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Old 08-20-2013, 05:49 PM   #1
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Nodules and Biopsy - Trying Not to Panic

I just got the results on my 2nd annual thyroid ultrasound. Last year they found one small nodule but said it was nothing to worry about. We'll just keep an eye on it. I have Hashi's so I wasn't surprised to have a nodule.

My latest result showed another nodule though. They recommended to my NP that I have a fine needle aspiration biopsy done. I'm trying not to freak out as I've read that the chance of thyroid cancer is small. Of course, once you hear the word "biopsy" for the first time it's hard not to worry. My NP is going to call an ENT doctor tomorrow (she said he's very good with thyroid issues) to see if he can do the biopsy or if I need to go through the radiology department.

In the mean time, I'm sitting here wondering why another nodule showed up. Is there something specific that causes them? Am I not doing something right? I'm on Nature-Throid and working on getting my levels adjusted properly. Is there something more I should be doing to keep the nodules at bay?

I'm going back and forth between being okay and then panicking. Anyone have any words of encouragement?
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Old 08-21-2013, 05:24 AM   #2
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If you see a Hashimoto's thyroid after surgery..it actually means many nodules on the thyroid...multinodular goiter...it's what Hashimoto's does. But that doesn't mean one can't be 'suspect'...so have the FNB and know for sure...and an ENT can really find a nodule fast and are very good in the throat region...it's what they DO.

How are your most recent FT's? Having FT3 in the upper 3/4 usually holds Hashimoto's nodules at bay...but nodules come in different 'types'. Hot nodules or non uniform looking ones need FNB'd. Better to be safe than sorry. Hope it all goes well for you.
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Old 08-21-2013, 05:39 AM   #3
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Jiggles- I have Hashi's--and nodules (3 or 4), but I had the opposite problem for a long time. A nodule has to be a certain size before it can be biopsied accurately, and for about 3 years, I had annual ultrasounds, but mine were all too small for biopsy. I wanted to have it done just to be sure that they were not cancerous (although 85% of all thyroid nodules remain benign).

Finally, one was large enough, and I had the fine-needle procedure, and all was well. They stopped growing when my meds were optimized, and now I have annual ultrasounds to check. It's been about 5 years with no changes. If they were to begin to grow again, my endo would do another FNA, but as long as they are not growing, he assures me that there's nothing to worry about.

Nodules are characteristic of Hashi's, so it's not really unusual to have them.
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Old 08-21-2013, 11:01 AM   #4
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Thank you for your posts. It always helps to hear something positive.

My NP called & had spoke to the other doctor. He still does some biopsies in his office but mostly passes them on to radiology so they can use the ultrasound to be more efficient. She said I could still see him if I want but we could skip that step and she'd just send an order over to scheduling. I said to just do that. I'd like to get the biopsy over as quick as possible.

And I've heard that doctor is a real jerk (even though he's good). Even my NP said his bedside manner isn't the best & she's heard that from patients. My SO saw him once & said "Yeah, he's a real jerk but if you don't ask any questions you should be fine." WTH, don't ask questions?!!

ETA: Since I wasn't thinking clearly last night I forgot to ask my NP about the first nodule so I asked today. She said that's the one they want to biopsy since it's grown. They aren't concerned about the new nodule yet.

Last edited by jiggles; 08-21-2013 at 11:05 AM..
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Old 08-21-2013, 02:57 PM   #5
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I know costs vary, but any idea what this procedure costs? I've been looking online and seen anywhere from $400 - $4000. I'm panicking more about that at the moment then the actual results.

I have a crappy high deductible insurance plan and am not even close to meeting my deductible. So, I know I will end up paying for this out of pocket.
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Old 08-21-2013, 03:53 PM   #6
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jiggles-
Sorry that I can't help on cost. My FNA was about 5 years ago, and I have full coverage insurance, so I didn't pay anything. I would have seen the cost on my insurance company's report to me, but I just don't remember.

They really do best with the ultrasound. When mine was done (by a pathologist who was a family friend), the radiologist told me that it was so deep, they wouldn't have been able to locate it without the ultrasound.

Don't worry about asking questions. There really aren't any to ask there. Because my doctor was a family friend, he gave me a preliminary assurance that it was benign--which he told me was only 98% certain. But most won't give you any info until the tissue can be examined. Your doctor will get a full report--and that's when you might have questions.

I'm a 'question person.' And I didn't have anything to ask at the procedure. They just take tissue from the nodule for subsequent examination in the lab. Be prepared (I wasn't) for the fact that the protocol requires 3 separate samples, so the doctor will insert that needle 3 times at least.

There's no pain (if they do it right), but you do feel pressure, and it's uncomfortable.
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Old 08-21-2013, 04:50 PM   #7
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That's good to know on the needle insertion. And the pain. I was reading online and saw some horror stories, but also read some that said it wasn't really painful at all.

Hmm, I'm wondering now if I shouldn't check with the hospital on a price estimate. I found out the NP faxed my order over to the clinic which surprised me because I've had both ultrasounds done at the hospital because it's much cheaper. I did call the hospital to see if they could get me an estimate but they said it would be tough to do without the order. I will definitely ask the clinic when they call to schedule the appt.

