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Dr. Hasan
Dr. Hasan, Doctor
Category: Medical
Satisfied Customers: 7430
Experience:  MBBS, FCPS, with experience in all fields of medicine and surgery
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I have a question to an endocrinologist - My name isXXXXX

Customer Question

I have a question to an endocrinologist - My name isXXXXX and I have had a goiter for approx. 15 years but the nodules have been larger and also had biopsies and ultrasounds - I like to write down here my last ultrasound - also the dr I go to is a general surgeon and I like a skilled surgeon in southern florida to remove this goiter - I start to be apprehensive about this and have been rec to remove it. As follows a comparasion with an ultrasound in nov 2012 and this one is for 5/15 2013.
Technique gray scale and color Doppler ultrasound are used to evaluate the thyroid gland. Findings: Right thyroid lobe measures 4.62 x 2.28 x 2.19 and the left lobe 7.12 x 3.16 x 4.49 cm.
There is a very slight decrease in size of the right thyroid and very slight increase in size of the left thyroid lobe compared to prior study. Thyroid isthmus measures 4.3 mm in thickness which is slightly increased compared to the prior study.

Complex predominantely solid nodule mid to upper portion right thyroid lobe 2 cm.
complex predominantely solid nodule lower portion right thyroid lobe 1.4 cm
calcified 8 mm complex nodule upper pole left
2.45 cm complex predominantely solid nodule mid portion left thyroid lobe
3.87 cm complex predominantly solid nodule lower left thyroid lobe
Impression: Borderline increased size dominant 2 cm nodule on the right
Borderline decrease in size dominant 3.87 cm nodule left
Enlarged multinodular goiter appearance to the thyroid glad
The nodules bilaterally have a predominantely spongiform and complex appearance.
I have started to be very worried for danger here and I am 69 years old and the surgeon last year suggested to remove the left and now suggested to remove the whole - he is a general surgeon and I would need more specialized attention - the surgeon knows about the ultrasounds and comparisons and asked me to come back in 6 months. I feel more tension in the left area of neck and I have a lot of headaches and being very tense. To read up on internet about this is not good - makes me very nervous for the danger. He has biopsied several and last time the large on and benign - I am more worried about the calcification and also the other ones - which I like to have biopsied also. Thank you - also by the way tsh borderline low and the other values what I understand OK.
Eira Gregard XXX@XXXXXX.XXX
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Hasan replied 1 year ago.

HI, Thanks for your question. My name isXXXXX and I am here to help you today. I will be happy to help you with your follow-up questions also. I am an ENT and Head and Neck Surgeon so i do operate thyroid glands. I need few details. Do you have any symptoms like change in voice, difficulty in swallowing, shortness of breath etc? What are your specific questions? Regards

Customer: replied 1 year ago.

no change in voice no difficulties swallowing no really shorthness of breath when I get nervous and my bloodpressure goes up I feel some shortness of breath but not generally - the only thing is that my neck hurts on the left side and also on the rightsometimes and my headache seems to stem from that - can the thyroid push on structures - when I wrote this whole story I like you to give me an answer as to what you would recommend for something like this and if you need other information the prior ultrasound information I can write that for your comparasion. I always look to the most dangerous and read up on anaplastic so it made me very nervous -,........

Expert:  Dr. Hasan replied 1 year ago.
Eira thanks a lot for your input. I am really sorry to hear that you are so stressed. The information given by you is excellent and i can guide you what ideally should be done. I will try to be clear and precise. There are certain risk factors in your case but there are certain goods too. The risk factors are;
1. Age more than 40.
2. Solid nodules on USG scan rather than cystic.
The goods are;
1. The long history of 15 years.
2. Insignificant change in size of thyroid.
3. No associated symptoms which i asked for.
4. Your biopsies were normal always.

So the point is what should be done, here are the important points.

1. You should ask your general surgeon to proceed with surgery and he should do surgery on both sides because nodules are bilateral.
2. He should not wait for 6 months now. This doesn't means that you have cancer but earliest intervention is best.

As far as anaplastic CA is concerned, just forget it, i assure you because that type of carcinoma of thyroid is so aggressive that you cannot stay with that for so many years. You don't have a single symptom associated with it. Your biopsies were always negative so that is not a problem. I give you my words that you should not stress yourself.

