I had a thyroid sonogram which revealed cystic and solid nodes, biopsy, benign, drained cyst, wonder if I should have further concerns. have many symptoms of hyper and hypo thyroidism, could the above be the cause. What if any treatment?
Reply ------------------------------
The necessary routine steps in the evaluation of a thyroid mass simply include a measurement of thyroid hormone levels and a fine needle biopsy of a dominant thyroid mass. Additional tests may be obtained subsequent to these basic steps based upon individual considerations, but thyroid sonograms and nuclear thyroid scans are no longer considered important routine tests. Imaging studies such as a chest x-ray or CT scan are commonly done with multi-nodular goiters primarily to evaluate the overall size of the goiter and to determine the presence of any compression of the swallowing tube or windpipe. A thyroid stimulating hormone measurement (TSH) level is a blood test which can help determine whether you are producing adequate thyroid hormone levels and thus determine whether you are hyper- or hypothyroid. If a biopsy by fine needle technique has resulted in a benign diagnosis, then I will generally recommend a repeat biopsy for confirmation in 2-3 months. Beyond that, assuming the second biopsy is also benign, then it is just a matter of periodic examinations to monitor any change in size or character of the thyroid mass. After a confident benign diagnosis has been reached, indications for surgical removal would include bothersome symptoms such as swallowing difficulty, hoarseness, or breathing problems that could be attributable to the thyroid mass. For patients with fluid-filled thyroid cysts which recur despite repeated needle aspirations, surgical removal via partial thyroidectomy is commonly recommended.
Occasionally solitary thyroid nodules are hyperfunctional and result in hyperthyroidism. Surgery may be recommended in this situation as well. Some patients with benign solitary nodules and many with multi-nodular thyroid glands (with normal hormone levels) will be advised to take thyroid hormone medication (such as Synthroid) in an attempt to suppress further enlargement of the thyroid however this is controversial, and there are some situations in which this medication will not be appropriate.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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