Thyromegaly, calcifications, colloid of Thyroid

[tykemeister]

Good day.

Help please Doc. Ira and eyedoc.

A 54 yr. old female relative of mine had a needle aspiration biopsy taken for suspected cyst found on the right thyroid gland. One thyroid gland is larger than the other.

Ultrasonography showed small calcifications on the right thyroid gland.

Need to ask if a CAT scan is also warrented.

When is radioactive iodine treatment needed for goiter?

Also, is it possible to not treat goiter in adults?

Would aspiration be enough if a cyst is present?

I can't understand some of the texts I found in the internet as I am not a physician.

My relative already has a physician, but I wish to ask if you know of other physicians and where they hold clinics who specialize in dealing with thyroid problems in case a second opinion would be needed.

Masasabi ba po nila if my relative would require surgery?

Many thanks and more power.

[Ira]

What is the needle aspiration biopsy result? Offhand, if there is no cancer or lymphoma, I don't see the need for a CT scan. It's not a sensitive test for masses localized to the thyroid gland.

[tykemeister]

Hinihintay pa po namin yung results ng needle aspiration.

May kilala ba po kayo specialista sa pagsusuri ng mga problema sa thyroid?

[Ira]

The next step towards the management of your relative and what type of doctor she will go to will depend in large part to the biopsy results. A CT scan is totally unnecessary at this point since there is no result yet.

If you need a referral, it will be better if you can post the results too, that way you don't get referred to the wrong specialist.

[tykemeister]

Thanks Doc Ira. I'll try to post the results once they are available.

[tykemeister]

Doc Ira, ito na po yung resulta:

Date Aspirated: 11-21-03

Gross description of Aspirate/Fluid:
Aspirated 1.5 cc of brown fluid

Cytologic Description:
Aspirate smear shows amorphous granular debris, with occasional histiocytes and modest colloid in the brackground. Rare benign thyrocytes are present. No atypical cells nor patterns are seen.

Cytopathologic Diagnosis:
Cell findings are consistent with a colloid nodule with cyst degeneration, right.

Thyroidectomy daw po yung recommended treatment. Si Dr. de Villa, isang General Surgeon, ang mag-oopera.

[Ira]

It's a benign nodule. There is no need for a CT scan nor radioactive iodine. A general surgeon is the right person to see. You will have to take out the nodule because it may grow larger or it may result in malignant degeneration, but surgical excision is the correct and sufficient treatment for now. After surgery, the nodule will be sent for formal histopathology reading, and if it turns out to be totally benign, then your relative is cured.

[tykemeister]

Salamat Doc Ira.

Tanong uli po, is it possible to live a normal life without the thyroid gland? Nabasa ko ho na thyroid hormone replacement therapy would be needed for life. Tama ba ho pagkakaintindi ko?

May risk din daw ho ng hyperparathyroidism kung natamaan ang parathyroid glands.

[Ira]

If it's just a benign nodule, the surgeon will not remove all the thyroid gland so there is no need for medications. And even if the surgeon removes the whole gland, your relative can easily take thyroid hormone replacements. It is for life, but I personally don't consider taking 10 secs everyday to take a pill an "abnormal" kind of life. There is absolutely no limitation post-surgery.

In the rare cases that you secure the service of an extremely incompetent surgeon, the risk is hypoparathyroidism. Transient hypoparathyroidism may occur because of transient inflammation post-op, but that's only temporary and is very easily managed.

[tykemeister]

Hypoparathyroidism pala, sana 'di mangyari.

Maraming, maraming salamat Dr. Ira.

[Ira]

You're welcome.