Dr. Andrew Chellakumar Fenn
Radiation Oncology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I had a chest MRI for chest wall pain today. All looked good compared to a chest CT scan done two years back, but there was an incidental finding of a thyroid nodule that is 0.23 inches on today's MRI. I am not sure if this was on the previous chest CT scan or not. The old CT scan report does not mention a thyroid nodule. Meanwhile, how do I know if this 0.23 inch nodule on the thyroid is old or new? Should I worry if it has appeared suddenly?
Please help me.
Thank you.
Hi,
Welcome to icliniq.com.
Thyroid nodules are incidental findings on most CT (computed tomography) and MRI (magnetic resonance imaging) scans. In general, these nodules are evaluated if there are worrying features such as large size, blood vessel activity (vascularity), and texture variations. A 0.23 inch nodule would be too small to characterize. Another thing to note is comparing CT findings to MRI findings is like comparing apples to oranges. For all you know, it may have been there earlier. In general, there is nothing to worry about. But if you are a bit worried, you could do an ultrasound of the neck to better characterize the lesion. But I doubt they will be able to find the nodule. It is a bit like searching for a needle in a haystack. The nodule is quite small.
Hope this helps you.
Thank you.
Patient's Query
Hello doctor,
Thank you so much!
Hi,
Welcome back to icliniq.com.
You are welcome.
Patient's Query
Hello doctor,
One more question. Is there any TSH blood work that would be illuminating? I had my thyroid tested and my TSH and T4 were normal. Please clarify my doubt.
Thank you.
Hi,
Welcome back to icliniq.com.
Generally, we do not evaluate single nodules. If there were multiple nodules, it is worth doing a workup for autoimmune thyroiditis. I do not think that is the case here.
Thanks and regards.
Patient's Query
Hello doctor,
Here is the ultrasound report: Findings: The right lobe measures 17.7 x 8.26 x 5.9 inch. The left lobe measures 18.11 x 7.08 x 0.55 inch. Right lobe has homogeneous echotexture. There is a 0.55 x 0.35 x 0.23 inch isoechoic solid nodule. There are no calcifications. The left lobe of the thyroid has a homogeneous echotexture. There are no significant nodules in the left lobe of the thyroid. The thyroid isthmus is unremarkable.
Impression: Right thyroid nodule. 12-month follow-up thyroid ultrasound is recommended.
Thank you.
Hi,
Welcome back to icliniq.com.
I have seen the report. They have not given a expand score, so I assume It is two or three based on the recommendation of a 12-month follow-up. The size of the nodule is definitely more than what was reported on the MRI (magnetic resonance imaging). I would advise repeating an ultrasound in six months and planning a needle aspiration or biopsy if there is a change in size. It still looks like an incidentally detected nodule.
I hope this helps answer your query.
Thanks and regards.
Patient's Query
Hello doctor,
They gave it a score of 3 but here is my question. The biggest dimension was 0.55 inches. If it were 0.59 inch solid with no calcifications would it need a needle biopsy? In other words, a 0.55 inch solid nodule does not have a biopsy but a 0.59 inch solid nodule does. (again, no calcifications and isoechoic). I am trying to decide if I push for the needle biopsy where it is so close to 0.59 inch (also it is not on the thyroid isthmus which I read is good).
Thank you.
Hi,
Welcome back to icliniq.com.
I would like to reiterate that thyroid nodules are fairly common on routine imaging done for other reasons. Even if it were 0.59 inches, it may not be prudent to do a biopsy (biopsies do have complications). If it were more than 0.98 inches, I may recommend a biopsy or ask for a shorter follow-up scan (three months). At the end of the day, if you have understood the pros and cons, and still want to get a biopsy done, you should discuss the same with your physician.
Thanks and regards.
Patient's Query
Hello doctor,
I just learned nodule was not seen on the old CT scan. But they said the thyroid was captured. I am sending over the files from the ultrasound. Can you look for nodules?
Thank you.
Hi,
Welcome back to icliniq.com.
I am unable to view the file. I will try to open the file again at work, later in the day.. I will get back to you soon.
Thanks and regards.
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Radiation Oncology
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