What's going on with my thyroid?

March 7, 2006 3:32 PM

I am asking this question for Kickstart70: "A couple weeks ago, over the course of a day, the left side of my thyroid gland swelled to a visible lump on my neck (ie. it wasn't swelled in the morning when I shaved, but was in the evening).

Blood tests show my thyroid levels to be 'normal'. I don't know what 'normal' is, that's just what my family doctor said. She sent me to a specialist, who ordered an ultrasound of my neck and a needle aspiration test. The ultrasound showed that it was definitely my thyroid, the needle test was apparently not done properly and I have to do it again while ultrasound is performed again to make sure they hit the right spot. The specialist said "I don't think it's cancer", but he sounded...uncertain and concerned.

Now I know a few things:
- it's definitely thyroid
- it's one side of the thyroid and not the other
- it came on suddenly

So, if not cancer, what else could it be? If cancer, what's generally the likelihood of coming out of this without losing my thyroid? If cancer, is there any real chance of this spreading and me not coming out of it?

My wife is due with our first child in June, and I'm freaked out by the possibility that I won't be around for the majority of her life."

posted by amro to health & fitness (15 comments total)

My brother had something very similar to this happen to him when he was a teenager . It was really scary, but it went away after a couple of days. The doctors said that it probably had been an extreme allergic reaction to something airborne, and was probably caused by poor ventilation in the hotel we stayed in.

I hope that helps.
posted by grex at 3:38 PM on March 7, 2006

Thanks, amro!

Oh, I should add that the lump has not appreciably changed in any way since it was discovered almost 3 weeks ago. I have a very slight suspicion that the other side is very slightly swollen as well now, but not enough to verify.

I have every intention of following through with doctors, etc. I just want to be well-informed so I know what they are, and can be, doing to diagnose this.
posted by Kickstart70 at 3:44 PM on March 7, 2006

And, other than the needle aspiration which hurt like hell, there has been no pain or discomfort.
posted by Kickstart70 at 3:48 PM on March 7, 2006

I had thyroid cancer 9 years ago. If it's cancer -- and you'll hear this all the time, so I might as well be the first -- it's the cancer you want to have. Except for the subtype that killed Rehnquist (which you do not have, because it's an end-stage cancer seen in much older patients), it's the most survivable cancer out there. This is because it tends to be quite slow moving -- it can literally take years before it goes anywhere near a lymph node, for example. (My own doctors estimated that I'd actually had my cancer for as much as 8 years before I finally got diagnosed, and my tumor had only just started to look like it could spread.)

The treatment is to remove your thryoid (relatively quick surgery -- less than 2 hours), get a dose of radioactive iodine (gold standard of thyroid cancer treatment for 50+ years -- chemotherapy isn't necessary and doesn't really work on the thyroid anyway), and take thyroid replacement hormone daily for the rest of your life (easy: just put the pills next to your toothbrush and take 'em in the morning). You'll have bloodwork regularly and full body scans every few years to make sure you're still in remission. I'm due for my full body scan in April and the only bummer is that I have to go on a low-iodine diet for 2 weeks.

If it's not cancer, it's possible it's a benign nodule of some sort (another test they may want to run is to determine whether it's a "hot" or "cold" nodule with a thyroid uptake scan). Thyroid disorders can be managed with a variety of medications; sometimes it can take awhile to fiddle with the dosages, but they really are manageable. Also, if the next fine needle aspiration isn't definitive (and they aren't always -- I had a couple that didn't tell us much of anything), they may want to do a surgical lumpectomy/biopsy (which is how I finally got diagnosed).

Email's in profile if you'd like to contact me.
posted by scody at 3:55 PM on March 7, 2006

Thanks scody. That helps.

What does "hot" or "cold" mean though?
posted by Kickstart70 at 4:01 PM on March 7, 2006

"Hot" nodules are composed of functioning thryoid cells (which means the nodule is almost certainly not cancer), vs. "cold" nodules which are nonfunctioning (which means the nodule is slightly more likely to be cancer, but even then is unlikely.)

According to this article,

Nodular disease of the thyroid gland is quite common in the United States. The lifetime risk for development of a palpable thyroid nodule is estimated to be 5-10% and is more common in women than in men. In general, nodular disease of the thyroid is common; however, malignancy of the thyroid occurs in only 0.004% of the US population annually (12,000 new cases per y). Roughly 5% of thyroid nodules are malignant, whereas the remainder represents a variety of benign diagnoses.

and oh yeah: good luck, kickstart, and please try not to worry. Thyroid diseases and disorders of all stripes are pretty common and very treatable. Here's a good overview of thyroid nodules and possible diagnoses.
posted by scody at 4:17 PM on March 7, 2006

