Hi there,
I'm a sonographer and i do thyroid scans as well as assist radiologists in doing thyroid FNA's quite frequently. I don't have as much knowledge as a radiologist or endo by any means but can give you my insight.
There is absolutely no way other than by doing an FNA to determine malignancy. Thyroid nodules vary drastically. Cystic, solid, complex, etc as you know. The most worrisome features (for our radiologists) are MICROcalcifications and agressive growth. Generally our radiologists do not biopsy any lesion under 1cm unless punctate microcalcs are noted. Cystic nodules (colloid nodules) are generally not worrisome (if they have the true appearance of a colloid) and are not generally biopsied unless grow aggressively. As for vascularity, shape, hypo halo, these things are non specific when it comes to thyroid lesions. The thyroid is a very vascular organ. Malignant nodules can be either hyper or hypo vascular, unlike other tumours in the body which tend to have a certain blood supply. The taller than wide characteristic you describe i have never heard with thyroid nodules. We generally only use this with breast lesions. Perhaps there is some new literature on that but i am not familiar with it at all.

As for mixing samples.
The radiologists NEVER mix samples from different lesions with eachother. Each lesion gets 3 needle passes, atleast one of those samples going on a slide, and the other 2 in a cyto jar. Otherwise the cells from each nodule get mixed and if a malignancy is found, there would be no way to tell which one it came from. Perhaps your endo mixed the samples because the lesions were fairly similar in appearance, close together, were very small or just looked like benign colloids. In that case they probably werent really concerned for malignancy.

If you are very concerned you should have a follow up in 6 months time, and if any of the nodules have grown repeat the biopsy at that time.
Hope this helps

Thanks for your response. But if you look up online taller than wide shape of thyroid nodules you will find *a lot* of information about this as a common thyroid cancer ultrasound feature and I'm really surprised you have never heard of it!

Please look up online the ezxcellent extensive report, The American Association of Clinical Endocriniologists Task Force on Thyroid Nodules and academic papers online by a top University of Penn thyroid cancer doctor, Dr.Susan Mandel and Dr.Jack Baskin who is now retired but he was the past president and founder of The American Association of Clinical Endocrinologists and the director of a thyroid endocrine clinic and they and manyothers have all written about the taller than wide shape of thyroid cancers!

Last year I spoke with a university of Maryland radiologist who co-wrote an excellent article with another university of Maryland radiologist for the online journal, Applied Radiology Journal in March 2007, called, Thyroid Nodules:When to Biopsy, and I told her that my former endo at University of Penn kept dismissing the taller than wide feature as outdated,and she said Oh I think it still holds and that there was a recent study in the online journal Radiology by a Dr.Moon that found this too.

I asked her if it was from Korea and she said yes and after I hung up with her I looked up the study again online and sure enough it was the same exact study I had found recently!

Dr.Mark Lupo said to me last year on The excellent medical forum, Medhelp that taller than wide shape is debated as a suspicious feature but that it's still useful when looking at thyroid nodules.

The American Association of Clinical Endocrinologists Task Force Ojn Thyroid Nodules says to make an exception and biopsy thyroid nodules under 1cm if they have any suspicious ultrasound features which includes, taller than wide shape,hypoechoic,and absent halo all of which I have.

Also in a special online report on the increase in thyroid cancer from The National Cancer Institute last February and March, Dr.Michael Tuttle from the Sloan kettering Cancer Center said that when he was a fellow many years ago they could only biopsy nodules over 1cm, but he said technology has advanced so much that they can now successfully biopsy nodules smaller than 5 and 6mm!

I don't regret that I had my very small thyroid nodules biopsied and they couldn't ever see that I had any Hurthle cells from looking at my nodules on an ultrasound and I will be 45 next year and The National Cancer Institute and others says that after age 45 the prognoses is not as good and by the time my nodules if they are cancer grow large enough to be considered for biopsy, since recent studies found that many small papillary cancers didn't grow in 8 years, I could be 50 or older by the time I'm diagnosed!

Also, my endo couldn't really tell just by looking at my nodules and guessing that they were the same type of nodules are that they were colloid nodules by comning the cells from 2 nodules into one container. He said it cost less to do it this way and that if any were cancer my whole thyroid would have to come out anyway.

He said that he has even heard that the top thyroid cancer doctor Dr.Susan Mandel has done it this way.And Dr.Mark Lupo said to me on Medhelp that it's not an unusual thing to do.

Also there is an excellent online article for the Journal Thyroid from March 2006 written by Dr.Jack Baskin and Dr.Daniel Duick called,The Endocrinologist's View of Ultrasound Guidelines For Fine Needle Aspiration.

In it they criticize the 2004 Society of Radiologists in Ultrasound Conference because it's too narrow and limited because it only uses size and calification as features of when to do a thyroid FNA even though the SRU admits that size is not a determing factor with thyroid cancers and that many are very small.

They give examples of how reseachers found that good % of people with thyroid cancers smaller than 1.5cm were already stage 3 and that it had already spread outside the thyroid.

They explain that many of these people didn't just have solid nodules with calification but many likely had other and additional ultrasound features that are also common with thyroid cancer such as, taller than wide shape, hypoechoic,and absent halo.

Absent halo is found in 80% of thyroid cancers and I have no halo around all 3 nodules! In the online article,Thyroid Nodules:When To Biopsy? the 2 university of Maryland radiologists also report this but they also say that a halo may be absent in over 50% of benign nodules as well.

My daugther was recently dx with multinodulargoiter, she has 3 nodules, 2 of then more the 1cm of size, her tsh/ft4 are normal and she is positive for antithyroid antibodies, the u/s also showed multiples lymphatic nodules arround, at this point I dont know if she needs biopsy, and if this lymphatic nodules are related or symply is a normal finding in childrel. Should this nodules (solids) biopsied??