Great slideshow on ultrasound of the thyroid, clarifies report

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RE: fast-growing, annual screening for how long?

by ToddlerFather on Mon Jul 15, 2019 12:18 PM

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Note that size and location are only the preponderant factors. One other factor is whether your specific mutation is iodine-avid or not; those with non-iodine-avid (like me) have a not as good prognosis. 

So one thing that is not currently on any guideline I read, but in retrospect I would like to have done myself, would be a comparative imaging analysis with WBS versus TC, PET/CT or US, trying to assess beforehand whether the tumor is or is not iodine-avid. 

RE: fast-growing, annual screening for how long?

by butterfly501 on Mon Jul 15, 2019 11:30 PM

Quote | Reply

On Jul 15, 2019 12:18 PM ToddlerFather wrote:

Note that size and location are only the preponderant factors. One other factor is whether your specific mutation is iodine-avid or not; those with non-iodine-avid (like me) have a not as good prognosis. 

So one thing that is not currently on any guideline I read, but in retrospect I would like to have done myself, would be a comparative imaging analysis with WBS versus TC, PET/CT or US, trying to assess beforehand whether the tumor is or is not iodine-avid. 

What's a TC? 

And I'm pretty certain the only way to know if cells are avid for iodine is to dose them with RAI and use nuclear medicine imaging.

RE: fast-growing, annual screening for how long?

by ToddlerFather on Tue Jul 16, 2019 04:37 AM

Quote | Reply

On Jul 15, 2019 11:30 PM butterfly501 wrote:

On Jul 15, 2019 12:18 PM ToddlerFather wrote:

Note that size and location are only the preponderant factors. One other factor is whether your specific mutation is iodine-avid or not; those with non-iodine-avid (like me) have a not as good prognosis. 

So one thing that is not currently on any guideline I read, but in retrospect I would like to have done myself, would be a comparative imaging analysis with WBS versus TC, PET/CT or US, trying to assess beforehand whether the tumor is or is not iodine-avid. 

What's a TC? 

And I'm pretty certain the only way to know if cells are avid for iodine is to dose them with RAI and use nuclear medicine imaging.

Sorry, CT, not TC. 

And the challenge is to find the missing pieces not responding to RAI... so you need one exam where there are clearly structures that should have response to RAI, but there isn't. 

RE: fast-growing, annual screening for how long?

by butterfly501 on Tue Jul 16, 2019 04:52 AM

Quote | Reply

On Jul 16, 2019 4:37 AM ToddlerFather wrote:

On Jul 15, 2019 11:30 PM butterfly501 wrote:

On Jul 15, 2019 12:18 PM ToddlerFather wrote:

Note that size and location are only the preponderant factors. One other factor is whether your specific mutation is iodine-avid or not; those with non-iodine-avid (like me) have a not as good prognosis. 

So one thing that is not currently on any guideline I read, but in retrospect I would like to have done myself, would be a comparative imaging analysis with WBS versus TC, PET/CT or US, trying to assess beforehand whether the tumor is or is not iodine-avid. 

What's a TC? 

And I'm pretty certain the only way to know if cells are avid for iodine is to dose them with RAI and use nuclear medicine imaging.

Sorry, CT, not TC. 

And the challenge is to find the missing pieces not responding to RAI... so you need one exam where there are clearly structures that should have response to RAI, but there isn't. 

FDG-PET with detectable thyroglobulin and negative RAI imaging.

student2patient student2patient
(Inactive)

likelihood someone with six masses does not have cancer

by student2patient on Tue Jul 16, 2019 06:28 AM

Quote | Reply

On Jul 13, 2019 6:28 AM student2patient wrote:

I am unfamiliar with Doppler ultrasonography. It has supplanted the Technetium-99m scanning I studied in college. I learned the first dimensions mentioned in a report are the size of the lobe. Mine are normal sized.

