Thyroid Cancer
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Digezy, sorry you're going through so much right now. Elevated blood calcium over a period of time could be parathyroid, so glad you are being referred to an endocrinologist. Parathryoids (4) are located behind your thyroid, so could be either that lit up your scan. I learned that endo's often specialize in either diabetes type of problems, or thyroid/parathyroid issues so hope you get to one who specialize in the later. There are a couple of threads on BCO on parathyroid and high blood calcium so you may want to search for them. Did you have a DEXA scan to show if high blood calcium is coming from your bones? Parathyroid issues often cause the beginnings of osteopenia. Other symptoms might be fatigue, aches, kidney stones, and others. I've had thyroid out and also, years later after BC, a parathyroid adenoma taken out. Please ask any questions you have and let us know how you're doing..
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I had another ultrasound today and fine needle biopsy- good news, my nodules are benign
glad my body has not decided to grow any roguetumors in my neck0 -
Olma - Hooray. Great news. Congrats.
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Hi Ladies - I'm very glad I found this topic and have been reading all your posts. I feel like I'm back into that vertical learning curve mode researching Thyroid Cancer now. This is after my prior Breast Cancer dx in 2006 (at age 49) IDC stage 2 ER+, PR+, HER2-, 1/18 nodes +. Back then my treatment regimen was lumpectomy, chemo, rads, a few months of Tamox then oophorectomy to switch to AI for almost 9 years. I was swimming in hormones back then at 100% +.
Then around 2010, I started to have hypothyroid symptoms confirmed by abnormal thyroid blood labs and started on Armour Thyroid medication. Over the years, I've had to do some dosage increase but then my blood levels went out of range again into the hyperthyroid range. So my was medication decreased down to the original lower dose in recent months. I had a thyroid antibody test done years ago which was negative but never any Thyroid Scans until Dec 2021 - ordered by my GP.
So there were findings of nodules (small 7x4x8 mm) in both right and left sides for TI-RADS category 4. They are described as subcentimeter bilateral thyroid nodules where thyroid is unremarkable.
My concern is the description for the left thyroid lob withe hetergeneous solid lesion which might indicate an atypical lymph node or parathyroid adenoma. Recommended followup US for this node.
My breast cancer was also on the left side high up at 11:00 position - so this caught my attention just like the single sentinel lymph node found to be cancerous - my ticket to 8 rounds of chemo.
I have a very professional, caring and thorough GP who ordered this scan. When I provided this report to my oncologist during my recent visit - he made no comments about it except that some nodules were present. It wasn't until I saw the printed report reading the details that now I have concerns and questions. My poor GP has been swamped with the Covid situation trying to cover the medical practise after some of his associates were out on sick leave. So my next visit with him is not until May - with more blood labs for Thyroid status.
I do not want to over react as who knows how long I had these thyroid nodules. Should I just take a deep breath and a glass of wine until my next GP visit in May?
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cp418, very quick to let you know that I got thyroid nodules showing up in 6 months of letrozole (anti-hormone). One become visual in my skinny neck and US didn't look good but the biopsy showed benign. I am supposed to have US every year to keep an eye on this nodule (1.5cm). I wish you luck and biopsy is the one that will let you know what nodules they are.
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cp, sorry you are experiencing problems and the uncertainty of the test results. I've had both thyroid and parathyroid problems. My thyroid was removed years before the BC diagnosis and a parathyroid adenoma removed after BC. Since you mention the possibility of an adenoma, you might just ask your doctor for a referral to a parathyroid specialist (they are usually only available in large medical centers). You did not mention if you have had any abnormal blood calcium or parathyroid hormone level results. If an adenoma, those levels will vary from test to test, and so a specialist is often needed to diagnose. Is your calcium over 10? What is your PTH (parathyroid hormone)? Have you had a DEXA scan to determine if PTH is stealing calcium from bones? There are a couple of parathyroid threads on BCO which discuss all these. Just search "parathyroid." If you have any questions, please ask away!
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Thank you so much for replying here.