Lastly the types of headaches and neck pains you are having are not associated with your thyroid. They can be because of tension or anxiety or related to something else like muscles or spine. Tylenol or ibuprofen should be tried and if symptoms persist, see your PCP for this. But please don't stress yourself for anything life threatening.

I wish you good luck that you get well soon, please ask if you have any question because our discussion always remains open so you can always ask more till you are satisfied, You can click the smiley to rate the answer. You can come back here to ask anything even after you have rated the answer. I will be glad to help you always.

Customer: replied 1 year ago.

I like to write a couple fo more things from the ultrasound before for comparison. The thyroid lobes were then 5.2x2.2x2.7 cm the right one and in the upper one a complex 7x6x6mmpredominantely hypoechoic nodule.There is an isoechoic 1.7x1.2x1.8 cm round nodule in the mid rightthyroid lobe representing the dominant nodule from 6 months back.An echogenic nodule measuring up to 1.3x1.0x0.8 cm is seen in the inferior right lobe.Additional complex nodule measuring up to 1.3x1.1x1.1cm is seen in the inferior right lobe.


 


the left lobe measures 7.0x3.0x4.0 cm. In the upper pole is a 6x4x5mm heterogeneneous nodule. thereis a large echogenic focus with posterior shadowing in the upper lobe of the left measuring up to 6mm which is also present last ex. The left lobe is diffusely heterogenous and enlarged. The dominant nodule measures 4.4 x 2.7 x 3.5 and is heterogeneous in nature.


 


Impression - heterogeneous appearance of the thyroid with interval enlargement of the left lobe comp. to prior exam and multiple nodules.


Dominant nodule measuring 1.7cm in the mid right thyroid lobe likely representingthe previous dominant nodule on prior exam.


Heterogeneous nodlu on the left thyroid lobe measuring 4.4cm increased in size since last - 6 months ago.


This exam seems muh more specific than the new on in May this year - This one is from 11/19/12. And what I understand is the 1.7 nodule right now 2 cm and the 4.4 is 3.87 cm. I think the 6 mm in the upper left lobe is now 8 mm but in this report it did not say calcified - but I think I heard it was even before this report.


 


I like you if it is not too much to ask for look over this and compare - and I know that the biopsies were mostly for the left - compared to many years ago as the doctor was very through and checked many for biopsies. This doctor has just done the left lower pole and the needle biopsy then showed cystic lesion favor cystic change in an adenomatoid nodule and no malignant cells there - it was done once more and the same after the growth of the left lobe nodule to 4.4cm


 


I questioned this to the nurse and said why did he not take the right and the dr. was not concerned about the right was the answer.


 


I am Swedish and have lived all over the world and also know that in Chicago I was so well taken care of regarding the biopsies and nothing showed up - the nodules were of course smaller.


 


So, I understand I need to take this out and thank you for calming my scary thoughts about the worse scenario. Please let me know what you think about the comparison.


Thank you,


Eira Gregard


XXXXX@XXXXXX.XXX


 


 

Expert:  Dr. Hasan replied 1 year ago.
Eira thanks for your input. I guess that you have two concerns right now so i will address them and if i miss anything, please don't worry because i will be here to assist you. I have reviewed your reports and it has some good news for you. The size of some nodules have increased and some have decreased too so anything which decreases in size is mostly not cancer because cancer is supposed to increase in size. So this is one thing which is reassuring for me. Secondly your doctor was not concerned about th right lobe but was worried about the left. The reason is the presence of calcification which has been mentioned in one of your report. Calcification increases the risk of cancer but it doesn't always means that there is cancer underneath. Doctor preferred to take biopsy from left just because of the calcification found in that lobe. This must be the only reason because otherwise slight size fluctuations are not so big issue. If you are thinking that you should go for another biopsy then i would not suggest this because even that is done, you still have to get your thyroid out and in case of thyroid histopathology done after the thyroid is out is most reliable. So to conclude the comparison of the reports in your favor, meaning that you are at low risk of having carcinoma and there is not even 1% chance of anaplastic carcinoma. I hope this helps you, I wish you good luck that you get well soon, please ask if you have any question because our discussion always remains open so you can always ask more till you are satisfied, You can click the smiley to rate the answer. You can come back here to ask anything even after you have rated the answer. I will be glad to help you always.
Customer: replied 1 year ago.

