What should be the steps in the treatment of a thyroid nodule that has grown to 1.5 inch?

Question

Hello doctor,

I have been monitoring a nodule on my left thyroid for about the past 12 years. It has grown and is now 1.5 inches. Attached are the reports from a recent ultrasound, nuclear medicine thyroid uptake or scan, and biopsy. My blood levels have usually always been normal, however, in the last few months my TSH has been very low, and my endocrinologist thinks it is from my nodule being overactive. I would like a second opinion on what should be the next steps. Should I get radiation, or surgery, or do nothing and continue to monitor? Currently, I am taking Vyvanse 40 mg.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I just read your query and the reports that you have attached (attachments removed to protect the patient's identity). It does seem like your thyroid nodule has considerably enlarged and now turned overactive. In my opinion, it would be better to get it removed surgically. Now, how much to be removed surgically depends upon how fast it grew to its present size. If it was very soon, then the complete removal of the thyroid gland would be a possibility. However, it depends on what your endocrine surgeon thinks about the treatment plan. However, a 1.5 inch nodule is too large to be managed with medication only. Waiting and watching is not recommended for this large size nodule, and that too if it is overactive. I hope you discuss with your endocrine surgeon regarding the suitable plan of management as it also depends on clinical examination.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Radioactive iodine (RAI) is a less-preferred option than surgery in patients with large nodules, causing compressive symptoms, but it can be utilized when surgery is contraindicated or refused. Nodule shrinkage may occur post-treatment. It is contra-indicated for pregnant and lactating women. So, it is your choice and can be tried if you wish so but bear in mind if it does not work then you might need surgery. Some people respond to RAI and some do not. You must discuss with your endocrine surgeon the need for radioactive iodine therapy versus surgery. Yes, central hypothyroidism can benefit from a pituitary MRI (magnetic resonance imaging).

Thank you.