Why am I having small multiple nodules and enlarged lymph nodes?
Patient's Query
Hi doctor,
Recently, I got an ultrasound done and found multiple nodules that have changed in shape and size. TIRADS 4 complexes mixed with large echogenic focus one nodule over two adjacent (0.35 X0.31X0.35) inch, and lobulated. Nodule two (0.31 X0.28X0.31) inch completely solid hypoechoic with a well-defined border. Possible reactive enlarged lymph nodes are present. The physician has refused any follow-up tests because they are not large enough. Is this normal?
Hi,
Welcome to icliniq.com.
The nodules are low-risk ROM (risk of malignancy) which I could see in the pictures. Real-time imaging is always better. Which one of the nodules has the radiologist given TIRADS 4 score? Is nodule one (1.1X0.2X0.3) inch or nodule two is (0.35X0.31X0.35) inch? The hypoechoic nodule is less than an inch and does not have risk features, but it is close to the capsule so sometimes we do make exceptions and do FNAC (fine needle aspiration cytology) on less than one inch nodules. If you do not have any other higher risk such as a family history of thyroid cancer, radiation exposure in the past, then can repeat ultrasound in six months. The two adjacent nodules or lobulated with a large echogenic focus. If we consider them as a single nodule then maybe they will meet the size criteria for FNAC. Overall, the approach by your physician is reasonable but if you are concerned, meet with an endocrinologist and get FNAC done.
Patient's Query
Hi doctor,
The radiologist has classified nodules 3 and 4 (the hypoechoic) as TIRADS 4, and nodule 2 is (0.35X0.2X0.35) cm in size. I guess I was confused with them wanting to wait because nodule 2 has been there for a while it was only 3 mm and now larger with another nodule growing right next to nodule 4 was 0.02 inch with all benign features. Now it has grown completely solid and classified as TIRADS 4. I was diagnosed with Hashimoto's disease years back but my blood test reports have been fine so no medication was needed, but I do have chronic fatigue, joint pain and red dry skin. They are diagnosed as Rosacea, and there is a constant redness around my thyroid gland on my neck.
Hi,
Welcome back to icliniq.com.
Overall, the nodules you have are all low to intermediate risk. Among them, nodule 4 carries slightly more risk, but still, it is less than an inch. The nodule that has grown (cystic with large echogenic focus and adjacent similar nodule) still is less than an inch too. Since you have Hashimoto's disease, you may continue to form new nodules like these and notice changes in the existing ones. It is annoying sometimes (causing anxiety) and also financially more expensive to follow these nodules over time with repeated ultrasounds, unfortunately. Going for a biopsy or FNAC (fine needle aspiration cytology) will not solve the issue either. I agree with your physician now. It is recommended to repeat the ultrasound every six months.
Same symptoms don't mean you have the same problem. Consult a doctor now!
Read answers about:
hypoechoic noduleDisclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.