Lilly - interesting you mentioned Letrozole as I took the same AI for many years. I had the ooph procedure done in 2007 (age 50) because I did not tolerate Tamox . Plus I had a uterine fibroid that I did not want to aggravate with more complications. So far, these thyroid nodules cannot be seen or felt through the skin - only seen with the US scan. If the scan were not ordered by my GP I would never know they were present. So now I've lost that peace of mind.
Ceanna - my previous chemistry profile labs for calcium level and CEA are normal. I've never had the PTH level done related to the parathyroid adenoma. In the past, I was treated for osteopenia confirmed on DEXA with Zometa and then Prolia with twice yearly injections until my latest DEXA became barely back within the normal range years 2019 and 2021.
I realize that a scan only shows that something is there and establishes a baseline to compare against. So I'm wondering if it is too early to request a needle biopsy? I get the sense my oncologist is now in the wait and see mode. He is my 2nd oncologist after I left my first oncologist years ago.
Trivia comment - looking back I now wonder why breast cancer patients receiving radiation do not wear thyroid guard - like the kind when you get dental x-rays or during a mammogram. Do patients wear a protective guard now as it was not offered years ago? I see the risk for Thyroid problems is increased with prior exposure to radiation.
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Hmmm... thyroid nodules and Letrozole? I developed enlarged lymph nodes in my neck about 16 months ago. I've had 4 ultrasounds since then; the nodes have always looked benign on imaging and all of them have always been below 1cm, so other than continuing to check them, they have have not raised any alarm (at least with my doctors, a bit with me). Over time the nodes have been feeling smaller but they remain palpable and they certainly feel larger than 1cm - but apparently that's because what I'm feeling are actually groupings of several small nodes. Best guess of every doctor I've talked to is that this is all sinus/ear related; I do have constant sinus issues.
Over the course of these 4 ultrasounds, what's become more concerning to me is that with every imaging, a new thyroid nodule shows up. First it was just 1, then 2, and with my last ultrasound a few weeks ago, it's now up to 4. They are also each getting just a little larger. None of these nodules are concerning (TI-RADS 2) but I've been wondering what's causing this and it's on my list for discussion with my PCP when I see her in few weeks.
It never occurred to me that it could be the Letrozole that's causing this. I've been on Letrozole for close to 3 years. I guess I'll add this to the discussion list for my appointment with my MO when I see her next month.
cp418, I think with a TI-RADS 4 and the description of the node, it wouldn't be out of line or excessive to request a biopsy if it will ease your mind. Hopefully this is all benign but since it's now in your head, getting the answer sooner rather than later would probably be helpful.
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Bessie - so good to hear from you another alumni of 2006. Yes, the TI-RADS 4 score was given to both nodes and is my concern. I'm wondering if my GP who has been so over whelmed missed reading my results. I didn't know the actual results until after the oncologist provided me with a copy. So my questions and concern all happened after leaving my appt. I'm wondering why my oncologist didn't discuss with me then - maybe because he didn't order the scan?
This is causing me too much anxiety - so I will make a call to my GP to confirm his reading my report. Waiting around is not working for me......
Thanks Bessie for your input - I've always read your posts.
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Wrenn - Oh, I so hear you about finding these cysts or nodules during other scans. Been there too when I had a US scan for diverticulitis and they discovered a small pancreatic cyst. After yearly MRI scans to monitor it, I finally told my GP I couldn't take the anxiety and stress anymore and to stop these yearly scans.
The US technician mentioned like you said - how common these thyroid nodules are in the population (due to pollution and radiation exposure).
Yes - my TSH level and thyroid symptoms were elevated and occurred when I was taking Letrozole too. I've been on the Armour Thyroid medication now for about 10 years. These medications are so powerful that increasing my dose when my TSH started to creep up swung me into the hyper thyroid state. My TSH was very very low and suppressed so maybe this condition aggravated the formation of nodules. Who knows?
Off Topic - I have to mention that I LOVE Vancouver, BC after a short trip some years ago. I want to go back! The city and surrounding area were beautiful!
