Molly b.'s Ultrasound Page
Ultrasound Comparison - results before and after thyroid treatment
An ultrasound is also known as ultrasonography, sonography or sonogram. Ultrasound is not as thorough as a thyroid scan or a Technetium99 ( TC99 ) but it does provide basic information. While ultrasound will show some abnormalities, it can't test that the thyroid is working properly. It can't show hot and cold spots.
In June 1997, about a month after a doctor diagnosed my hyperthyroidism, I was sent for an ultrasound, while I waited to see the specialist in October. In October 1997 the specialist ordered a TC99, before we discussed treatment options at my second appointment. There were more nodules than appeared in the ultrasound. The TC99 showed these in greater detail, confirming the ultrasound suggestion of multinodular goiter and a thyroid cyst, and revealed that there were no cold areas. I had radioactive iodine treatment in early December 1997.
The specialist told me, at my last appointment, in March 1998, 'We'll have to keep an eye on the cyst".
In August 1998 I asked my family doctor if he'd order another ultrasound. The specialist didn't need to see me as long as my TSH every month is within normal range. I hadn't heard anything as to how we were supposed to 'keep an eye on the cyst'. I'd learned that my sister had a thyroid cyst surgically removed because she had trouble breathing, although her thyroid blood tests were normal. I still had a lot of tightness and lumpy sensations on the right side of my neck. Sometimes I worried that the cyst was silently, ominously growing. So what if my TSH every month was normal? Apparently my sister's had been fine too. A second ultrasound would alleviate my mind at the very least. After all, it had been 14 months since that first one.
1. The June 1997 ultrasound:
The Right lobe is 73 x 25 x 27 mm. 2 and 7/8 inches x 1 x 1 and 1/16 inch.
The Left lobe is 61x 16 x 18 mm. 2 and 7/16 inches x 5/8 x 23/32 inch.
Right lobe upper: 7 x 9 mm solid nodule. 1/4 x 5/16 inch.
Right lobe lower: 39 x 24 x 22 mm abnormality, 1 and 1/2 inches x 1 and 5/16 inches x 27/32 inch comprised of irregular fluid and solid portions. ( This is the cyst )
Left lobe mid portion: a 7 mm solid nodule. 1/4 inch. Left lobe lower: 13 x 11x 9 mm solid nodule. 1/2 x 7/16 x 5/16 inch.
2. The August 1998 ultrasound:
The Right lobe is 5.9 x 2.1 x 2.5 cm 2 and 1/3 inches x 13/16 x 1 inch smaller
The Left lobe is 5.6 x 1.7 x 1.4 cm 2 and 1/4 inches x 5/8 x 9/16 inch very slightly smaller
Right lobe lower: 3.1 x 2.1 x 2.5 cm 1 and 1/4 inches x 13/16 x 1 inch complex mass with multiple cystic areas and serpiginous thickened soft tissue. ( This is the cyst ) very slightly smaller
Left lobe lower: tiny hypoechoic nodule 5 mm 3/16 inch in maximal diameter smaller
Radiology assessment of ultrasound: Goiter with complex nodule lower pole right lobe. In view of the complex character a fine needle aspiration biopsy of the lower pole nodule should be considered.
Comments
Before and after radioactive iodine treatment results: The size of the enlarged thyroid gland has been reduced slightly overall. I expect this may be due to the effects of radioiodine therapy.
The family doctor I have now says that recommendations made by the radiology lab are done without knowing any history of the patient or the diagnosis and treatment the patient might have had, so the radiologist's suggestion of FNA is not necessary in my situation.
I would have liked a result that showed no goiter and no nodules at all, but it was a relief to learn that nothing had ballooned in size. Hyperthyroid patients tend to be easily worried, high strung, and it can last for quite some time. These events are proof of that! It was almost worth the frustration of having to remind the doctor of my sister's history, and of having to explain my feelings and worries, to convince him to order that ultrasound. It would have been better I think, had the specialist followed up on her statement, and had my doctor been more aware of the reassurance the ultrasound would bring. He was certain that everything was 'just fine' - but now I have proof. It has eased my mind a great deal, and now I don't feel like I might need a prescription for tranquilizers!