A 65 Y/O F patient was referred for biopsy for a 2.5 cm nodule.
She came from Cleveland on the Great Lakes, a known goiter area in the past from iodine deficiency. The ultrasound was eu-echioc, with significant 2 vessel blood penetration. She was told that benign nodules can have significant blood flow. She was not excited to be biopsied unless absolutely necessary. Even though the ATA guidelines call for biopsy, I elected to scan her first. The thyroid experts feel that if the TSH is normal you won't find a hot nodule on scan. Well her TSH was normal at 0.89.
She had increased uptake in the nodule with decrease in the rest of the gland. There were no nodules in the opposite lobe. I told her she had a hot nodule.It was not toxic yet, but was going in that direction. We talked about surgery, Radioiodine, or observation therapy. I told her it was not cancer, and she did not need a biopsy.Hot nodules are never cancer. She elected to be treated with radioiodine in the next few weeks.
We are too needle happy in the pursuit of cancer, when only 5 % of all nodules are cancer.
The longer I practice thyroidology, the less needle happy I have become.
We need to look at the whole patient and try to stop excessive surgery.
Dr.G.