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Update - I was able to get a repeat US done with extensive views of lymph nodes around the neck. Good news - it identified a single very small nodule of minimal concern and not the previous findings. This confirms how subjective an interpretation can be on some of these scans and how getting a second opinion is always worth some peace of mind. This second US was done at a different facility - MSK (NJ) which specializes in Thyroid Nodules.
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cp418. I had a rough summer. 3 nodules tirad4. I thought I had cancer. 2 Under 1 cm too small to biopsy. 1 was 2 cm and was biopsied. Also major fight with primary who read report wrong and would not prescribe biopsy, I couldn’t get in to endocrinologist. An ent wrote the script. Turned out benign. 4 months later saw endocrinologist. She said they don’t look suspicious to her and the tirad system is very inaccurate. I also had a lump in my throat when I swallowed and I considered getting them removed but no one thinks that’s a good idea. I heard about radio therapy but only in ny. After 5 months lump is better. I think it was the steroid shot the stupid rheumatologist gave me. Which msk office? I live near Middletown. Went there for a chemo opinion.
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Last year, diagnosed with DCIS, lumpectomy then mastectomy.
Now, I've got some thyroid nodules. Appointment with endo is Tuesday, probably going to have a biopsy.
I'm not sure how to feel about this. I know there's like a 10% chance it's cancer, I also know that the probability of Really Bad cancer is much smaller.
I just want to know, one way or the other, and get it over with.
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Thyroid nodules are extremely common. When we find them, most often through tests for other conditions, we look for a cause. Then we associate what we are doing in our lives and treatments as possible causation. But this is non scientific and usually inaccurate. They may be caused by simply being human. Biopsies of nodules are often inconclusive, very frustrating. Tirads 4 is not concerning at all. I was Tirads 5 and after a total thyroidectomy, benign. Now dependent upon synthetic drugs to keep me alive. I have felt completely normal since surgery but not everyone does. I suggest ongoing monitoring. A good endocrinologist is a must. A good looking one even better (mine). Lol. When I was being monitored for nodules and discovered that I may have breast cancer, he told me to forget all about the nodules as their threat was nothing compared to bc. I love how he helped me manage my stress at that time. I hope this can help you too. You have already faced far worse. As we age, we have lumps and bumps everywhere. The words of my sweet and wise father always trying to reassure me
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test
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janewhite, I hope your tests went well and they didn't discover any problems.
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Ceanna, I had my biopsy done, but they didn't get enough cells, so we need to wait a couple more months and then repeat the biopsy! Fun times.
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Oh Jane, I'm sorry the biopsy was inconclusive and that you have to repeat. Not a fun test if I recall! I had the same thing happen but didn't repeat the biopsy but found a specialist. Just keep following up and try again to find answers. Perhaps look into a thyroid/parathyroid specialist--your four parathyroids are embedded behind the thyroid so it can take some bloodwork (if your calcium levels are consistently higher than normal and PSH hormone level off means it could be paras instead). Thanks for the update!
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I had a small swelling in my upper neck, midway. When I was diagnosed with BC I asked my MO about it. She felt it and didn't think it was anything but said the PET scan will show if there is anything. There wasn't. Seeing this makes me wonder what it was/is. I haven't noticed it lately
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How painful is thyroid biopsy? I have a large (3.5 cm) nodule that was discovered on CT scan following my BC diagnosis in May. I finished chemo 2 weeks ago and have surgery next month. MO sent me for thyroid ultrasound, and it came back Tirads 4. I wasn't expecting this!
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Sorry Maggiehopely that now you have to have a thyroid biopsy. I totally understand! During my breast cancer recurrence in 2020 I had a suspicious nodule show up on PET which i had biopsied. I thought it was a little uncomfortable , felt pressure in the neck. They typically take several biopsies of the mass, I had 6 samples taken. It was quick only took a couple minutes.My doctor did use lidocaine which burns going in but reduces pain during biopsy.