Something very similar happened to me about two years ago. Out of nowhere a huge lump appeared on my neck and my first thought was cancer. After tests that sound similar to yours, it turned out it was a very large benign nodule that had taken over one side of my thyroid (my Ear Nose Throat doc said it was the largest she has seen). Long story short, she did an outpatient thyroid lobectory and removed the half of my thyroid that contained the nodule. Other than a really gruesome incision that took a while to heal, I made a full recovery with no side effects. My doc explained that for most people, the remaining half of the thryroid takes up the slack, but suggested I get tested for hypothyroidism anually just to be sure. Anyway, email is also in my profile if you'd like more detail.
posted by gilgamesh at 4:48 PM on March 7, 2006

I'm not a doc, but I doubt a cancer would just sprout overnight like a mushroom, and then stop.
posted by delmoi at 5:10 PM on March 7, 2006

I can't even begin to guess what you have, won't even try, but I can say that thyroid trouble runs in my family, and having it surgically removed has more often than not brought on no bad effects. The usual mode has been to leave only a sliver of thyroid in, and it kind of kicks in and does the job of a whole thyroid. And the rest of us sufferers, myself included, just have to take daily meds, no big deal. So don't fear the doctor. Get it taken care of, this is not one of those situations where the awfulness of the cure rivals the awfulness of the disease.
posted by Sara Anne at 5:29 PM on March 7, 2006

Maybe this will help you feel better for a bit...it sounds similar to the thyroglossal duct cyst that came on suddenly for me a decade ago. I had surgery, they took it out, sewed me up...no problems since. (Although it is more common in children, some adults get them. I was in my 20s.) Before the surgery, my throat/neck was uncomfortable and I had trouble swallowing. I suppose it could interfere with breathing. But I didn't have surgery right away -- I think it was a couple of weeks or more. So don't panic. There are lots of benign reasons for lumps to form. The important thing, for now, is that you got it looked at.
posted by acoutu at 5:46 PM on March 7, 2006

My mother had a thyroid tumour when I was 10. She had it (the tumour and the gland) removed soon after it was diagnosed, but the doctor said it had probably been there for several years. Anyway, it was benign, and apparently pretty huge. After the operation she had some paralysis on that side of her face for awhile and the scar was big, but it's all fine now and you wouldn't notice that she'd had anything done there unless you really looked.

Good luck!
posted by speranza at 6:19 PM on March 7, 2006

Don't sweat it right now. Take comfort in the fact that:
- many, many people get thyroid nodules
- 95-99% of all unilateral solitary thyroid nodules are NOT cancerous
- getting a fine needle aspiration is normal procedure for evaluation a nodule.

IF it is cancerous, take comfort in knowing that the most common type of thyroid cancer, comprising of ~3/4 of all thyroid cancers, has a high cure rate and low rate of metastasis. Also, the second most common type of thyroid cancer, while having a higher chance of metastasis, has an even higher cure rate. Surgery is indicated in both cases, and usually results in complete removal of the thyroid gland.

Overall, the two most common types of thyroid cancer make up something like 90-95% of all cases of thyroid cancer, and the cure rates are anywhere from 85-95%, depending on type and age.


Short version: don't sweat it. As Mamet awkwardly wrote, "worrying is like paying interest on a debt that never comes due." Also: I'm not an endocrinologist, and know little about the less common types of cancer or treatment options other than surgery.
posted by herrdoktor at 8:36 PM on March 7, 2006

My mom's right where you are right now. She's getting her US-guided needle biopsy in a week or two.

The take home point is that 95% of such nodules are totally benign and would never have amounted to anything bad, whether biopsied or not.

The other 5% of them are malignant cancers, which mostly are pretty treatable, especially if diagnosed early.

So, go get it biopsied, but don't sweat it.
posted by ikkyu2 at 9:19 PM on March 7, 2006

Two people I know have had growths on their thyroid in the past year. My next-door neighbour had a cancerous lump right on top of her thyroid, had it removed and received three courses of chemo. She's officially in remission now and the only complication was some minor damage to her vocal cords, which has been fixed via day surgery.

A good friend has just had a non-cancerous growth removed. She noticed it about a year ago when she started coughing in the night as the lump pressed into her throat. She said it felt like something stuck in her throat, a constant feeling of something alternately tickling or blocking her throat. It didn't impede her breathing but was an annoyance, especially with the coughing at night, so she had it removed last month with no ill effects. She has a four-inch (or so) scar at the base of her neck and a scar on the side of her chest where a drain was put in, but she's already much better.
posted by tracicle at 11:05 AM on March 8, 2006

A followup, finally!

On the 28th I had the left side of my thyroid removed. After numerous tests, a couple needle biopsies, and three doctors, no one could figure out what it was. Since it was bothering my swallowing, the best choice then was removal.

Simple surgery, one night in hospital. Unfortunately, a few days after that, my neck swelled up like a balloon and nausea and fever ensued. I ended up with a serious staph infection that put me in the hospital and on harsh antibiotics for a while. All this within two weeks of our baby daughter (Molly Elizabeth, 6 lbs 7 oz, 32 hours of back labour then a c-section - but it was all worth it. Named with good advice from another AskMe question I posed) arriving.

In other words, it's been one hell of a month, and I am glad things will hopefully start settling down now.

Thanks for the advice and caring!
posted by Kickstart70 at 1:30 PM on July 17, 2006