Changes in thyroid nodules in ultrasound reports?

Posted by jrmt26 @jrmt26, 5 days ago

Hi, I'm a little confused by some changes noted in ultrasounds of my thyroid. In short, can characteristics of nodules just disappear between ultrasounds, and when a nodule jumps to a TIRAD 5, is an annual follow-up ultrasound enough?
I had ultrasounds of my thyroid in 12/24, 6/25, and today. All highlighted 4 nodules, with FNA recommended for two of them. . In 1/25, I had an FNA of 2 of the right lobe TIRAD 5 nodule that was reported as solid or completely solid, hypoechoic, taller-than-wide, and havig punctate echogenic foci as well as TIRAD 4 that was reported as solid or completely solid, hypoechoic and wider-than-tall. The biopsies came back Bethesda II.
In the report for the 6/25 ultrasound, the TIRAD 5 was rated as a TIRAD 4 but now described as wider than tall, with no mention of punctate echogenic foci. The isthmus nodule remained the same.
However, in the report for today's ultrasound, while the right lobe nodule remained the same, the isthmus nodule is now a TIRAD 5 with punctate echogenic foci. This one is 2.2x1.3x 2 cm, which reflects a few tenths of a cm difference across the 3 reports. The radiologist's recommendation for the isthmus nodule was "follow-up ultrasound. Given stability."
So, back to my questions at the top. Is it normal for the right lobe nodule to have punctate echogenic focii in 12/24 and none reported in either of the two follow-up ultrasounds? As for the isthmus nodule, which I understand is a particularly concerning location for nodules, given that it is solid or almost completely solid, and is hypoechoic, and is newly reported as having punctate echogenic focii, that doesn't seem "stable" to me. (Then again, I'm not a doctor.) Would it be reasonable to have another FNA of the isthmus nodule or something else? Could the differences in what reported perhaps be the result of the technique of the persons performing the ultrasounds and/or interpreting them?
I'll discuss all this with my endocrinologist. (I see the endocrinologist for unspecified thyroiditis, and I have been in methimazole for a few years because without it, my TSH is barely detectable.) However, I don't have the appointment until August 4, and I'm trying to manage my imagination and TBH, worry. So, any general insights into this situation would be welcome. Thank you.

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Sue, Volunteer Mentor | @sueinmn | 5 days ago

@jrmt26 Welcome to Mayo Connect, where patients share their health journeys and support one another along the way.

I understand you are worried about latest ultrasound, the radiologist's report, and whether it is too dismissive. Please take a deep breath, the report is not a bad one.

I understand your anxiety, we have been watching my thyroid nodules for almost 30 years now, and for the first few years I was very nervous. I had quite a few fine needle aspirations (FNA) - all uncomfortable and unremarkable. The nodules in each of my scans looks different from the previous ones in size and shape. Some nodules have disappeared entirely, while new ones have shown up.

You said "Then again, I'm not a doctor..." I'm not a doctor either, but maybe I can shed some light on how radiology reports work.

First, depending on the technician, their skill, and your positioning, thyroid nodules can appear very different from one scan to the next.

Next, the radiologist uses a template, a calculator (TIRADS), and experience to analyze the ultrasound and reports everything they see. It is apparent they had prior scans for comparison, they may have prior biopsy reports as well. You can learn about TIRADS scoring here:
https://radathand.com/radiology-calculators/body-imaging/tirads-calculator/
Finally, the endocrinologist uses all of that information, along with your medical history, to decide next steps. Your previous biopsy results, "Bethesda II" means benign - less than 2% risk for cancer, so that should be reassuring. Based on that, the radiologist seems comfortable with a longer follow-up. You and the endocrinologist may or may not agree.

If you are too anxious to wait for your appointment, maybe you can contact the doctor ahead of time on the patient portal for a preliminary reading?

jrmt26 | @jrmt26 | 5 days ago

In reply to @sueinmn "@jrmt26 Welcome to Mayo Connect, where patients share their health journeys and support one another along..." + (show)

@sueinmn Thank you very much for your helpful reply. I'm sorry you've been dealing with thyroid issues for so long, and I appreciate your willingness to share what you've learned. It really enables me to put the various things into perspective, especially the part about why the scans can vary. I sent a note to my endo.
Thanks again!