It’s just annoying after dealing with breast cancer to have to deal with this also! I did have thyroid cancer and had total thyroidectomy, was annoyed to have another surgery. If it’s any consolation to you only 5 percent of thyroid nodules are cancer. So the odds are on your side. I obviously have no luck ,ha! Good luck and positive vibes for a good outcome.
Hugs
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Thank you. I had 4 biopsies with my BC diagnosis and it sounds like this will be similar. I find the lidocaine pretty painful but oh, well. My MO has referred me to the endocinologist but I will not have the biopsy until after my mastectomy in 3 weeks. I really don't like having to wait that long.
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Maggiehopley - It's a shame that you have to deal with BC surgery and the Tirads 4 biopsy at the same time. I have had two rounds of thyroid biopsy and I found it far easier than the breast core needle biopsy to recover from, probably because it is a fine needle aspiration biopsy. The lidocaine hurt a bit but there was not much bruising, swelling or pain afterward. In 2018 I ended out having a partial thyroidectomy even though the biopsy was benign because I had a huge one-sided goiter which was almost totally compressing my trachea so that I could not breathe at all unless I was sitting or standing upright. I figured that would be the end of it but right after finishing radiation in the summer of 2021 a swelling appeared on my neck. A CT scan showed the remaining side of my multinodular thyroid is growing and compressing my trachea by 30%. The two biopsied nodules (3.4 and 3.6 cm) were benign, but this time I have an endocrinologist to keep an eye on my thyroid so surgery can be done before my airway gets cut off.
Even if you do have thyroid cancer it tends to be indolent. Sometimes, they don't do surgery right away and wait to see how it progresses. I would take the time to recover from your mastectomy and try not to worry too much. I hope your surgery goes well and your nodule is benign.
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It's good to hear that even larger nodules can be benign. I also have 2 smaller ones on the other side that do not need to be biopsied at this time, but I guess that could change if they grow. I will try not to worry for now.
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Yes, thyroid can wait for sure. If it is positive, thyroid typically is very non agressive. Obvious things first, take care of yourself and recover from mastectomy. One step at a time, best wishes
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Regarding biopsies, if I were to compare my personal biopsy experiences of a suspicious thyroid nodule on ultrasound (also, separately, a neck lymph node) and suspicious breast findings on mammography (all malignancies, as it turns out), the thyroid nodule biopsy was definitively weirder while the breast biopsy was more painful and invasive...In more detail if it helps:
My thyroid nodule biopsy was an FNA (fine needle aspiration) biopsy, and the experience was more involved than I expected. An interventional radiologist and three others (ultrasound tech, lab tech, and nurse or medical assistant) were present. I was lying down and draped across a broad area of chest and neck and the site surface was lidocained. The fine needle passes (maybe four or five passes) were located by ultrasound, and I felt resistance and pressure upon needle entry. (Malignancies tend to be hard, while a benign nodule might have been softer.) The needle is long and skinny with a diameter of less than 1 mm. It was a weird and unsettling experience to have a long needle pressed into the front of the neck. I was asked to keep as perfectly still as possible, holding my breath, not swallowing, not vocalizing during the procedure. Afterward, slight bruising showed up a few days later, and the slight pain sensations that occurred included jaw, ear, neck, and other types of odd-seeming, fleeting jabs of referred pain. I did not use any pain meds or ice packs, though, and it was not too painful, just weird. (A biopsy of a neck lymph node a little later, also using a fine needle, was not quite as weird and even less painful, as it was not as hard/resistant of a tissue, though it was again somewhat unsettling to have a needle introduced into the front of the neck. Also: I did not have a FNA Washout Tg test on the node, but that is sensitive biomarker for malignancy in neck nodes that they can do upon node biopsy, FYI.)