Thank you for your respons - I am more comforted and also thinking if the dr was concerned about any serious issues he would not choose to wait 6 months either -So in all regards XXXXX XXXXX to believe that the nodules are benign at this time, Eira

Expert:  Dr. Hasan replied 1 year ago.
Eira, you got my point. I am quite hopeful that things will go in your favor. Yes doctor must not have chosen 6 months if he was suspecting anything serious. My best wishes and prayers will be with you. I wish you all the best, XXXXX XXXXX if you have any question because our discussion always remains open so you can always ask more till you are satisfied, You can click the smiley to rate the answer. You can come back here to ask anything even after you have rated the answer. I will be glad to help you always.
Customer: replied 1 year ago.

Yes I worry like crazy - and wonder if something the real serious can develop out of a goiter and would the specimen - the biopsy have shown that - I am worried about the 6mm havingincreased to 8mm and also I hav a feeling that I was told that it was some calcifications already some years ago in Dallas by a surgeon because I asked her to biopsy that part and she said it is too hard but the former ultrasound did not say anythingabout calcifications only the one from 5/15/2013. I am crazy worried! having missed the boat! Eira

Expert:  Dr. Hasan replied 1 year ago.
Eira i am so sorry that you are still worried. Possibilities definitely remains there but in your specific case there are certain aspects which are reassuring. Increase from 6 to 8 mm is not that significant increase. Suppose if you had calcifications in the previous report but no having them in this report are again reassuring. Again if there were calcifications related to cancer, the thyroid would have grown significantly by now. So in any case, things are not as liely to be serious as you are stressing yourself. So please calm down and hope for the best. Please feel free to ask anything that is not clear, Please rate my answer once you feel appropriate. Regards
Customer: replied 1 year ago.

Yes I belive that the thyrod needs to come out - I found a report from 2.22.2011 and by the way all reports are not showing calcifications dor at least the reader has not put it in. However the thyroid over these two years have grown significantly and the report from above mentioned date says - both lobes are enlarged but at the time not as enlarged as dnow - worse on the left - in theis report it says that both lobes are very heterogeneous and show increased vascularity - there are nodules bilateraly - they are solid in the right lobe and there are both cystic and solid in left.


there is a course calcification measuring 5 x 4 mm in the left - and that must be the one that is 8 mm now? multinodular goiter most likely correlation with a thyroid uptake and can is recommended.


So at that time the lobes were right 3.9 x 2x 1.9 cm and thee left 5.2 x 2.8 x 2.7cm and the larges in the right at that time measured 10 x 9 x 8mm. In the reporte the isthus have changed in this on 3.2mm


Greatful for an answer!


 


Do these nodules and the lobes do change over time? But as not knowing much I am more worried about calcifications


 


Another thing probably in my favor is that I was in the hospital and test wee taken lungs - mri - spine and plenty of bloodwork up to 26 tubes over 3 days and also the sed rate was almost 0. They did not find anythjingwrong with me they also cchecked the carotid arteries and the thyroid is from that time in May this year/


Greatful again for an answer

Expert:  Dr. Hasan replied 1 year ago.
Eira you are always welcome. Yes even benign nodules change in size. So the change in size is not just consistent with cancer. It is possible and common with benign lesions also. Calcifications are seen in both benign and malignant lesions. If we evaluate all your reports including biopsies, the things are more in your favor as there are more chances for your thyroid enlargement to be benign in nature. Your hospital work up again is reassuring. I wish you all the best again. Please feel free to ask anything that is not clear, Please rate my answer once you feel appropriate. Regards
Customer: replied 1 year ago.

Dear Dr!


 


I am more and more aware of the problem now and having had and have headache and soreness in neck kfor long time and fatigue and tiredness I have now made app;ointment with an endoscrine surgeon and go there in 3 weekws. I will also go b ack to the surgeon I have been too and talk to him - I have no problems in swalloing but noticed a sore troat on the left side moslty where the big nodule is - and noticed that already last october - but it went away and have come back now and then and now it is beck - also some dry cough for one month - could this be consistent with issues - I just feel more on the left side.


