009

New User

My endo said when he told me that the second opinion pathologist saw some oncocytic(hurthle) cells when I told him that this could be cancer, he said only when there is sheets of them .

He said what the pathologist told me also that I don't have a lot of Hurthle cells and it's only a concern if there are a lot present. For a nodule benign or cancer to considered a hurthle cell tumor it has to have at least 75% hurhle cells, so yes it does matter how much there are.

I don't know for sure if I have thyroid cancer and really need surgery or not.

But like you said your ENT doctor said and I have read a lot of posts from other people on other thyroid boards saying too, that Hurthle cells can turn cancerous.

Yet 2 top university of Penn pathologists said to me that they are not something so abnormal or worrisome unless there is a lot of them.

But I have read quite a few people say on 3 different thyroid boards that their endo or surgeon told them to get their thyroid out because even if the hurthle cells nodules aren't cancer now they will likely turn that way.

I still cqan't really see myself going through with the thyroid surgery and reading your descrption of it just re-enforced that!

MyrahU

replied on May 26th, 2009

Active User, very eHealthy

I was trying to make you feel better about the surgery by letting you know that the pain really isn't that bad and you don't remember anything. It's just like sleeping.

I tried to look up Hurthle cells, but unfortunately didn't really understand much about them, except that they were associated with thyroid cancer and Hashimoto's thyroiditis, an autoimmune disease that causes hypothyroidism.

My ENT told me that it is possible for a benign tumor to turn cancerous, but didn't say much about the Hurthle cells. I don't know how many I had. They turned up on both the FNAs, but whether they were cancer was "inconclusive." Apparently, these FNAs aren't as accurate as they would like them to be.

From what I read, whether they are cancer or not depends on if they are invading the capsule and the blood vessels. I got that information off of the web (an endocrine website, you should be able to find it if you do a search for Hurthle cells or cancer), but the pathologist probably is more of an expert. There may even be newer research into the matter.

Ultimately, the decision whether to have surgery or not is up to you. Unfortunately, you may never get a test result beforehand that will tell you 100% what to do. My ENT estimated that there was around a 25% chance that mine was cancer when I had the surgery (although at that time I was sure that it was--and was right).

You have to weigh the pros and cons, the risks and benefits for yourself. Don't make the decision, one way or the other, out of fear. Go get a second or third opinion, if that would help. Every doctor and pathologist have slightly different ways of doing things. You may get a different perspective.

mhc4165

replied on May 26th, 2009

New User

Why DID your ENT beliVE that there was about 25% that you HAD IT ?

MyrahU

replied on May 26th, 2009

Active User, very eHealthy

There were several factors: a single nodule rather than multiple ones make it a little more likely to be cancer, the fact that it was growing (not hugely, but significantly), the presence of the Hurthle cells, and the biopsy being inconclusive, rather than negative.

When the lump was first found, he said there was about a 5% chance it was anything (since nodules are very common), but the other stuff kinda stacked up. We played the odds and ended up making the right call.

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