For breast biopsy (you all probably share this experience, but just to compare to thyroid), the needle was a vacuum-powered core needle biopsy (CNB), 9-gauge (almost a 3 mm inner diameter), and similarly, there were multiple passes (8 passes) in my case. The lidocaine was injected deeply with a needle, itself an uncomfortable step. The interventional radiologist was assisted by mammography tech and nurse and the procedure was mammography guided and I was sitting on a mammogram-facing chair. The site required a small incision (a spot nick) with a scalpel. The biopsy device was a much more powerful and powered device and more immediately painful than with the thyroid one. For several days after, there was general area pain and increasingly visible bruising. I used over-the-counter pain meds and made good use of the gel ice packs provided for several days. The bruising fully cleared up by two weeks later.
In net, the thyroid biopsy (and neck node biopsy) was rather more unsettling and unnerving, while the breast biopsy was more straight-up painful and the healing took longer. Everyone's situation and experience is different, but hope this helps, as a perspective on both.
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Thank you for all those details!
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Looking into whether and how to adjust the thyroid meds dose with tamoxifen or other endocrine therapy (seems like I might need to up my thyroid dose when starting on endocrine therapy), I was kind of distressed to come across a quite thoroughly evidenced 2021 journal article about thyroid and estrogen by researcher Reema Wahdan-Alaswad PhD and colleagues at the University of Colorado (PubMed ID: 33097494, link: https://pubmed.ncbi.nlm.nih.gov/33097494/). It includes several types of studies (in cells, in mice, and in clinical epidemiology analyses), all showing that exogenous thyroid hormone ups risk in ER+ breast cancer. I am still puzzling through this article and I have asked my medical oncologist about it. It is also summarized in Clinical Thyroidology. It suggests that tamoxifen is less effective or possibly even worse than neutral in the context of exogenous thyroid hormone and ER+ breast cancer, but that AIs and particularly "ICI" aka fulvestrant may be better. I will add more when I learn more after discussing with my MO. Has anyone considered or used a different endocrine therapy option other than tamoxifen in the context of being on thyroid hormone replacement (especially post thyroid cancer and/or thyroidectomy)? Thanks.
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emmaleah - There have not been many studies done about AIs and thyroid meds: just a few retrospective analyses of letrozole and TSH/T4 levels which only lasted several months and were observational, not clinical trials. Most of my thyroid has been removed, but I am euthyroid with TSH levels tending toward the low end of normal. Neither my MO nor endo could tell me how AIs or tamoxifen might affect me. Since my thyroid is enlarging again and deviating my trachea, I was not willing to do anything which might accelerate this as I have pulmonary problems caused by radiation which make intubation for surgery dangerous. I also have other issues (osteoporosis, arthritis, family history of blood clots) so I decided to opt out of endocrine therapy. According to my Oncotype I am increasing my risk of recurrence by 8% but I am trying to buy time. I am 70 and might have decided otherwise if I were younger. My MO supports my decision because I have valid concerns and understand the risk I am taking. I hope you can get some answers and make a good decision for your situation
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Hi maggie, thanks, and all the best on all the issues you are managing and balancing. I agree that there is not much definitive research, and that we each need to make decisions about endocrine therapy as best we can in our individual situations and often without the benefit of much in the way of a prediction as to how we will do on it. I am glad to hear that your MO is supportive and that the absolute added risks are small, especially if counterbalanced against other important risks.
That 2021 paper on thyroid and estrogen has taken me aback by identifying exogenous thyroid hormone as a risk factor and an independent driver of ER+ breast cancer, almost as if it (thyroid hormone) were estrogen itself, which of course we are precisely trying to limit the effects of, when we do endocrine therapy.
Personally I need to take thyroid hormone (post-thyroidectomy for thyroid cancer), but I do want to monitor and keep the thyroid dose and TSH normal rather than high dose with low TSH (even though often recommended post thyca). I have sent my MO the paper and will ask next month when I see her about the various endocrine therapy options. I also submitted a question to the UCSF Bay Area Breast Cancer Forum to see if they (breast oncology team with a periodic public-facing online panel discussion) might have thoughts.
A lot of middle aged and older women are in both camps -- we take thyroid hormone and have had ER+ breast cancer. Hopefully some better guidance about endocrine therapy in the context of taking thyroid hormone can emerge from some of this.
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