Funny thing is that both the clinic and the hospital are owned my the same organization. Yet the clinic was about $300 more on the ultrasound. I don't get it.
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Old 08-21-2013, 06:38 PM   #8
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I agree with one of the other posters--got to an ENT! I had all kinds of thyroid issues. I had a huge goiter and my thyroid was riddled with a bunch of small tumors. I was sent to a general surgeon who was going to just remove half of my thyroid. Mind you, I kept having problems with going hyper and ended up in the hospital several times with SVT (my heart rate in the 170's). I asked the surgeon how removing 1/2 my thyroid would fix this and he said if it didn't, I would have to have the other half removed. I fired him and went directoy to an ENT who scheduled me for surgery immediately. He wouldn't risk doing a biopsy. The good thing was he was also a plastic surgeon so my scar is almost nonexsistent! I did not have cancer (thank God) and have been on my Nature throid doing great every since. Don't be afraid. Just find a good ENT. Good luck!
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Old 08-22-2013, 06:04 PM   #9
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My sister has had that heart rate issue. Yesterday she was in the ER with a pulse rate of 197. Her thyroid has been removed and she takes t4 only. She asked her thyroid Dr. for T3 but they said it was too late for her to start using the T3 because it would further increase her heart rate. Seems to me if they started her slowly and monitored her carefully they could maybe help her??
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Old 08-23-2013, 05:40 PM   #10
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isnt that what block and replace is for! doctors.. grrrrr
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Old 09-13-2013, 12:31 PM   #11
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Old 09-15-2013, 09:22 AM   #12
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Thanks for asking but I haven't had it done yet. I have an appt the first week in October. I know I said I wanted to get it over with quickly but I decided to wait until then for insurance reasons and my NP thought it would be fine since it isn't too far away.

I'm actually not real nervous about it at the moment. I'm trying to think of it as more routine and not that it could actually be cancer.
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Old 09-15-2013, 02:08 PM   #13
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I had an ultrasound led FNA a few yrs ago. I was very nervous, but honestly, it wasn't bad at all. The worst part was leaning my head back that far! lol. One of the needle insertion points got a little infected afterwards also. I will say, that of the 6 nodules I had, they sampled 3 and they came back noncancerous. We continued to watch them for a few yrs and the largest one (very large) continued to slowly grow and one of the smaller ones, not tested on the other side did too, finally getting large enough that removing that side of my thyroid was now an option. Endo decided it might be time to get it removed, since it was growing and not responding to meds. I had a TT in June and the largest of the nodules, that was biopsied yrs before did end up have a microcarcinoma in it. So, please keep an eye on the nodules (via ultrasound) if surgery is not recommended at this time. Continued growth is usually not a good sign, obviously.
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Old 09-15-2013, 03:04 PM   #14
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Thank you for sharing your experience. Hopefully nothing will be found with my appt but I will definitely keep an eye on the nodules with routine ultrasounds.

My appt is at 8 AM. The nurse said they usually recommend taking the whole day off from work. I was kind of surprised by that. She said I could feel somewhat of a sore throat after but the most uncomfortable part is having to lean your head back for so long. I have plenty of time off so takings the whole day isn't a big deal, but I wonder if it's really necessary.
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Old 09-19-2013, 07:54 PM   #15
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I don't work, so I didn't need to take time off of work, but probably not a bad idea. Slight tenderness and to be honest, one place started to become infected within hours. (sorry, I think this is rare though) Take some Advil for swelling/pain and relax the rest of the day. Please keep us updated!
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Old 09-21-2013, 04:24 PM   #16
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Well, I never really mind a good excuse to stay home from work. LOL I'll definitely update!
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Old 09-22-2013, 03:32 AM   #17
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Hi Jiggles, I had a biopsy in January and I got 3 separate bills:

Radiology $815
Hospital $2231
Pathology $559

I have pretty good insurance so I only paid about 20%. I had an excellent radiologist who didn't have the greatest bedside manner but his nurse was absolutely wonderful and answered all my questions beforehand. She even held my hand during the procedure and told me step by step what he was doing.

I saw the doc at a restaurant not too long ago and said hi and introduced myself and he was one of the nicest men I've ever met!
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Old 09-23-2013, 07:48 AM   #18
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The hospital sent me a quote for about $1500. I hope it's not much more than that but I know when I got my first ultrasound last year they quoted me about $180 which was about what I was billed for but then I got another bill for $50 later that came out of the South Dakota billing office and was for the Pathologist. It's all one big system but yet the bills come from all of the place. So, I'm concerned that even though they sent me a detailed biopsy quote in the mail it still won't include all of the charges.

I need it done so I just have to eat the costs.
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Old 09-23-2013, 11:51 AM   #19
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I've had my 6 or 7 nodules biopsied at least 2 times. It's been about 4 yrs since the last time. Didn't hurt - felt tight. I did go to work after but had a bad bruise for awhile.

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Old 09-25-2013, 04:22 AM   #20
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I just had one nodule, no bruising - looked like a mosquito bite!
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Old 10-03-2013, 04:34 PM   #21
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Had the biopsy this morning on the one nodule. Wasn't too bad. They numbed the area and then all I really felt was when the Radiologist moved the needles around to get the samples. They used 8 or 9 needles. They gave me an ice pack to take home.

Now it's the waiting game which is harder than the biopsy. They said the results could be ready tomorrow but probably not until Monday. They will be faxed to my NP of course. She's had an odd schedule for a while so hopefully she gets them right away.

Thanks for all the info and support. I really appreciate it.
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Old 10-21-2013, 03:45 PM   #22
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Jiggles pathology report?

Jiggles, I assume you received the results of your thyroid FNA biopsy. Hope it was good news.

I had my first thyroid US a year ago and had no nodules, also confirmed by RAIU (radioactive uptake test) which showed a nodular-free but great big whopping thyroid with a diffusely high intake. In other words, Grave's disease, of which hyperthyroidism is one symptom.

A few weeks ago (a year later) I had another US and now have a <1 cm nodule that my endocrinologist wants to biopsy with fine needle aspiration. She does both the ultrasounds and the needle procedure herself in her office. Is that a good thing?

Was so grateful to hear that the needle biopsy is not painful. I'm not too worried about the results, as I know the vast majority of thyroid nodules are benign. I hope that was your result. Kim
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