I am relieved to correct that the maximum dimension of largest lesion in each lobe are both UNDER 3 cm. Whew!

There are still plenty of suspicious findings in my ultrasound, and there is a nice chart on page 25 to show the increasing likelihood the FNA will find cancer with each feature. 

If enough suspcious features are found in an ultrsound, an FNA is ordered because of its high specificity. However, on page 22, the pitfalls of ultrasonography are explained:

- 66% of benign nodules have at least one positive US predictor of papillary thyroid cancer

- 66% of papillary cancers have at least one non-suspicious US feature

https://www.thyroid.org/wp-content/uploads/2013/10/Gianoukak is_ThyroidUntro2013.pdf"" target="_blank" rel="nofollow">https://www.thyroid.org/wp-content/uploads/2013/10/Gianoukak target="_blank" rel="nofollow">https://www.thyroid.org/wp-content/uploads/2013/10/Gianoukak

I still believe the FNA will find cancer in at least the left lobe. I wonder what happens if no cancer is found in my right lobe. If I have a choice, I would want both lobes out and have surgery just once.

Let's say I have six nodules. I am likely low-balling this for the finding of multiple in each lobe Each one has a 1 out 3 chance of being not benign (the 66% rule of thumb for a positive attribute on ultrasound diagnosed benign on biopsy, from the slideshow, which disappeared, 404 Error). The chance none will biopsy as malignant is 1 out of 729, or 0.137 percent chance.

So here are the ultrasound predictive factors for cancer in a thyroid nodule, ordered by positive predictive value: abnormal lymph nodes, microcalcalcifications, marked hypoechogenicity, taller than wide, calicifications, irregular or lobulated margins (have this one, 63% positive predictive factor, and the next five, the large one in my left lobe), hypoechogenicity, solidity, solitary, diameter => 1 cm, marked growth (5.6% positive predictive).

I am relieved "marked growth" was at the end of the list.

RE: likelihood someone with six masses does not have cancer

by butterfly501 on Tue Jul 16, 2019 10:47 AM

Quote | Reply

I can lend you my magic 8 ball, if you want to ask it.  LOL  :D :D :D

Even if you do have thyroid cancer, it's usually very survivable, curable, and thriveable. 

I've been on this site for close to 10 years and tons of people come here; worry, worry, worry, and then we never read another peep from them again.

Is it possible you do not have thyroid cancer: Yes.

Is it possible you do:  Yes.

You will not begin to know something until the FNA results. 

I'm sorry you feel the need to spin your wheels on an unknown future, and I understand why you want to do it. 

Having been in the position of being told most likely my thyroid nodule was nothing, then being told on my birthday while 7.5 months pregnant after contracting food poisoning from my b-day dinner night out with my husband....(the only time I barfed during my entire pregnancy), that I had cancer, while pregnant with my first (and only) child:  I can tell you first hand, you can't statistic this stuff.  You can not.

Allow yourself to relax for a moment, and just be.  No one has any idea if it will be or not be thyroid cancer.  But, at the very least, know that is rarely is a death sentence, is most likely quite survivable, and usually has a good prognosis. 

Be well, and give yourself a break from the worry.

RE: fast-growing, annual screening for how long?

by ToddlerFather on Tue Jul 16, 2019 12:23 PM

Quote | Reply

On Jul 16, 2019 4:52 AM butterfly501 wrote:

On Jul 16, 2019 4:37 AM ToddlerFather wrote:

On Jul 15, 2019 11:30 PM butterfly501 wrote:

On Jul 15, 2019 12:18 PM ToddlerFather wrote:

Note that size and location are only the preponderant factors. One other factor is whether your specific mutation is iodine-avid or not; those with non-iodine-avid (like me) have a not as good prognosis. 

So one thing that is not currently on any guideline I read, but in retrospect I would like to have done myself, would be a comparative imaging analysis with WBS versus TC, PET/CT or US, trying to assess beforehand whether the tumor is or is not iodine-avid. 

