TIRAD 4 and worried about thyroid cancer

Personally, (and everyone is different) I would not wait a year and would get a second opinion at a large hospital where different specialties are under one roof. I would want to know what it is, and what to do about it if necessary. Where are you located?

Thanks for the validation! I don't want to wait a year at all. I'm located in Toronto, Ontario - i'm already being followed by the big cancer centre here (princess margaret) for the breast lesion. I speak to my doctor on Tuesday so i'm going to push for a referral to a specialist who will do a biopsy - i'd rather know, one way or the other, rather than have this hanging over my head for a year. Things can sometimes move slowly here (depending on the situation) - when i had a suspicious breast lesion, i got into Princess Margaret in about two weeks. but it may be a longer wait for something that is thyroid related - i'm obviously ok waiting for a few more months or whatever, i just don't want to wait an entire year.

Please get a second opinion, it is your right to ask for one!

In my opinion, having a second opinion is good if it will put your mind ease. I don’t think it is helpful to go for second opinions with a preconceived idea about wanting a biopsy; let the doctor you go to decide how best to proceed. Your nodule is very small and I was told that they can’t do FNA on very small nodules…. Too small to be sure they aspirate the nodule. It may never grow so why risk an FNA! As for your concern about something growing in your body….. nodules and cysts come and go; don’t worry about them until you have a reason to. Having nodules removed/ partial thyroidectomy, is not a simple fix. If there is a high probability of cancer; definitely have it removed. However, the risks involved with surgery and a life of Synthroid is not something that should be taken lightly.
It sounds like you are in a good place to get excellent cancer care, so you can get a good second opinion. Good luck!

I think if i get referred to a specialist and they tell me "hey we need you to wait a year because of x,y,z" then it would be much easier for me to do so. I don't like being told i have a nodule that is TIRAD 4, which obviously comes with an above average risk that it's malignant, and then being told to come back in a year and not given a reason as to why. If they did the ultrasound and said, yes you have these nodules but they all look benign, i wouldn't be worried at all. Even with my breast lesion, a BIRAD of 3 means that they can't say for certain that it's not cancer but the risk of it being cancer is really really low - i was ok with waiting 6 months for a follow up - with breast lesions, anything that is a BIRAD 4 is biopsied . I do agree though that i shouldn't go into a specialist appointment with the expectation of getting a biopsy - it will help me to keep that in mind. Thanks for the feedback!

I would definitely get a second opinion. When I found out that I had a nodule on accident as well, and I did have a biopsy, thankfully, as they saw as the primary diagnosis Oncocytic (Hurthle Cell) Neoplasm and are only able to tell you if it is cancerous by taking out the tumor and putting it through pathology. That was in May, 2023. I went ahead and got three opinions on my surgery and decided to go with the surgeon who recommended taking out the whole thyroid (total thyroidectomy) and several lymph nodes behind the thyroid that cannot be seen on an ultrasound for lymph node mapping. I also had Hashimotos's and she said it should help those symptoms as well. Additionally, she did not recommend I wait too long to get the surgery as these types of cells can spread through the blood vessels and not always to the lymph nodes first. The other two surgeons were only wanting to take out half and then go back for the other half if it was cancerous, and actually couldn't do the surgery until late August and September. As well, they were not able to do the surgery for at least 3 months! I am glad I went with the TT and the surgery sooner than later as it did end up bein Oncocytic HC Carcinoma which they said is only found in 3-5% of malignancies. I believe you know your body best and if your gut is telling you not to wait, which mine was too, then don't and find someone who is willing to help you get to the bottom of the situation sooner. As well, I have a few questionable spots on my lung and liver, however, they are thinking the liver is cysts, and we are repeating a CT scan this December for the lung to see if anything has changed. I am currently doing the rest of my follow up through Mayo Clinic, and will follow through with any treatment plans most likely local to my home. I wish you the best and encourage you to ask questions, find second opinions and utilize this platform for additional information and possibly referrals.

thank you -your response was really helpful. I'll see what my doctor says tomorrow.

I am sorry you are having to walk through this. Given your case, and your desire to advocate for yourself... I would think a 2nd opinion / referral to an endocrinologist would be totally appropriate. A simple email to your doctor , outlining your concerns you listed , your concern about cancer and your desire to reduce your stressor by getting the specialist input would be helpful. I always make a point to thank my doctors for their help and wisdom... but they understand the need for a 2nd opinion as well.
Wishing you the very best

I hope all goes well!

well honestly my doctor seemed kind of annoyed with me. He said "well, we typically don't worry about nodules that are 1cm or less" and i acknowledged that and told him that it was the TIRAD 4 rating that had me concerned, so he kind of abruptly cut me off and said "ok i'll refer you to an ENT for a biopsy." told me i should hear about when my appt is from his office sometime in the next two weeks or so and then he hung up. Normally i have a very good relationship with him and i agree with him that i don't know if a biopsy is absolutely necessary but i do need a second opinion. So we will see how it goes.