The first patient of the week was from Italy, and had pain and tenderness in her neck area by the left lobe. She was treated for iodine deficient nodular goiter from Italy. The Ultrasound confirmed a cystic nodule. she must have bled into her goiter. An US guided FNA confirmed no cancer in the cystic nodular goiter.
A 14 Y/O male from a family, where many members have autoimmune thyroid disease, had a goiter for several years, but because the TSH was normal, no therapy had been given by the child's physician. By the time I saw him he had a larger goiter, positive TPO, and Tg antibodies, and a 1.8 cm nodule in the right lobe. He now will need a needle biopsy, because the physician did not get an endocrine consult 2 years earlier. Thyroid therapy,then, may have prevented the nodule formation.
An 85 Y/O with a long standing goiter that was never treated, developed apathetic toxic nodular goiter, which was noted on routine yearly physical,by low TSH. The only abnormal finding was lid lag. She had no symptoms to report.
77 Y/O female with Hurtle Cell Follicular Carcinoma treated 7 years ago by lobectomy only, and no radiation I/131 ablation, presents with a new nodule in the other lobe not removed at the first surgery.
A patient from Chicago was told after a six hour thyroid surgery for a nodule, that all was well. She sent me all the material including the orginal surgery slides. On the slides I noted a cancer which was not reported on the original report. She was very upset and came out to LA to see me. She had papillary thyroid cancer, but had no abnormal cancer nodes on my neck node ultrasound.She will follow up yearly with me.
Have a good week,
Dr.G.
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