Thanks,


Eira

Expert:  Dr. Hasan replied 1 year ago.
Eira thanks a lot for your input. No these symptoms are not consistent with any thyroid problem, neither benign nor malignant. The causes here can be either GERD or sinus issues. Other than this nothing possible. I wish you all the best again. Please feel free to ask anything that is not clear, Please rate my answer once you feel appropriate. Regards
Customer: replied 1 year ago.

Dr. Hassan thank you for excellent service - also I have additional questions - this with sore throat issues - the soreness is very far down and I can't see it - it feels like my left lobe is hanging down and that was the one the dr biopsied. - and it feels larger - it is one month ago I had the last ultra and that lobe was somewhat enlarged. This has been going on for one week now - and I called the office and the dr - is out of the country for long and I got the app the 19 of july but I go to specialists on the 7th. I have no problems swallowing or talking no horseness - some dry cough - putting my shin down I feel the fullness on the left - primarily on left this soreness - can the lobe hang on structures that feels like soreness? No problems breathing. Greatful for an answer


Eira

Expert:  Dr. Hasan replied 1 year ago.
Eira thanks for your input. The symptoms you are having are consistent with acid reflux from stomach causing soreness. Dry cough is also indicative of that. Thyroid lobes can only cause respiratory distress and difficulty swallowing. OTC cap omeprazole 40mg once daily can help you get rid of this. Please don't stress yourself. I wish you good luck for the appointment. Your feedback is requested and i will be grateful for that. Regards
Dr. Hasan, Doctor
Category: Medical
Satisfied Customers: 7430
Experience: MBBS, FCPS, with experience in all fields of medicine and surgery
Dr. Hasan and 9 other Medical Specialists are ready to help you
Customer: replied 1 year ago.

Dr Hassan!


 


I tested my selft through a laboratory and found out that my thyroglobulin QN was 124 and the normals should nopt be mopre than 55 - what does that mean? Does that mean I have thyroid cancer? Eira

Expert:  Dr. Hasan replied 1 year ago.
Hi Eira, Its not so. Thyroglobulin antibodies can be elevated in three types of lesions.
1. Goiter
2. Hyperthyroidism
3. Thyroid tumors (sometime)

The first thing which you should clarify in your mind that we never order thyroglobulin test to diagnose or screen thyroid cancer. In your specific case, in the light of your negative biopsies and other findings which i know as per our last conversation, i really don't think that they have any relation with your problem being cancer related. So please don't stress yourself for this. This is just due to goiter which you have. These antibodies have just a role in monitoring thyroid carcinoma after surgery because in that case it indicate that some thyroid tissue is still in body. So you can now easily understand that it's not related to your case. Please ask if you have any question because our discussion always remains open so you can always ask more till you are satisfied, You can click the smiley to rate the answer. You can come back here to ask anything even after you have rated the answer. I will be glad to help you always. I hope this helps you.
Customer: replied 1 year ago.

Thank you for clarifications - I am so tired mostof the time and have about every second day muscle spasm in back and migraine - I will have an epidural soon as I have herniated discs in cervical spine - I am so tired and worried about that also - I would like to write down the valuse:


This is from Lab corp - Thyroglobulin QN 124 and ref 0,5 - 55


Antithyroid globulin Ab less than 20 ref 0 - 40


T4 Free direct 1.28 ref 0.82 - 1.77


Reverse T3 serum 15.1 ref 9.2 - 24.1


T3 106 ref 71 - 180


TPO ab less than 4 and ref 0-34


Triiodothyroinine free serum 2.8 2.0 - 4.4


TSH 0.592 ref 0.450 - 4.500


Thyroxine T4 7.8 ref - 4.5 - 12.0


T3 uptake 34 ref 24 - 39


Free thyroxine index 2.7 ref 1.2 - 4.9


I went to the endocronologist the other day and he felt the big lum smooth and nice but I also mentioned that the surgeon did not biopsy my left side some nodules there are 2.0 cm and one 2.4 cm and as per the surgeon he was not concerned aboutthe rightside! The endoscronoligist mentioned that he ought to biopsy the right side also but he was not that concerned - I am going tosome specialist on the 5th of july- as I am so tiredand worried and most likely my migraine and muscle spasm and fatigue has intensified. Greatful for reply again. Eira