What's a TC? 

And I'm pretty certain the only way to know if cells are avid for iodine is to dose them with RAI and use nuclear medicine imaging.

Sorry, CT, not TC. 

And the challenge is to find the missing pieces not responding to RAI... so you need one exam where there are clearly structures that should have response to RAI, but there isn't. 

FDG-PET with detectable thyroglobulin and negative RAI imaging.

After a full thyroid removal, yes. But in his or her case, the thyroid is still there, both tumorous and non-tumorous parts. 

RE: fast-growing, annual screening for how long?

by butterfly501 on Wed Jul 17, 2019 06:20 AM

Quote | Reply

On Jul 16, 2019 12:23 PM ToddlerFather wrote:

On Jul 16, 2019 4:52 AM butterfly501 wrote:

On Jul 16, 2019 4:37 AM ToddlerFather wrote:

On Jul 15, 2019 11:30 PM butterfly501 wrote:

On Jul 15, 2019 12:18 PM ToddlerFather wrote:

Note that size and location are only the preponderant factors. One other factor is whether your specific mutation is iodine-avid or not; those with non-iodine-avid (like me) have a not as good prognosis. 

So one thing that is not currently on any guideline I read, but in retrospect I would like to have done myself, would be a comparative imaging analysis with WBS versus TC, PET/CT or US, trying to assess beforehand whether the tumor is or is not iodine-avid. 

What's a TC? 

And I'm pretty certain the only way to know if cells are avid for iodine is to dose them with RAI and use nuclear medicine imaging.

Sorry, CT, not TC. 

And the challenge is to find the missing pieces not responding to RAI... so you need one exam where there are clearly structures that should have response to RAI, but there isn't. 

FDG-PET with detectable thyroglobulin and negative RAI imaging.

After a full thyroid removal, yes. But in his or her case, the thyroid is still there, both tumorous and non-tumorous parts. 

That doesn't exist.

student2patient student2patient
(Inactive)

going off-board

by student2patient on Wed Jul 17, 2019 07:02 AM

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I'm sorry you feel the need to spin your wheels on an unknown future, and I understand why you want to do it. 

I pretty sure you do not. I do not consider it "spinning my wheels" because I learned so much about this disease, with 27 days left on the clock for the first appointment. Some people deal with bad news by getting information, which is what I was doing, working things out, and is so much easier in the Internet age.

The cold hard statistics say I have it but must wait to be officially diagnosed. I was in this situation nearly 25 years ago but with no one to "talk" to, helplessly awaiting impending doom. 

I read what goes on in a first appointment so, yeah, no diagosis then either, but likely an H & P and referral for the biopsy. Since this seems to bother you, I am going off-board.

RE: going off-board

by butterfly501 on Wed Jul 17, 2019 07:57 AM

Quote | Reply

On Jul 17, 2019 7:02 AM student2patient wrote:

I'm sorry you feel the need to spin your wheels on an unknown future, and I understand why you want to do it. 

I pretty sure you do not. I do not consider it "spinning my wheels" because I learned so much about this disease, with 27 days left on the clock for the first appointment. Some people deal with bad news by getting information, which is what I was doing, working things out, and is so much easier in the Internet age.

The cold hard statistics say I have it but must wait to be officially diagnosed. I was in this situation nearly 25 years ago but with no one to "talk" to, helplessly awaiting impending doom. 

I read what goes on in a first appointment so, yeah, no diagosis then either, but likely an H & P and referral for the biopsy. Since this seems to bother you, I am going off-board.

Sorry you're choosing to leave. 

You're not posting anything here that we don't already know from long term experience, and I'm sorry you do not realize this. 

I'm sorry you choose to put the cart waaay ahead of the horse, when you don't even have a thyroid cancer diagnosis.

Good luck to you on your path.  Wishing you a benign Dx, and if not; a good prognosis. 

Aloha!

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