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EndocrineWeb Community Advice

Possible Exophytic Thyroid Nodule

From: alovely83 - 44 weeks 5 days ago

Hi there- I am a 35 yo woman with a history of nodules. I get an U/S done every year to check on growth or change. I've had two FNA's- one in 2013 on a 1.9 cm left lobe nodule (benign) and one in 2017 on a 0.9 right lobe nodule (I believe this one was inconclusive). The U/S I had 6 weeks ago show the one on the right lobe has gotten bigger. This was the report for my right lobe:

Complex nodule posterior to the right lobe of the thyroid measuring 1.6 x 1.1 x 0.7
cm. It is unclear if this represents a thyroid nodule or a parathyroid nodule. On the prior
exams this was measured up to 0.9 x 0.8 x 0.7 cm. Further evaluation with CT scan
recommended (parathyroid protocol).

Last week I had a CT done, but the tech messed up and didn't do the "parathyroid protocol" as stated on my CT order. This was the result:

1. Lesion along the posterior margin of the right thyroid lobe has features most
suggestive of an exophytic thyroid nodule. Correlate with parathyroid hormone levels. If
abnormal, consider parathyroid sestamibi scintigraphy for further assessment.
2. Small heterogeneous areas of increased density throughout the deep cervical fat
bilaterally. This is not definitively seen on cervical spine MRI imaging. The etiology is
unclear, though this may represent prominent lymphatic channels. No lymphadenopathy.

My bloodwork for both thyroid and parathyroid are all within normal range. What's concerning me most at this point is the "exophytic" nature of this nodule. (Plus the strange report on my "deep cervical fat"--- what is that about?!) And it doesn't look like my CT results really confirmed if this was on my thyroid or parathyroid. Everything I've been reading online shows a "high malignancy" rate of exophytic nodules, which is really scaring me. Does anyone have experience with this? The waiting and not knowing is the worst part. I'm assuming they are going to biopsy it again. At this point I have been referred to an endocrinologist, so it looks like the biopsy won't happen before the endo appt. I have heard it will take awhile to get an appt as well :( At the end of the day, I just want to stop worrying that I have anaplastic thyroid cancer... I swear, even if something has a tiny percentage of possibility, that's all I can focus on!

Any knowledge or feedback would be helpful as this is confusing and my doctor hasn't given me much to go on.

Thanks, all!

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Forgot to add these additional CT findings in as well:

NECK GLANDS: Nodule along the posterior margin of the right lobe of the thyroid
gland, along the right lateral margin of the esophagus, measuring 0.9 x 1.2 x 1.6 cm.
This appears contiguous with the right thyroid lobe based on multiplanar imaging. The
nodule demonstrates a heterogeneous enhancement pattern. Small hypoenhancing left
lobe thyroid nodule.
LYMPH NODES: No pathologically enlarged or morphologically suspicious lymph
nodes. Heterogeneous areas of increased density in the deep cervical fat bilaterally.
Specifically, this involves fat deep to the platysma, with a normal appearance of
subcutaneous and posterior cervical fat. Density measures less than 0 Hounsfield units,
likely related to volume averaging with fat.

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