Expert:  Dr. Hasan replied 1 year ago.
Eira you are always welcome. The other values are normal and this is an excellent news. As far as your tiredness is concerned, it is not related to thyroid. There can be some other cause. It might be due to a throat infection as you were having sore throat, it can be due to low hemoglobin, can be side effect of some of your medicines but thyroid has no relation here. Don't stress yourself about biopsy issues because even it's also likely to be benign. I would prefer if you see your PCP for your tiredness or an internist.

please ask if you have any question because our discussion always remains open so you can always ask more till you are satisfied, You can click the smiley to rate the answer. You can come back here to ask anything even after you have rated the answer. I will be glad to help you always.

Customer: replied 1 year ago.

Hemoglobin and bloodwork mostly fine - so thyroid has nothingto do with this - like I can be more or ls OK and suddenly this muscle pasm comes ovr me and I get some higher bloodpressure and heart rate - by th way that ha also been tested - and my breathing gets a little labored and stomach acid start moving and headache starts - that can last from 10 minutes to hours to almost whole day and I am never rested when -I wake up - and the fatigue - but they state I hve fibromyalgia - some of my dr friends in dallas state when they can't find anything some dr attribute all this to fibromyalgia. Sometimes I don't know what to believe? /so when my values are OK this has nothing to do with the thyroid? ?But my migraine contribute a lot to my issues I am sure?


Thank you for your answers......And my internist she does not know!

Expert:  Dr. Hasan replied 1 year ago.
Thanks a lot for your input. Yes i was also thinking about this. Have you seen a rheumatologist? Regards
Customer: replied 1 year ago.

Dear Dr Hassan!


As per my fatigue and weakness etc I would like to ask another question about my blood work. I took the full panel and all the hematological measures were OK except Eos: H 0.5 0.0-0.4. Why? Apparently all times before it has been just fine.


 


The glucose was high - I ate some and shouldnot have donethat 109 65-99


Cloride serum always low 92 97-108


Bun/creatinine ratio L 11-26


Sodium always on the low side for me - 130 134 - 144


Cholesterol total 207 H 100 - 199 surprising!


Triglycerides H 150 0 - 149


LDL H 120 0 - 99


 


HDL 57 greater than 39


 


Pleased for an answer,


Eira


 


 

Expert:  Dr. Hasan replied 1 year ago.
Thanks for your input. If you are concerned about EOS only then i would like to reassure you that it is just above normal and this much elevation can be due to a slight lab error. Even if it is actually raised, it has no significance at this level. Regards
Customer: replied 1 year ago.

Dear Dr Hassan!


I have a question pertaining to hot flashes - I don't know if I mentioned that before but this inconvenience started in January and before then I was not feeling good - having fatigue and aches and pains etc - etc. It seems like I have a virus all the time - very horrible - some say it is fibromyalgia - but what about these hot flashes - can they be part of the thyroid issues? The thyroid problems I have had for a long time but the growth started last year and was noticed in Nov last year - would that be a connection? Thanks so much, Eira

Expert:  Dr. Hasan replied 1 year ago.
Hi Eira, have you got your esterogen and progesterone hormones checked?
Customer: replied 1 year ago.

T hank you - the hormones are probably non-existent atthis time but I will ask - I have patches I got from the gyn-dr and have had one forone week but really not helpful and I bought some supplements now and will go for that for the time.


Still worried about my thyroid as I can feel the right side now - and I go the the specialists this Friday - and my aches and pains and fatigue and also something else occurring is a tight squiss in the sides and the whole back and it feels like the bones are hurting also and not only the muscles - I go to a fibro dr in Miami and have not had this stabbing squizzing pain before came about two weeks ago - now in my little mind I think perhaps the thyroid issue has spread to the bones???!!!!!! Eira

Expert:  Dr. Hasan replied 1 year ago.

Thanks a lot for your input. No it is not your thyroid affecting your bones. In my opinion you should be checked for osteoporosis and your gynecological hormones should be checked. These both problems are interrelated and can be the cause of your problem. I assure you that your thyroid is not responsible for your other symptoms. Regards

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